Management Of Incomplete Abortion Research Articles

Efficacy, Safety, and Acceptability of Manual Vacuum Aspiration with Para Cervical Block as a Management of Incomplete Abortion

Limited access to safe abortion is a leading cause of maternal mortality and morbidity in the developing world, overwhelming hospitals with a large number of women seeking treatment for complications of unsafe abortion. In many cases, more than half of all gynecological admissions are due to incomplete or septic abortions. The primary aims were to assess the efficacy and cost-effectiveness of the manual vacuum aspiration (MVA) procedure for managing incomplete abortion, considering completeness, procedure, duration, and hemorrhage. Additionally, safety aspects, such as complications (hemorrhage, perforation, and cervical injury), pain relief, patient satisfaction, and factors like reduced hospital stays and waiting times, were evaluated. This descriptive cross-sectional study was conducted at Dhaka Medical College and Hospital, focusing on women with incomplete abortions up to 12 weeks of gestation. It took place over six months from July to December 2013, with a purposive sample of 100 cases selected based on specific criteria to represent the study's objectives. Statistical analysis was done by using SPSS (version 16.0, SPSS Inc., Chicago, Illinois, USA). Out of 100 respondents, more than two-third of the patients (68%) were in 21-30 years age group. Half of the patients (50%) came from lower middle class family and most of them were housewives (80%). Majority (58%) of the patients had average gestational age 6-10 weeks. More than two-third (70%) of the patients had incomplete abortion, with 47% having attempted to terminate pregnancy. Abdominal pain was reported among 64% of patients, and the average bleeding period was 5-7 days for 62% of them. More than two-third (68%) of patients had no palpable uterus, and active bleeding was also found among two-third 66.0% of cases. Nearly one-third of the patients (32%) received injectable oxytocin and 13% received blood transfusion. Method of para-cervical block was applied for pain management in all patients (100%), while pethidine was used in only 3% of cases. Almost all of the patients 97%) were given sedatives (diazepam) and oral non-steroidal anti-inflammatory drugs (NSAIDs). Duration for the procedure was 10-15 minutes for 46% of patients, and excessive hemorrhage was found in 2% of cases. The average hospital stay ranged from 2-11 hours. Treatment cost in the majority of cases was only 75-150 Bangladeshi taka (BDT), which was statistically significant. The MVA with paracervical block was found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with few complications. MVA procedure had less blood loss, less time consuming, safe and effective with shorter hospital stay. Bangladesh Med J. 2022 May; 51(2): 21-29

Experiences of Using Misoprostol in the Management of Incomplete Abortions: A Voice of Healthcare Workers in Central Malawi.

Complications after abortion are a major cause of maternal death. Incomplete abortions are common and require treatment with surgical or medical uterine evacuation. Even though misoprostol is a cheaper and safer option, it is rarely used in Malawi. To improve services, an intervention was performed to increase the use of misoprostol in post-abortion care. This study explored healthcare providers’ perceptions and experiences with misoprostol in the Malawian setting and their role in achieving effective implementation of the drug. A descriptive phenomenological study was conducted in three hospitals in central Malawi. Focus group discussions were conducted with healthcare workers in centres where the training intervention was offered. Participants were purposefully sampled, and thematic analysis was done. Most of the healthcare workers were positive about the use of misoprostol, knew how to use it and were confident in doing so. The staff preferred misoprostol to surgical treatment because it was perceived safe, effective, easy to use, cost-effective, had few complications, decreased hospital congestion, reduced workload, and saved time. Additionally, misoprostol was administered by nurses/midwives, and not just physicians, thus enhancing task-shifting. The results showed acceptability of misoprostol in post-abortion care among healthcare workers in central Malawi, and further implementation of the drug is recommended.

