Manual Vacuum Aspiration Group Research Articles

Study on Misoprostol in Case of Missed Abortion

Background: Misoprostol and manual vacuum aspiration (MVA) are both effective treatments for incomplete abortion. Misoprostol, a medication that induces uterine contractions, is often preferred for its non-invasive nature and ease of administration. MVA, a surgical method, involves removing retained products of conception using suction. Studies suggest that while MVA has a higher success rate and faster recovery, misoprostol is a cost-effective, accessible option with fewer complications, though it may require follow-up treatment in some cases. Objective: In this our main goal is to assess the efficiency of misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion. Method: This hospital based randomized controlled trial study was conducted in in-patient patient Department of Obstetrics and Gynaecology, Chittagong Medical College and Hospital from October 2007 to September 2008. A total of 128 women between the age of 15 to 40 years with diagnosis of first trimester uncomplicated spontaneous incomplete abortion was included in this study. Among them 64 patients were randomized in group ‘A’ as case who were treated with Misoprostol and 64 patients were in group ‘B’ as control who were treated with Manual Vacuum Aspiration. Results: During the study, where the mean gestational size of uterus was 9.52 weeks at the time of initial examination. The mean size of uterus in misoprostol group was 9.07(SD ±1.93) and that of MVA group was 9.87 (SD± 1.35). More women in case group had no child of viable age on the other hand increased number of women in control group had at least one viable birth. 36 (60%) out of 60 women in misoprostol group 26 (41.93%) out of 62 reported pain and 36 (58.07%) out of 62 women in MVA and 24 (40%) patients in misoprostol arm said bleeding as the worst feature. Thirty six percent women in misoprostol group and 16% women in MVA group reported that the adverse effects were easily tolerable. Thirty percent women ...

Effectiveness of Misoprostol Versus Manual Vacuum Aspiration for the Treatment of the First Trimester Pregnancy Termination

Objective: To compare the effectiveness of misoprostol versus manual vacuum aspiration (MVA) in the treatment of pregnancy termination at first 12 weeks of pregnancy, evaluating the outcomes among women undergoing these procedures. Methodology: A comparative analysis was carried out at the Obstetrics and Gynaecology department of Bakhtawar Amin Hospital, Multan from January 2023 to December 2023, included pregnant women presented with age of gestation age up to 12 weeks, open cervical os and indication for elective termination of pregnancy. Participants were randomized into two groups. Misoprostol group received 400 mcg of misoprostol intravaginally every 4 hours for up to three doses for softening cervix, its dilatation, and uterine contractions, with starting oxytocin infusion after 6 hours. While manual vacuum aspiration group underwent the procedure under general anesthesia without receiving any uterotonics. Patients were followed up on the 7th day post-procedure, undergoing ultrasonography to measure endometrial thickness for efficacy assessment based on complete abortion. Results: A total of 126 patients were comparatively studied; 63 in each group with mean age in the Misoprostol group was 33.45±3.11 years, and was slightly lower the MVA group as30.22±4.76 years. The average gestational age at the time of treatment was almost similar between the groups, 8.33 ±1.29 weeks for Misoprostol group and 7.99±2.56 weeks for the MVA group. The Misoprostol group exhibited an efficacy rate of 95.20% among patients, compared to 90.50% in the MVA group (P=0.148). Furthermore, the efficacy between Misoprostol and MVA across different age groups, gestational ages, and parity, was statistically insignificant (p->0.05). Conclusion: Basis on the study findings, the efficacy of misoprostol for first trimester termination of pregnancy was observed to be 95.20%, slightly higher than the 90.50% with manual vacuum aspiration (MVA).

