#87 : Intrauterine Adhesion in Ultrasound-Guided Manual Vacuum Aspiration (USG-MVA) Versus Electric Vaccum Aspiration (EVA): A Randomized Controlled Trial

Abstract

Background and Aims: Intrauterine adhesion (IUA) is a possible complication after uterine surgery, especially after sharp curettage for miscarriages as it destroys the endometrial stratum basalis. This study aimed to determine and compare the IUA in women who underwent ultrasound-guided manual vacuum aspiration (USG-MVA) as opposed to traditional surgical evacuation (EVA) for the management of their first-trimester miscarriage. Methods: This was a prospective single-centre, randomised controlled trial conducted in a university-affiliated tertiary hospital. Chinese women aged [Formula: see text]18 years with a delayed miscarriage [Formula: see text]12 weeks of gestation or incomplete miscarriage attending the hospital were randomized to either USG-MVA or EVA for the management of their miscarriage. They were invited to come back for a hysteroscopic assessment for IUA at 6-20 weeks post-surgery to assess the incidence of IUA. Patients were contacted by phone at 6 months to assess their menstrual and reproductive outcomes. Results: 303 patients underwent surgical evacuation, of whom 152 were randomized to the ‘USG-MVA’ and 151 patients to the ‘EVA’. 126 from the USG-MVA group and 125 from the EVA group returned and completed the hysteroscopic assessment. The incidence of the IUA from USG-MVA was 19.0% (n=24/126) and was significantly lower compared to EVA, which was at 32.0% (n=40/125). There was no significant difference in menstrual outcomes at 6 months postoperatively between the two groups, but more patients had miscarriages in the EVA group with IUA. Conclusions: IUAs are a possible complication of USG-MVA. However, USG-MVA is associated with a lower incidence of IUA postoperatively at 6-20 weeks. USG-MVA is a feasible, effective, and safe alternative surgical treatment with less IUA for the management of first-trimester miscarriage.