Manual vacuum aspiration: a safe and effective surgical management of early pregnancy loss

Abstract

One of the most important aspect of surgical intervention is pain control, to ensure the procedure can be completed with minimal or no distress to the patients. Analgesia that had be used in MVA include oral, rectal or parenteral analgesia, intracervical analgesia, paracervical block, Entonox, oral and parenteral opiod or combination of these techniques. 5-11 All these methods had been shown to be effective in providing pain relieve during MVA, but the factors that may contribute to the pain sensation had not been adequately addressed. Here we are discussing the pain perception of our patients during MVA and the associated factor. ABSTRACTBackground: Manual vacuum aspiration (MVA) is an alternative to the standard sharp uterine curettage, performed under local anaesthetic or sedation in the daycare setting. The objectives of this study were to assess the efficacy and safety of MVA, the pain perception and the factors related to it. Methods: This was a prospective observational study of 58 consecutive patients who had undergone Manual Vacuum Aspiration (MVA) in Early Pregnancy Assessment Clinic, Hospital Kemaman between January and December 2017. Data on the patients' characteristics and the procedures were analysed. Results: The efficacy of the procedure was 96.5% (56/58) with no major complication recorded. Majority of the patients (91.3%) reported mild to moderate pain with 2/3 of them agreed to undergo MVA in the future and would recommend it to other patients. There was no significant difference in mean pain score between different groups of women (parity, education levels, occupations, previous uterine evacuation) or procedural techniques (analgesia, sedation, cervical block, cervical dilatation, procedure duration, number of aspiration passes). Conclusions: MVA is safe and well accepted procedure for out-patient surgical evacuation of early miscarriages.

Manual Vacuum Aspiration in IUFD 18 Weeks

“…MVA is a safe, easy-to-do, and costeffective procedure that benefits both patients and health facilities. 4,6,9 In this case report, the magnitude of 18 weeks gestation did not become an obstacle to cleaning the uterine cavity using the MVA procedure. MVA's action is a procedure that is more effective than sharp curettage, which Brown et al, MVA also conveyed to be cheaper with shorter hospital stays.…”

“…The parenteral opioid used was pethidine 50 mg. Sedation such as intravenous midazolam was also used when it was needed. 4 In this case, the bleeding and tissue discharge occurred, with the administration of 100 µg misoprostol first. Thus, the diagnosis turned into incomplete abortion.…”

“…Evacuation of the uterine cavity using MVA is indicated for the evacuation of the uterine cavity until 14 weeks gestation 3 or not more than 12 week's gestation. 4 This paper is a case report about the evacuation of uterine cavities in IUFD cases at 18 weeks gestation using MVA preceded by administration of 100 μg misoprostol orally for dilation. This case is interesting as the respondents experienced 3x pregnancies, all of which experienced abortions.…”

“…Meanwhile, AVM is usually done at a gestational age of no more than 12 or 14 weeks. 4 MVA was firstly described in the 1970s. MVA is an action used in the handling of incomplete abortion.…”

Analgesic Efficacy of Paracervical Block for Manual Vacuum Aspiration of Incomplete Abortions: A Randomized Controlled Trial

“…These are all avoidable, by using appropriate concentration (1%) and preventing an inadvertent injection of drug into the blood vessels, this is by doing test aspiration before injection [14] [15] [16] [17]. There is little information about how useful local anaesthesia is when manual vacuum aspiration is used for treating incomplete abortion and available studies have evaluated the efficacy of local anesthesia in patients with abortions with a closed cervix, and as such, the evidence cannot be directly extrapolated to the treatment of incomplete abortion, in which the cervix is usually open [17] [18] when the cervix is closed, it is necessary to dilate the cervix through mechanical procedures; this is the most painful part of the procedure [10] [19] [20] which is not necessary in incomplete abortion because the cervix is open. Therefore, the role of paracervical block in this group of abortion is less clear couple with the paucity of such studies in our environment.…”