Optimization of intrauterine interventions in spontaneous abortion

Introduction. Retained products of conception (RPOC) are detected in 15 % of women after spontaneous or medical abortion. RPOC blind removal from the uterine cavity remains the "gold standard" of surgical treatment, which, however, may be associated with a high risk of certain complications that pose a serious threat to female reproductive function and quality of life. An alternative method for eliminating RPOC proposed by operative hysteroscopy demonstrating the visual control advantages.Aim: to evaluate clinical effectiveness and safety of RPOC removal in incomplete spontaneous abortion using hysteroscopic morcellation.Materials and Methods. The prospective comparative study included 135 women with incomplete spontaneous abortion aged 18 to 40 years, divided into 3 groups: group 1 – 42 patients after RPOC electromechanical vacuum aspiration (EVA); group 2 – 44 patients after RPOC manual vacuum aspiration (MVA); group 3 – 49 patients after RPOC hysteroscopic morcellation (HM). In all patients, the level of total endotoxin was measured, metroaspirate cytokine profile was analyzed, the indicator of endometrial microcirculation was assessed before surgical treatment and on day 1 afterwards, and genital ultrasound examination was performed on day 3–5 post-surgery.Results. In the post-surgical vs. pre-treatment period, the EVA and MVA groups revealed significantly increased levels of total endotoxin and interleukin (IL) IL-1β (p < 0.05). In contrast, these parameters in the HM group changed insignificantly (p > 0.05). In all groups, IL-8 and tumor necrosis factor alpha (TNF-α) levels after surgery were significantly elevated (p = 0.001). In the EVA and MVA groups, levels of anti-inflammatory cytokines IL-4 and IL-10 were markedly decreased (p = 0.001), which did not change in the HM group (p > 0.05). A significantly accelerated microcirculation rate was noted in the EVA and MVA groups while comparing it at pre-surgery level (p = 0.001), but not in the HM group (p = 0.415). Incomplete RPOC removal was reported for 4.5 % MVA patients, all EVA and HM patients had total RPOC elimination. Intraoperative bleeding, uterine perforation were not reported in any examined patient.Conclusion. The early-stage treatment results showed that RPOC removal by the HM is an effective and safe approach. Limited inflammatory response and stable endometrial microcirculation upon using the HM evidence about a minimal impact on the endometrium that lowers probability of postoperative adhesion.

MANUAL VACUUM ASPIRATION VERSUS DILTATION AND CURETTGE TERMINATION OF FIRST TRIMESTER ABORTION AMONG WOMEN ADMITTED AL-SADAQA TEATCHING HOSPITAL, ADEN JAN1st DECEMBER 31st 2020

Early pregnancy failure is a medical complication and major health problem across the globe. The aim of this study is to compare manual vacuum aspiration (MVA) and dilatation and curettage (D&C) for first trimester abortion, in terms of the efficiency of eliminating retain product of conceptus, frequency of complications, duration of the procedure, and duration of patients' hospitalization. This is a prospective comparative descriptive study performed at Al-Sadaqa Teaching Hospital. Over a period from 1st Jan 2020 to 31st December 2020, a total of 143 women, these patients either MVA group (n=72) or D&C group (n=71). Presented with spontaneous abortion and gestational age less than 12 weeks, patent cervix, and no signs of septic abortion, hemoglobin ≥9 g/dl and no bleeding disorder. Data was collected on prescribed questionnaire. The total number of abortion 637 in compare to 259 (40.7%) patient with first trimester abortion, 143 patients was included in this study, MVA group (n =72) and D&C group (n=71). The distribution in respect to the age, parity & gestational age was similar in both groups. The mean duration of procedure was significantly higher (P<0.05) in D&C group compared to MVA group. The duration of hospital stay was significantly lower (P<0.05) in MVA group compared to D&C group. MVA group showed the least incidence of complications regarding the amount of blood loss, and cervical laceration. Complete evacuation was achieved in 95.8% in MVA vs. 98.6% in D&C group with no statically significant (P=0.304). MVA is as effective as popular dilatation and curettage for treatment of early pregnancy failure while it need less time consuming, requires a shorter hospital stay and subsequently costs less. It does not require general anesthesia and complication rate is less than dilatation and curettage. So it can be easily accessible to the woman of both rural and urban societies belonging to any socioeconomic strata especially where high tech equipment and power supply are not available.

Efficacy of Manual Vacuum Aspiration versus Dilatation and Curettage in First Trimester Miscarriages

Objective: To compare the efficacy of Manual Vacuum Aspiration (MVA) with Dilatation and Curettage (DNC) in miscarriages of the first trimester. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology CMH, Peshawar Pakistan, from Feb to Aug 2018. Methodology: A total number of 182 Adult female (20-35 years of age) patients having miscarriage during the first trimester who were either primigravida or with previous history of spontaneous vaginal delivery were included in this study. Patients were assigned randomly into Manual vacuum aspiration (MVA) and Dilatation and Curettage (DNC) groups using the draw randomization technique. Data regarding the efficacy of both procedures and procedural success rate was measured in all patients. Results: A total of 182 Adult female patients, with a mean age of 30.53+5.23 years, having miscarriage in the first trimester, were evaluated. The mean gestational age at the time of abortion was 8.64+1.30 weeks, and the mean parity of study females was 1.96±0.82. The procedure was successfully done in 87(95.6%) patients in the MVA Group versus 84(92.3%) in the D&C Group (p-value 0.35). Conclusion: Manual vacuum aspiration (MVA) is an effective and safe method of abortion with a success rate comparable to that of Dilatation and Curettage (D&C).

