1. G. Marchand MD, A. Weeden MS1, A.J. Citrin DO
MEDUSA PROTOCOL
Minimizing the blood loss and maximizing the efficacy of Oxytocin Sensitive Dilation and Curettage procedures
G. Marchand MD, A. Weeden MS1, A.J. Citrin DO
Abstract
Methods
Results
A retrospective study of 96 serial cases to examine effectiveness of MEDUSA PROTOCOL
Ours differs from traditional dilation and curettage procedures because of the avoidance of volatile gas based anesthesia and the aggressive use of Oxytocin.
The regimen appears to be safe and effective for oxytocin sensitive gynecological emergencies
Our protocol achieved 100% success rate with avoiding the need for transfusion, hysterectomy, and reoperation.
Average blood loss was 44cc
No complications or retained products of conception
During pre-op patient is given Versed 2mg, Zofran 4mg, Atropine 0.4mg
Administer 10 units IV bolus Oxytocin in combination with Propofol at time of anesthesia, specifically avoid use of Isoflurane and Sevoflurane to maximize strength of uterine tone.
Begin induction with 200mg Propofol and administration of Atropine and Ketamine. Start a continuous drip of Oxytocin, 20units/1000cc saline bag.
Following induction, patient is maintained with 10mg bolus of Propofol intermittently and 50% oxygen and nitrous oxide gas.
We placed the speculum in the patient’s vagina and visualized the cervix. If dilation is necessary use Hank dilators
Following dilation, a 12-mm curved suction curette was placed inside the cervix and curette pressure was set to 60mmHg.
After emptying product of conception, we performed 1x additional pass with suction curette until no additional products of conception were removed
We examine the uterus using a sharp curette, uterine wall may be felt by demonstrating a gritty cry. Then, make one final pass with a suction curette.
Finally, Undertake a vigorous uterine massage until vaginal bleeding slowed to that of spotting
Conclusion
The MEDUSA PROTOCOL is safe and effective in minimizing blood loss and maximizing the efficacy of oxytocin Dilation and Curettage procedures, including missed, incomplete, and septic abortions, as well as complete and partial hydatiform molar pregnancies.
All practitioners stated they believed from their experience that the protocol would be an excellent method of performing the five selected procedures.
Objective
To examine the effectiveness of MEDUSA PROTOCOL in 5 Oxytocin sensitive obstetrical emergencies, including treatment of missed, incomplete, and septic abortion, as well as complete and partial
hydatiform molar pregnancy