A Comparative Study on the Effectiveness of Paracervical Block and Diclofenac Versus Paracervical Block and Pentazocine for Analgesia During Manual Vacuum Aspiration

Management of incomplete abortion with the use of manual vacuum aspiration is associated with pain. A good pain relief option is necessary during the procedure to improve the outcome and increase patients’ satisfaction. The study was aimed atdetermining and comparing the effectiveness of combining paracervical block with pentazocine and paracervical block with diclofenac as pain relief during manual vacuum aspiration for first-trimester incomplete abortion. This study involved 100 eligible women with the diagnosis of first-trimester incomplete abortion. Half of the participants were given paracervical block and intramuscular pentazocine 60 mg stat while the other half were given paracervical block and intramuscular diclofenac 75 mg stat before the manual vacuum aspiration procedure. The intensity of pain during the procedure was assessed using the Visual Analogue Scale (VAS). The level of significance was set at p value<0.05. The mean pain intensity was significantly higher in the diclofenac group than in the pentazocine group. From the study it was concluded that intramuscular pentazocine used as an adjunct to paracervical block during manual vacuum aspiration when compared to intramuscular diclofenac as an adjunct to paracervical block was found to be a more effective method of pain relief. The patient’s level of satisfaction was same in both study arms. However, participants in the pentazocine arm had more side effects.

The study of efficacy and safety of expectant management of incomplete abortion

Expectant management of incomplete abortion is a watch full waiting without intervention for certain period of time so that the retained product of conception will be expelled spontaneously. This study was carried out to see feasibility and safety of expectant management of incomplete abortion. It was observational descriptive study which was carried out in Nepal Medical College Teaching Hospital from July to December 2020 in 60 patients of spontaneous incomplete abortion. The patients which fulfill the inclusion criteria were sent home after bleeding has settled and ultrasound was carried after two weeks to see the success of the treatment. The success of the expectant management was found in 86.7%. There were heavy bleeding in 6.7% cases, unscheduled surgical evacuation was done in 13.3% cases. Blood transfusion was carried out in 5.0% of cases. The number of cases complained of severe low abdomen pain were 8.3% and limitation of activity were present in 10.0% of cases. There was one (1.7%) patient who showed the sign of genital infection. With the success of 86.7% of expectant management of incomplete abortion in our study we can consider expectant management of incomplete abortion as a safe option. However, small percentage of complications such as heavy bleeding, emergency surgical evacuation and severe pain are seen.

Medical and Surgical Treatment of First Trimester Miscarriage, A Randomized Controlled Trial

Background: Abortion is a common complication of early pregnancy that can have both medical and psychological consequences. Complications following spontaneous or induced abortion are a major cause of maternal morbidity. Objective: To better management and improving outcome of first trimestric miscarriage. Patients and Methods: A randomized clinical trial study was conducted at obstetric outpatient clinic, Gynecology and Obstetrics Department, Zagazig University during the period from May 2019 until June 2021. The study included 52 women suffering from abortion who were randomized to receive either medical treatment: 800 µg misoprostol prescribed as 400 mg orally and 400 mg vaginally or surgical treatment: evacuation with dilatation and curettage. All patients were followed up with a transvaginal ultrasonography (U/S). Results: The mean of endometrial thickness after treatment was 12.5±2.65 mm and 8.3±1.97 mm in misoprostol and surgical evacuation group respectively, the difference between both groups was statistically significant (p < 0.05). Failed treatment was in 8 (30.7%) patients in misoprostol group and in 2 (7.7%) patients in surgical evacuation group. The difference in failure rate between both groups was significant statistically. Conclusions: A single dose of 800µg misoprostol given as outpatient treatment may be used as first line in management of incomplete abortion.

Efficacy of Sesame (Sesamum indicum L.) in the Management of Incomplete Abortion: An Open-Label Randomized Controlled Clinical Trial

Background: Incomplete abortion is a common complication of pregnancy. Sesamum indicum L. is a widely used emmenagogue herb. Objectives: We designed a clinical trial to evaluate the efficacy of sesame for the removal of retained products of conception (RPOC). Methods: In this randomized, open-label, and controlled trial, 45 patients received sesame powder as an intervention group and 45 patients received expectant management as a control group for 5 days. The primary outcome measure was complete resolution of RPOC assessed by sonography. Secondary outcome measures were severity of patients’ vaginal bleeding and pain. Results: 84.1% had complete resolution of RPOC in the sesame group, while 26.2% had complete resolution of RPOC in the control group, which was statistically significant (p < 0.001). Moreover, patients in the sesame group showed a significantly more decreasing trend in pain and vaginal bleeding compared to the control group (p < 0.001). Conclusion: Sesame had a significant effect on the removal of RPOC and the reduction of pain and vaginal bleeding.