Manual Vacuum Aspiration Versus Expectant Management for First Trimester Miscarriage: A Randomized Controlled Trial.

Background Miscarriage is one of the common problems encountered in pregnancy. The treatment modalities are expectant, medical, and surgical management. This study compared the effectiveness and safety of manual vacuum aspiration (MVA) with expectant management for first trimester miscarriage. Method This randomized controlled trial was conducted in Teaching Hospital Jaffna, Jaffna, Sri Lanka, and 134 eligible patients with first trimester spontaneous miscarriage were randomized to expectant management (67) and MVA (67). Those allocated to expectant management were managed expectantly for up to two weeks, and those allocated to MVA underwent aspiration under a paracervical block in the ward. The primary outcome was complete evacuation of the uterus, and the secondary outcomes were duration of bleeding, duration of pain, level of pain, need for the second procedure, cervical or uterine injuries, and patient satisfaction. Results Of the 134 eligible women, seven were lost to follow-up and 127 were analyzed. The MVA was superior in achieving complete evacuation compared to expectant management (95.2% vs. 70.3%; p ≤ 0.001). Notably, in both groups, complete evacuation was more readily achievable in incomplete miscarriage than in missed miscarriage. Duration of bleeding (mean days, 1.6 vs. 4.3; p ≤ 0.0001), duration of pain (mean days, 1.0 vs. 4.2; p ≤ 0.0001), and the need for additional surgical procedure in the form of dilatation and curettage (4.8% vs. 29.7%; p ≤ 0.001) were lower in MVA. Patient satisfaction was higher in the MVA group than in the expectant group (93.7% vs. 65.6%; p ≤ 0.001). No statistically significant differences were observed between the groups in terms of blood transfusion and infection. There wasn't any incidence of cervical damage or uterine perforation. Conclusion MVA is an effective and safe treatment method for first trimester miscarriage with higher patient satisfaction.

A Comparative Study of Sublingual Misoprostol and Manual Vacuum Aspiration for Incomplete Abortion Treatment

Objective: The purpose of this analysis is to do the comparison of sublingual misoprostol and manual vacuum aspiration for the incomplete abortion treatment. Study Design: Randomized/Control Trial Place and Duration: Department of Gynecology and Obstetrics of Combined Military Hospital, Peshawar from January 2021 to December 2021. Methods: There were 108 women with ages 18-50 years were presented in this study. All the included women had incomplete abortion. Age, BMI, gestational age, and parity were among the specific demographics of the recruited cases that were documented after receiving written, informed consent. 54 females received sublingual misoprostol (600mg) in group I and 54 patients of group II manual vacuum aspiration. Post-treatment outcomes among both groups were assessed in terms of decreased hemoglobin, side effects, abortion completion and satisfaction rate by using visual analogue scale. SPSS 24.0 was used to analyze all data. Results: Among 108 females, 35 (32.4%) patients had age 18-30 years, 55 (50.9%) had age 31-40 years and 18 (16.7%) had age >40 years. 60 (55.6%) had BMI <25kg/m2 and 48 (44.4%) had BMI >25kg/m2. Mean parity of the females were 2.04±3.19 and mean gestational age was 13.4±8.61 weeks. In group I hemoglobin level <1 g/dl was lower found in 27 (50%) cases as compared to group I in 35 (64.8%) cases. Frequency of side effects in group I was higher 38 (70.4%) as compared to group II 22 (40.7%) with p value 0.006. Frequency of complete abortion in group II was higher in 50 (92.6%) as compared to group I 39 (72.2%) with (p<0.003). Satisfaction rate was higher in manual vacuum aspiration group as compared to sublingual misoprostol group. Conclusion: This study exhibited that MVA was effective and satisfactory among patients of incomplete abortions in terms of decreased hemoglobin level, less side effects and higher number of complete abortions. Keywords: Incomplete abortion, Hemoglobin level, Side Effects, Complete Abortion

