Safety and efficacy of manual vacuum suction compared with conventional dilatation and sharp curettage and electric vacuum aspiration in surgical treatment of miscarriage: a randomized controlled trial

Abstract

Background The World Health Organization does not recommend dilatation and sharp curettage (D&C) for the surgical treatment of miscarriage during the first trimester because this may cause Asherman’s syndrome due to endometrial damage; therefore, suction remains the primary treatment option. While manual vacuum aspiration (MVA) has been widely used since the 1990s outside Japan, the use of an MVA device (Women’s MVA system) was approved in Japan in October 2015. Here, we examined the efficacy of the MVA kit in women surgically treated for miscarriage. Methods This retrospective cohort study was conducted between 2014 and 2018 at the International University of Health and Welfare Hospital in Japan. Women who underwent surgical treatment for miscarriage within 12 weeks of pregnancy were identified and enrolled in the study. A total of 404 women were included who underwent the following procedures: 121 D&C, 123 electric vacuum aspiration (EVA), and 160 MVA. For each participant, the duration of surgery, amount of bleeding, amount of anesthetic used, incomplete abortion requiring repeat procedures, and intraoperative/postoperative complications were evaluated. Results The duration of surgery was 13.7 ± 7.2, 11.2 ± 4.2, and 6.9 ± 4.3 min in the D&C, EVA, and MVA groups, respectively (p = 1.00). The amount of anesthetic used was not significantly different among all groups. Bleeding of ≥ 100 mL was confirmed in three (2.4%), one (0.8%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively (p = 0.50). Incomplete abortion was identified in three (2.4%), two (1.6%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively (p = 0.61). However, severe intraoperative/postoperative complications were not observed in any group. Conclusions Surgical treatment for miscarriage performed using the MVA kit has safety and efficacy similar to those of conventional methods, such as D&C and EVA.

Safety and efficacy of manual vacuum aspiration under local anesthesia compared to general anesthesia in the surgical management of miscarriage: a retrospective cohort study

“…In another study, Azumaguchi et al [ 8 ] found a clear inverse relationship between endometrial thickness and previous D&C rates, suggesting that D&C is the primary cause of endometrial thinning [ 8 ]. In an evaluation performed before and after miscarriage surgery, our observation confirmed that there was no endometrial thinning when MVA was used [ 4 ]. MVA has a limited risk of endometrial damage and reduces the occurrence of Asherman’s syndrome and adenomyosis.…”

“…In October 2015, the Women’s MVA system was approved in Japan, and its use in the clinic has rapidly spread throughout Japan in recent years. In 2016, the MVA kit under general anesthesia was introduced at the hospital and has been used as a first-trimester pregnancy miscarriage surgical treatment, with its utility to date being reported [ 4 ]. The MVA kit is safe and effective and has a lower risk of endometrial damage, leading to a reduction of pain during and after the miscarriage surgery, thus simplifying anesthesia during the surgical procedure.…”

Survey on spontaneous miscarriage and induced abortion surgery safety at less than 12 weeks of gestation in Japan

“…Several reports compared MVA with other surgical methods, 7,8 and in Japan, an RCT by Kakinuma et al showed that MVA safety was comparable with existing surgical techniques. 9 It was also reported that abortion surgery using curettage increases the risk of developing postoperative Asherman's syndrome compared with MVA. 10 Considering the WHO recommendations, 1 previous studies, and our survey results, MVA use for spontaneous miscarriage and induced abortion should be considered more in Japan.…”

A Case Report of a Patient with Spontaneously Resolving Unruptured Uterine Artery Pseudoaneurysm after Surgery for Miscarriage during the Early Stages of Pregnancy Using Manual Vacuum Aspiration

“…[ 3 ] In Japan, an MVA kit (Women's MVA system MVA kit, Women's Health Japan) was approved in October 2015 and its use is becoming more widespread; the efficacy and safety of this MVA kit for miscarriages in the early stages of pregnancy have been reported previously. [ 4 ]…”