Management of Incomplete Abortions by the Manual Intra Uterine Suction Technique at Sylvanus Olympio Teaching Hospital of Lome-Togo

Management of Incomplete Abortions by the Manual Intra Uterine Suction Technique at Sylvanus Olympio Teaching Hospital of Lome-Togo

Comparison of manual vacuum aspiration and misoprostol in the management of inc omplete abortion

Background: Incomplete abortions can be managed expectantly, surgically and medically (using misoprostol). Expectant management is safe in places where women have access to information, appropriate care and follow-up; however, in isolated and poor areas women who come for help need an intervention. Objective: To compare the efficiency of manual vacuum aspiration (MVA) and misoprostol in the treatment of incomplete abortion. Patients and method: This was a prospective study over five months from March to August 2015. All patients admitted with a diagnosis of incomplete abortion were recruited into the study. Results: 308 patients with incomplete abortion were randomized into two treatment groups - MVA (done under local anaesthesia) and misoprostol (400 micrograms by the vaginal route). MVA was successfully performed for all patients. Two patients presented with anaemia. In the misoprostol group, 23 patients had vaginal bleeding, and 10 persistence of incomplete abortion. Conclusion: MVA is more effective than misoprostol with less complications in the treatment of incomplete abortion when it is done by a trained person. Keywords: incomplete abortion, manual vacuum aspiration, misoprostol, management, Chad

Interest of manual vacuum aspiration in the management of incomplete abortion at the district hospital of n’djamena south, chad

Background: abortion is one of the main causes of maternal mortality and morbidity in Chad. Objective: The aim of this work was to evaluate the interest of manual vacuum aspiration (MVA) in the management of incomplete abortion.Methods: This was a prospective and descriptive survey for five months from March 5th 2014 to August 05th 2014 conducted at the district hospital of N’ Djamena South. All women admitted for incomplete abortion were included. Before including the patient in our investigation her consent should be gotten after some explanations on the necessity of the survey have been given. Data analysis has been done by EPI INFO 3.5.1.Results: we enumerated 154 incomplete abortions among 2327 pregnancies registered at the prenatal consultation service and emergency unit. That gave the prevalence of 06.6%. The majorities of our patients had spontaneous abortion (96.1%). The time allowed for management was ?12 hours (90.3%). No complication was observedConclusion: MVA is an effective and sure method to evacuate uterus when incomplete abortion is diagnosed.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.572-574

Integration of Post Abortion Care Package in the Activity of 56 Health Facilities by the Burkina Faso Society of Obstetricians and Gynecologists (SOGOB)

Introduction: This article is an analysis of post-abortion care in 56 health facilities after their capacity building by the Burkina Faso Society of Obstetricians and Gynecologists (SOGOB). Patients and Methods: In 2012, with funds from Safe Abortion Action Fund, the SOGOB trained care providers and equipped 56 health facilities for post abortion care. Statistical data on the management of incomplete abortions after the capacity building were analyzed. The significance level was set at 0.05. Results: There were 6316 cases of abortion that have been managed in 56 health facilities. The evacuation of the uterine contents for incomplete abortion has been provided to 6167 patients. Manual vacuum aspiration (MVA) and misoprostol were used respectively in 69.4% and 26.9% of cases to evacuate uterine content. Post-treatment complications were 1.8% for MVA and 0.9% for misoprostol (p = 0.004). MVA’s complication rate in the health facilities of the 1st level of care (1.7%) was not different from the third level of care (1.2%) with p = 0.21. A modern method of contraception was provided after abortion to 65.7% of the patients. In addition to the post abortion care, 7.3% of the patients received other reproductive health services. The community was involved in the development process of post abortion care in the facilities of the first level of care. Conclusion: The support of health facilities by SOGOB has provided post abortion care to thousands of women with little complications. Given the good results, an extension to other health facilities is desirable.