Efficacy of Vaginal Misoprostol Administered for Rapid Management of First Trimester Spontaneous Onset Incomplete Abortion in Comparison to Manual Vacuum Aspiration: A Randomised Clinical Trial

Introduction: Both, surgical and medicinal techniques can be used vaginally to treat incomplete abortions. Although, Manual Vacuum Aspiration (MVA) is a safe and efficient surgical treatment for the management of incomplete abortion, it is not frequently offered and is not very cost effective in rural areas, especially in low resource settings. Misoprostol is an alternative to MVA for the treatment of incomplete abortion. Aim: To assess the effectiveness and acceptability of using vaginal misoprostol for the management of first trimester spontaneous incomplete abortion as an alternative to MVA. Materials and Methods: A randomised clinical trial was conducted between February 2020 to July 2021 in the Department of Obstetrics and Gynaecology, at RG Kar Medical College and Hospital, Kolkata, West Bengal, India. A total of 144 participants were randomised into two groups with 72 women in each group, to treatment with either MVA or 400 mcg vaginal at 3 hour intervals. The main outcome measures assessed at 24 hour follow-up were complete uterine evacuation confirmed by transvaginal sonography, and client acceptability and satisfaction were assessed from entry in data form by participants. Chi-square (χ2 ) tests were used for categorical data, and the Student’s paired t-test was used for continuous data. Statistical significance in all calculations was defined as p<0.05 and the study would follow the Intention To Treat (ITT) analysis while computing the results. Results: The mean ages were 27.44 years (6.8) and 28.47 years (6.6) for the misoprostol and MVA groups respectively. For the gestational age, the mean gestational ages were 8.88 (2.01) and 8.90 (2.17) weeks for the misoprostol and MVA groups, respectively. A higher failure rate in terms of incomplete abortion was encountered in the misoprostol arm compared to the MVA arm. Although this difference in complete uterine evacuation rate did not reach statistical significance (RR=4, 95% Confidence Interval (CI) 0.879-18.192, p=0.0728). Pyrexia appeared to be a significant complication in the misoprostol group compared to MVA group (p=0.038). There was no significant difference in satisfaction in both groups (p=0.659) and no significant difference in acceptability. Conclusion: As an alternative to surgical intervention, three 400 mcg misoprostol pills could be administered vaginally over the course of three hours to treat spontaneous first trimester uncomplicated incomplete abortion.

Manual vacuum aspiration (women's MVA) for endometrial biopsy for patients with suspected endometrial malignancies.

Endometrial biopsy is generally performed with a metal uterine curette sonde; however, recently, many types of vacuum aspirators are available, including the manual vacuum aspiration (MVA) system. We used the women's MVA system for endometrial sampling and evaluated its effectiveness in determining the presence of endometrial malignancy. Forty-seven samples were examined using the following procedures after measuring endometrial thickness by transvaginal ultrasonography: fractional curettage biopsy (Bx; 20 samples), total curettage under general anesthesia (T/C; 13 samples), and MVA (14 samples). The quality of the endometrial samples was classified into four types: 1-4, where 1 denoted poor and 4, good quality. The mean score of the MVA group was significantly higher than that of the partial curettage biopsy group (p=0.0065). No differences were observed between the MVA and total curettage groups (p=1.00). When patients were divided into two groups according to endometrial thickness (<10 mm or ≥10 mm) and analyzed, both the MVA and T/C groups did not show a significant difference in their scores compared to the Bx group when the endometrial thickness was <10 mm. However, when the endometrial thickness was ≥10 mm, the MVA and T/C groups had significantly better scores than the Bx group (p=0.0225 and p=0.0244, respectively). Vagal reflex, as an adverse event, was observed only in two patients in the Bx group (2/20, 10%). Considering its quality and safety, Karman-type MVA for endometrial sampling could be an alternative to fractional curettage using a metallic uterine curette sonde.

