Abstract
To compare manual vacuum aspiration (MVA) and uterine curettage (D and C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. Groups were similar regarding gestational age (9.93 +/- 2.40 vs 9.73 +/- 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 +/- 4.80 vs 22.68 +/- 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D and C group (p = 0.02). MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments.
Highlights
Durations of the procedure and of hospitalization were significantly shorter in the manual vacuum aspiration (MVA) group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively)
Decrease of hemoglobin levels was greater after the surgical procedure in the D&C group (p = 0.02)
MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. Both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments. [Rev Assoc Med Bras 2006; 52(5): 304-7]
Summary
PEDRO PAULO PEREIRA*, ANDRÉ LUIZ MALAVASI LONGO DE OLIVEIRA, FÁBIO ROBERTO CABAR, ADRIANO R. Comparar aspiração manual intra-uterina (AMIU) com curetagem uterina (D&C) em abortamentos no primeiro trimestre no que se refere a eficiência para eliminar restos ovulares do método de aspiração manual intra-uterina com a dilatação e curetagem, ocorrência de complicações (perfuração uterina, laceração cervical, hemorragia pós-tratamento), tempo duração dos procedimentos e tempo de internação das pacientes. Entretanto, ambos os procedimentos cirúrgicos mostraram-se eficientes para o tratamento de abortamentos incompletos no primeiro trimestre da gestação, não havendo complicações após a realização dos tratamentos. Em 1997, Lara Ricalde et al publicaram estudo comparando dois grupos de pacientes submetidas a esvaziamento uterino; os autores referem que a AMIU foi tão eficaz e segura quanto à D&C, sendo, porém, mais facilmente executável e não associada a complicações graves[22]. Eles concluíram que pacientes tratadas com AMIU necessitaram 77% de tempo de internação hospitalar a menos e consumiram 41% a menos de recursos hospitalares que pacientes tratadas com D&C21
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