Oxytocin, Functions, Uses and Abuses: A Brief Review

Oxytocin a peptide hormone has the distinction of being the first among the peptide hormones to be sequenced and biochemically synthesized. Oxytocin is secreted from neural as well as non-neural sources inside the body. Among the neural sources supra-optic and paraventricular nuclei of the brain are major sources of secretion, the arcuate nucleus being a minor source. There are many non-neural sources from which synthesis of Oxytocin has been reported. The important ones include interstitial cells of Leydig in testis, epididymis, prostate glands, corpus luteum inside ovary, uterus, oviduct, placenta and adrenal glands. Oxytocin directly acts on the smooth muscle cells and causes muscle contraction. Indirectly it stimulates synthesis of PGF2α inside the female genital tract. As such the Oxytocin is involved in a wide spectrum of activities from milk letdown, parturition, penile erection and ejaculation to social, sexual and maternal behavior. Because of the spectrum of its functions it has since been used therapeutically for conditions like facilitating parturition in uterine inertia, prevent bleeding after parturition and abortion, management of incomplete abortion, milk letdown, retention of placenta etc., although the success has not been predictable. However, Oxytocin is also being misused under the false impression that its use in dairy animals increases the milk yield. Oxytocin abuse is also rampant in fruits and vegetables. This article is an attempt to explore the body of knowledge with respect to functions, uses and most importantly the abuses of this wonderful hormone.

Manejo ambulatorio del aborto como estrategia para aumentar la cobertura y reducir los costos.

Se presenta este trabajo con el propósito de precisar si una forma diferente de atender el aborto tiene o no ventajas sobre la metodología convencional. Desde el 1 de junio de 1989 se inició en el Departamento de Ginecoobstetricia del Hospital María Auxiliadora de Lima-Perú una investigación operacional acerca de la atención ambulatoria del aborto incompleto no complicado. Para ello se evaluó la atención del aborto incompleto en el año inmediatamente anterior, periodo en el cual todos los casos eran manejados a través de hospitalización, con una permanencia promedio de dos días. Los casos seleccionados como aborto incompleto no complicado, luego de preparación en la sala de emergencia, fueron derivados a la sala de legrados uterinos que para tal fin se instaló al ingreso del Centro Obstétrico. Realizado el procedimiento con analgesia o anestesia local, las pacientes eran ubicadas en un ambiente contiguo para observación, y al cabo de dos horas fueron enviados a su casa con la indicación de regresar a control en un mes. Durante el año de evaluación previa, se encontró una tasa de aborto de 193,3 por mil nacidos vivos, todos manejados mediante hospitalización. Al 31 de mayo de 1990, en que terminó la investigación, se había atendido 1078 abortos (tasa 260 por mil n.v.), de los cuales 641 (60%) fueron de manejo ambulatorio. En los casos atendidos ambulatoriamente, no se registró complicaciones en el acto operatorio ni en las dos horas subsiguientes. De otro lado, es notoria la ventaja que significó el uso de este procedimiento al abaratarlos los costos para el hospital y la propia paciente. Por cada procedimiento, el hospital dejó de gastar 106 dólares americanos y, a la paciente le significó reducir el costo a la mitad. De otro lado, el procedimiento contribuye a descongestionar los servicios de hospitalización y dedicar las camas a otro tipo de atenciones, por lo que se aumentó el rendimiento. En conclusión, recomendamos el uso de este procedimiento en todas las instituciones como metodología para resolver los casos de aborto incompleto no complicado.

A Clinical Study on Management of Incomplete Abortion by Manual Vacuum Aspiration (MVA)