Efficacy of Manual Vacuum Aspiration Vs Conventional Evacuation and Curettage

OBJECTIVES: To evaluate the safety and efficacy of Manual Vacuum Aspiration (MVA) compared to Conventional Evacuation and Curettage (E &amp; C) in managing first-trimester miscarriage. METHODOLOGY: A total of 160 patients were enrolled in this comparative study. Patients were categorized into two groups (Group A undergoing MVA) and (Group B undergoing E&amp;C). Each group had 80 cases randomly selected. Stable patients with miscarriages ­&lt; 12 wks of gestation and no comorbid were included in the study. Data was recorded on pre-designed proforma, and analysis was done by SPSS Software. RESULTS: Efficacy of MVA was 97.5% and 92.5% in E&amp;C, with a 7.5% vs 30% complication rate in MVA and E&amp;C Group, respectively. The mean duration of the procedure was 9 minutes in the MVA group versus 18.8 minutes in the E&amp;C group. The hospital stay was 14.2 hours vs 20.3 hours in MVA and E&amp;C Group. 16.25% vs 46.25% of women in MVA vs E&amp;C Group reported post-op pain. 93.75% of women were satisfied with MVA, whereas only 50% of women were satisfied with E&amp;C. 81.25% 91.25% required Anesthesia/Analgesia in MVA and E&amp;C Group, respectively. CONCLUSION: MVA is a more effective and rapidly performing outpatient procedure with a lower complication rate. In this study efficacy of MVA is 97.5% compared to the E&amp;C group, i.e., 92%. Its safety, cost-effectiveness and efficacy advocate its extended use as an alternative to the conventional surgical method of miscarriage

Early Pregnancy Loss: Manual Vacuum Aspiration (MVA) Vs. Conventional Evacuation and Curettage

Objective: The purpose of this study is to assess the effectiveness of manual vacuum aspiration vs standard evacuation and curettage in the case of early pregnancy loss: HMC hospital, Peshawar, gynecologic and obstetrics department Study Design: A Single-center study Duration and place of study: From January 1st, 2017, to January 30th, 2020, the study was carried out in the gynecological and obstetrics unit B of the HMC hospital, Peshawar. Patient Methodology: One thousand and sixty-three (603) patients were studied. According to the inclusion criteria, all patients who experienced an early miscarriage (18-42 years old) were recruited for the research. The lottery approach was used to split the patients into two groups. Those in Group A who had been treated by MVA Group B were individuals who had traditional surgical evacuation and curettage. Age and BMI were obtained after obtaining written consent from the patient. The patient's entire blood picture, blood group, hepatitis serology, and coagulation profile were analyzed as part of a baseline assessment. Ultrasound and the starting day of the last menstrual cycle were used to determine gestational age. Two hours before the surgery, misoprostol 400mcg was used to ripen the cervical lining. Aseptic procedures were followed during the process. Ultrasound was used to verify that both methods had successfully evacuated the uterus. Results Group A had a mean age of 27 years, while Group B had a mean age of 29 years, both with a standard deviation of 7.55 years in Group A. Approximately 40% of the patients in Group A were mono para, and 60% of the patients in Group B were multipara. Forty-two percent of patients in Group B were first-time paras, whereas 58 percent of patients in Group B were second-time paras. In Group A, 40% of the patients were first-time mothers, whereas 60% were multiple mothers. There were 42 percent primi gravida and 58 percent multi gravida in Group B. Aspiration using manual vacuum and conventional evacuation and curettage were equally successful for 92% and 82% percent of patients, respectively. Keywords: Early Pregnancy Loss, M .V. A, Conventional Evacuation And Curettage

Comparison of Feasibility, Efficacy and Patient Acceptability of Manual Vacuum Aspiration Vs Sublingual Misoprostol in Early Pregnancy Loss

Objective: To compare feasibility, efficacy and patient acceptability of manual vacuum aspiration with sublingual Misoprostol in early pregnancy loss.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Gynecology and Obstetrics Department, Combined Military Hospital Okara Pakistan, from Aug 2019 to Apr 2020.&#x0D; Methodology: 200 Patients with early pregnancy loss (missed, incomplete abortion) at gestational age 6 to 12 weeks were randomly allocated to Manual vacuum aspiration (group A) and oral Misoprostol (group B) by lottery methods. Manual vacuum aspiration was done in the outpatient department. While in Group B, oral Misoprostol was given with a protocol 600 micro gram sublingual stat observe for 1 hour for any complication. Afterwards, they were given Misoprostol 600 micrograms sublingual, 3 hourly total of 2 doses. Patients from both groups were called for follow-up after one week.&#x0D; Results: Efficacy, feasibility and patient acceptability was 88%; p-value &lt;0.001, 95%; p-value &lt;0.001 and 97% respectively in manual vacuum aspiration group as compared to 64%, 68% and 70% in sublingual Misoprostol group. There were fewer systemic side effects and fewer visits in manual vacuum aspiration group 1 vs 3 in the sublingual Misoprostol group.&#x0D; Conclusion: Manual vacuum aspiration is more effective than Misoprostol as it has no systemic effects. Both options are cheap and can be achieved in outpatient settings. However, manual vacuum aspiration provides complete evacuation and is a good option for low resource settings and a developing country like Pakistan with frequent electricity disruptions. It offers a substantial saving on resources, cost and...

