Outcome Of Manual Vacuum Aspiration Vs Surgical Evacuation

Abstract

Objective: To compare the safety, efficacy and complications of manual vacuum aspiration (MVA ) versus surgical evacuation in low resource set up. Study Design and Setting: This crossectional study conducted at Department of Obstetrics & Gynaecology at Kulsoom Bai Valika Social Security SITE Hospital Karachi from January to June 2017. Methodology: A total of one hundred patients with less than 12 weeks of gestation and diagnosis of missed miscarriage, incomplete miscarriage, blighted ovum or with retained products of conception (RPOCs) were recruited and randomly allocated to MVA without anesthesia (Group A) and surgical evacuation under general Anesthesia in Operation theatre (Group B).Both groups were compared in terms of demographic and obstetric data, clinical course (need of anaesthesia, operating time, approximate blood loss and stay in hospital) ,complications(excessive bleeding, uterine perforation, need for re-evacuation/ failed procedure, sepsis and maternal death ) and patient satisfaction. Results: Mean age of patients was 28.68 in Group A and 26.90 in Group B ( P value-0.136). Average gestational age in weeks at which procedure was performed in Group A found to be 8.32 and 9.546 for Group B ( P value-0.007 ). Parity was comparable in both groups (P value-0.746). Most of the patients were literate. Mean operating time and amount of blood loss comparison among groups had no statistical difference. Average hospital stay was significantly short in MVA Group ( P value-0.001). No maternal death or uterine perforation observed in both the groups,6% and 8% of patients had excessive bleeding in Group A & Group B respectively, one patient underwent re-evacuation in MVA group and one had sepsis after surgical evacuation. Post procedure satisfaction was comparable in both the groups. Conclusion: Manual Vacuum Aspiration is comparable to surgical evacuation in terms of safety, efficacy, complications, patient satisfaction and superior in shorter hospital stay, no need of anesthesia and access to operation theater

Effectiveness of Manual Vacuum Aspiration in the Management of Miscarriage and Retained Products of Conception

“…These findings were almost similar to the study by Tasnim N et al 1 as the multiparous women were the majority. These findings were also supported by Akmal F et al 6 , as in their study (in the MVA group), nulliparous women were 26%, while multiparous (para 1-3) women were 52%, and 22% of women were para 4 or above. Although Kishwar N et al 12 also found comparable findings regarding parity.…”

“…According to Akmal F et al (2006), the MVA is equivalent to surgical evacuation in terms of safety, effectiveness, fewer complications, and better patient satisfaction, as well as superior in terms of shorter hospital stays, no need for anesthesia, and access to the operating room. 6 MVA was conducted in the operative room, and after the procedures, the patients were discharged within a few hours as a routine hospital policy; those who were clinically stable, while those who complained of severe pain or experienced excessive vaginal bleeding were admitted to the hospital's inpatient unit until they reached a stable condition. There were several limitations to the study, specifically the limited sample size, not compared with any other technique.…”

“…4,5 The therapeutic interventions include either waiting it out, medical treatment, or surgical intervention, based on the clinical conditions and the preferences of the patients. 6 Although expecting management typically requires longer time, therefore most of the time, medical or surgical approaches are favored over expectant management in clinical practice, and this is due to greater psychological concerns in both the patient and her caretakers. 6,7 However, D&C is commonly used even though, it usually requires general anesthesia, must be performed in an operating room, and can cause patients to spend more time in the hospital, all at a higher cost.…”

“…6 Although expecting management typically requires longer time, therefore most of the time, medical or surgical approaches are favored over expectant management in clinical practice, and this is due to greater psychological concerns in both the patient and her caretakers. 6,7 However, D&C is commonly used even though, it usually requires general anesthesia, must be performed in an operating room, and can cause patients to spend more time in the hospital, all at a higher cost. 6 Manual vacuum aspiration seems to be the procedure of choice in the early stages of pregnancy.…”

“…6,7 However, D&C is commonly used even though, it usually requires general anesthesia, must be performed in an operating room, and can cause patients to spend more time in the hospital, all at a higher cost. 6 Manual vacuum aspiration seems to be the procedure of choice in the early stages of pregnancy. However, some of these skilled midwives had worked out how to use MVA even in really difficult settings.…”