Background: Abortion is an important social and public health issue. In Bangladesh complication from unsafe abortion is one of the leading causes of maternal mortality. It is a serious health problem. World Health Organisation estimates that 14% of maternal deaths which occur every year in the countries of South Asia including Bangladesh are due to abortion. Study shows manual vacuum aspiration procedure is safe and effective in incomplete abortion. Very few clinical trials were carried out in Bangladesh to assess the safety and effectivity of manual vacuum aspiration in managing incomplete abortion.Objective: To find out the outcome of manual vacuum aspiration in the management of patients of incomplete abortion.Materials and Methods: This observational descriptive study was conducted in the department of Obstetrics &amp; Gynaecology, Dhaka Medical College &amp; Hospital from June to December, 2004. One hundred cases of diagnosed incomplete abortion up to 12 weeks of gestation were managed by manual vacuum aspiration during this period. A data recording sheet was designed for this purpose. Haemodynamically stable patients with no history of induced abortion and fever were enrolled. Results: Procedure time of manual vacuum aspiration was short, average duration was 7 minutes. Bleeding was minimum (20-30 mL) in 67% cases and weighted mean was 29.80 mL. Eighty three percent patients were stable during the procedure and only 3% needed blood transfusion. Nonnarcotic analgesics were used in 59% cases and 33% needed only proper counselling. Average duration of hospital stay was 2 hours. Effectiveness of the procedure was about 98% with very low post procedure complication rate (2%). Conclusion: MVA procedure is a safe and effective technique of uterine evacuation in incomplete abortion. It is quick, less expensive, effective and less painful. Hospital stay and chance of perforation of uterus is less. So this procedure should be considered by health care system in Bangladesh for improving treatment of incomplete abortion to reduce both maternal morbidity and mortality. DOI: http://dx.doi.org/10.3329/jemc.v2i1.11918 J Enam Med Col 2012; 2(1): 24-28

Misoprostol Use in Incomplete Abortion

Objective: The objective of the study was to assess the efficacy of two doses of oral misoprostol in cases of incomplete abortion. Study Design: Cohort study design. Sampling techni-que used for patient selection was nonprobability (pur-posive sampling). Settings: This study was conducted in Royal Bapco Hospital, Bahrain from 2008 - 2009. Material and Methods: All women presenting in gynaecological clinic with incomplete abortion were selected. The diagnosis was made on history, exami-nation and ultrasound. 100 women opted the offer of medical management with oral misoprostol .Baseline investigations (blood group, Rh factor and CBC) were done. Oral misoprostol 600 µg was given and repeated after 12 hours. The follow visit was scheduled after one week to assess the efficacy of treatment. Results: Nearly all patients had complete abortion by one week as confirmed by Ultrasonography. The ave-rage bleeding lasted for one week and all patients were satisfied with the medical management and wan-ted to use it in future. Conclusion: Misoprostol is very effective in mana-gement of incomplete abortion and obviates the need for surgical treatment which is not cost effective in busy obstetrical units. Two doses of misoprostol were used which according to our study reduces the dura-tion of bleeding which on an average at least three weeks in most of the studies.

Providing information about misoprostol to health workers in a low-resource conflict setting: evaluation of an initiative along the Thai/Burma Border

As a result of the 60-year civil conflict in Burma and the consequent population dislocation, disruption of services and shortage of trained health service personnel, the maternal mortality rates along the Thai/Burma border are among the highest in the world. In both migrant communities in Thailand and in communities inside eastern Burma, complications from unsafe abortion are one of the leading causes of maternal death. This pilot project aimed to provide health workers and medics with medically accurate information about the use of misoprostol for the prevention of postpartum hemorrhage, management of incomplete abortion and induction of early abortion.

Comparative study between single dose 600 μg and repeated dose of oral misoprostol for treatment of incomplete abortion

Objective To evaluate and compare the effectiveness and side effects of two regimens of oral misoprostol, single dose (600 μg) and repeated dose (1200 μg), in the treatment of incomplete abortion. Methods A prospective randomized controlled trial was conducted. One-hundred women who had incomplete abortion (gestational age <20 weeks) and consented to randomization by computer-generated randomization model prior to treatment. A single oral 600-μg dose or repeated oral dose after 4 h (total 1200 μg) was given to the randomized women. Results The overall incidence of complete abortion was 86.9%. This incidence was not statistically different between the single-dose and repeated-dose groups (81.6% vs. 92%, p > 0.05). However, there was a significantly decreased incidence of diarrhea (18.4% vs. 40%, p < 0.05) with the use of single-dose treatment. Overall rate of acceptability and tolerable side effects were 88.9% and 97.9%, respectively. These rates were similar in both groups (87.8% vs. 90% and 98% vs. 98%, p > 0.05). Conclusions Oral misoprostol may be a practical alternative in the management of incomplete abortion. Oral misoprostol is acceptable and tolerable to women. Single-dose regimen is as effective as repeated-dose regimen, with a reduction in the incidence of diarrhea.