Oral 600mg misoprostol vs manual vacuum aspiration (MVA) for the management of incomplete abortion- a randomized controlled trail

Approximately one in five recognized pregnancies are spontaneously miscarried in the first trimester and an additional 22% end in induced abortion. Incomplete abortion occurs when there are retained products of conception (POC) after induced abortion (whether by unsafe or safe methods) or after spontaneous abortion, also known as miscarriage. Some women may resort to self-induction. These conditions increase the likelihood that women will experience abortion complications and will seek treatment for incomplete terminations. Incomplete abortion can be treated with expectant management, which allows for spontaneous evacuation of the uterus, or active management, using surgical or medical methods. Expectant management is not preferred by many providers due to its relatively low efficacy and the fact that the time interval to spontaneous expulsion is unpredictable.The study was performed in a Durgapur Steel plant hospital, a tertiary care Hospital in West Bengal, India. The institute caters a huge area, both rural and urban. The study was done between 1st January2019 to 31st October 2020.Study population was drawn from patients attended OPD and patients admitted with incomplete abortions, either of spontaneous or, induced etiology in the Dept. Of Obst, &amp; Gynae, Durgapur Steel plant hospital. A total of 80 women were randomised to either a single dose of 600 micrograms of oral misoprostol or MVA.160 women were recruited to the trial, of which 80 women were grouped into misoprostol group &amp; another 80 to MVA group. Immediately after abortion, all the patients were available &amp; data collected from all the patients. But during next follow-up after 1-2 wk, 33 in the MVA group &amp; 27 in the misoprostol group did not come (Lost to follow up n=33) for follow-up. So, approximately 41% (33) of participants in MVA group &amp; 34% (27) in the misoprostol group were lost to follow-up.In our study both MVA &amp; Misoprostol groups had similar age distribution. Mean age in MVA group 23.5 years (± 4.5) and in MISO group 23.4 Years (± 4.8). For treatment of first-trimester uncomplicated incomplete abortion, both manual vacuum aspiration and 600 µg oral misoprostol are safe, effective, and acceptable treatments. However, misoprostol appears to be somewhat better option than MVA, in regards to availability, low cost of therapy, less pain, less need of expert manpower or specialised instruments.

Misoprostol Versus Manual Vacuum Aspiration in Treatment of Missed Miscarriage in First Trimester

Abstract Background: Manual vacuum aspiration (MVA) is a safe and effective technology for the treatment of missed miscar-riage but it is not widely available and affordable in rural areas particularly in low resource countries. Misoprostol is an alternative to manual vacuum aspiration for the treatment of missed miscarriage. Aim of Study: The purpose of this study was to compare the effectiveness, patient satisfaction and hematocrit drop of misoprostol versus MVA to understand the potential role of misoprostol as a first line for treatment of first trimester missed miscarriage. Patients and Methods: A Randomized Controlled Trial was conducted from January 2020 to January 2021 at Mansoura University Maternity Hospital. Included 70 participants were randomized to treatment with either MVA or 800µg vaginal misoprostol. The main outcome measures assessed at 1 week follow up were complete uterine evacuation, patient's accept-ability and satisfaction. Results: There is no statistically significant difference between studied groups regarding success rate and mean patient satisfaction score immediately and after one week, 82.9% of misoprostol group and 94.3% of MVA group suc-cesses. The mean hemoglobin and hematocrit after treatment illustrated statistically significant lower mean value among misoprostol group than MVA group (10.07 & 10.91, respec-tively for Hb) and (30.75 & 33, respectively for hematocrit value). Hemoglobin drop for both groups illustrated no statis-tically significant difference between studied groups. There is statistically significant negative correlation between en-dometrial thickness/mm and satisfaction after one week among both group. Conclusion: Both misoprostol and MVA had high rates of satisfaction and complete uterine evacuation, which could ultimately reduce maternal complications from abortion. Medical treatment is as effective as surgical treatment of first trimester missed miscarriages. Recommendations: Although misoprostol is a very effec-tive drug, the health care professional should have thorough knowledge of the dose, side effects, complications and contraindications before prescribing it. More studies with larger sample size are needed to elucidate the optimal method for missed miscarriage management and patient satisfaction.