Management of incomplete abortion in South African public hospitals

To describe the current management of incomplete abortion in South African public hospitals and to discuss the extent to which management is clinically appropriate. A multicentre, prospective descriptive study. South African public hospitals that manage gynaecological emergencies. Hospitals were selected using a stratified random sampling method. All women who presented to the above sampled hospitals with incomplete abortion during the three week data collection period in 2000 were included. A data collection sheet was completed at the time of discharge for each woman admitted with a diagnosis of incomplete, complete, missed or inevitable abortion during the study period. Information gathered included demographic data, clinical signs and symptoms at admission, medical management, surgical management, anaestetic management, use of blood products and antibiotics and complications. Three clinical severity categories were used for the purpose of data analysis and interpretation. Detail of medical management, detail of surgical management, use of blood products and antibiotics, methods of analgesia and anaesthesia used, and use of abortifacients. There is a trend towards low cost technology such as the use of manual vacuum aspiration and sedation anaesthesia; however, this is mainly limited to the better resourced tertiary hospitals linked to academic units. The use of antibiotics and blood products has decreased but much of the use is inappropriate. The use of abortifacients does include some use of misoprostol but merely as an adjunct to surgical evacuation. The management of incomplete abortion remains a problem in South Africa, a low income country that is still managing a common clinical problem with costly interventions. The evidence of a trend towards low cost technology is promising, albeit limited to tertiary centres. This study has given us information as how to best address this problem. More training in low cost methods is needed, targeting in particular the district and regional hospitals, and reinforced by skills training focussed mainly on undergraduates and midwife post-abortion care programmes.

Audit the manual vacuum aspirator for the management of incomplete abortion (1000 cases) and termination of pregnancy (3 000 cases) in a tertiary centre in the developing world

Audit the manual vacuum aspirator for the management of incomplete abortion (1000 cases) and termination of pregnancy (3 000 cases) in a tertiary centre in the developing world

A comparison of manual vacuum aspiration (MVA) and sharp curettage in the management of incomplete abortion

Objectives: A prospective longitudinal study was carried out in two Harare hospitals to determine whether manual vacuum aspiration (MVA) was as safe and as effective as sharp curettage for treatment of incomplete abortion. Methods: Demographic and clinical data were collected over a 3-month period on 589 women treated with sharp curettage for incomplete abortion ≤ 12 weeks gestation. One year later, after faculty and staff at the two hospitals were trained to use MVA, data were similarly collected on 834 women treated with MVA for incomplete abortion. Results: Based on procedure-related complications at the time of treatment, MVA was found to be as safe as sharp curettage in treating incomplete abortion ≤ 12 weeks gestation. MVA was more effective than sharp curettage in achieving complete uterine evacuation (0% incomplete evacuations vs. 0.7%, P < 0.05). Conclusions: Given the safety and effectiveness of the MVA procedure and the potential for reducing health care costs and improving patient management, this technology should be considered by health care systems in developing countries for improving treatment of abortion complications.

A time and cost analysis of the management of incomplete abortion with manual vacuum aspiration

OBJECTIVES: Traditionally, management of incomplete abortion involves use of D&C or suction curettage in the operating room. Such management is costly and time-consuming. In order to potentially save time and money, we studied the use of manual vacuum aspiration curettage (MVAC) for the management of this problem. METHODS: Data on hospital charges and times (e.g. waiting time, procedure time) were obtained for all cases of incomplete abortion presenting to hospital between January 1990 and July 1992. Between January 1990 and July 1991, all cases were managed traditionally. After July 1991, all cases were managed using MVAC in either the emergency room or the labor ward. RESULTS: Compared to the use of electrical suction equipment in the operating theatre, MVAC procedures resulted in significant savings in terms of both waiting times and costs. Waiting time was reduced by 52% and procedure time was reduced from a mean of 33 min to 19 min (P < 0.01). Total hospital costs were reduced by 41% (P < 0.01). CONCLUSIONS: Use of manual vacuum aspiration curettage in the management of incomplete abortion can reduce hospital costs and save time for both patients and clinicians.