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

BackgroundThe 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.MethodsThis 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.ResultsThe 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.ConclusionsSurgical treatment for miscarriage performed using the MVA kit has safety and efficacy similar to those of conventional methods, such as D&C and EVA.

Outcome Of Manual Vacuum Aspiration Vs Surgical Evacuation

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 &amp; 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 &amp; 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

Manual Vacuum Aspiration (MVA) versus Electric Vacuum Aspiration (EVA) in first trimester medical termination of pregnancy (MTP)

Background: Approximately 47000 pregnancy related deaths occur due to complication of unsafe abortion. To correct this Ministry of Health and Family Welfare had appointed the expert group for MTP Act and amend it to enable increased access to safe abortion services for all women. The WHOs preferred methods to safely and effectively terminate pregnancy during the first trimester of pregnancy are vacuum aspiration and medication abortion. Objectives: To evaluate and compare the efficacy of MVA and EVA in first trimester pregnancy termination. Methods: Study includes cases of pregnancy with less than or equal to 12 weeks of gestation. After receiving consent, cases allocated in two groups Group A followed Manual Vacuum Aspiration while Group B followed Electric Vacuum Aspiration. Each group contains 75 cases. During these procedures, relation of uterine size, blood loss, post-operative pain score, complications were noted and compared between two procedures. Results: The average blood loss was significantly higher in MVA group in more than 10 weeks of gestation. MVA is comparatively less painful than EVA. There is no major difference in complications. Conclusion: MVA is best suited for infra-structure in rural areas and is very useful in poor resource setting hence It is best suited for rural setting, where there is an unmet need for abortion services. Key words: Manual Vacuum Aspiration (MVA), Electric Vacuum Aspiration (EVA), Medicaltermination of pregnancy

Randomised Trial of Oral Misoprostol Versus Manual Vacuum Aspiration for the Treatment of Incomplete Abortion at a Nigerian Tertiary Hospital

ObjectivesThis study aimed to compare the efficacy of oral misoprostol with manual vacuum aspiration (MVA) in first trimester incomplete abortions.MethodsThis randomised controlled trial study was conducted at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between April 2014 and November 2015. Pregnant women who presented with clinical features of incomplete abortion at a gestational age of 13 weeks or less were included. Patients who had profuse vaginal bleeding, an intrauterine device in situ, signs of pelvic infections or who were younger than 18 years old and had no accompanying adults to give informed consent were excluded. A total of 200 participants were randomly and equally allocated to either the MVA or misoprostol treatment group. The treatment group were given 600 μg of misoprostol orally. The primary outcome measure was complete uterine evacuation, while secondary outcome measures included the need for additional surgical evacuation for failed treatment, adverse effects/complications, acceptability of and satisfaction with the treatment.ResultsBoth misoprostol and MVA had high complete evacuation rates, yet MVA was significantly higher (99% versus 83%, relative risk [RR]: 0.84, confidence interval [CI]: 0.766–0.918; P <0.001). Significantly more women in the misoprostol group required additional MVA for failed treatment than in the MVA treatment group (17% versus 1%, RR: 16.67, CI: 2.260–12.279; P <0.001). No significant difference was found between the misoprostol and MVA treatment groups in terms of satisfaction (92.7% versus 89.8%, RR: 1.04, CI: 0.946–1.127; P = 0.473).ConclusionTreatments with misoprostol and MVA had high complete uterine evacuation rates, as well as high rates of acceptability and satisfaction. However, MVA had a significantly higher complete evacuation rate than misoprostol.

Hysteroscopic Endometrial Polypectomy with Manual Vacuum Aspiration Compared to Mechanical Morcellation

To examine the effectiveness of hysteroscopy plus manual vacuum aspiration (MVA) for endometrial polypectomy compared with hysteroscopic morcellation. Retrospective cohort study (Canadian Task Force classification II-2). Duke University Medical Center database. Women who underwent hysteroscopic removal of endometrial polyps performed by Duke Fertility Center faculty physicians between January 1, 2015, and January 29, 2018, using either hysteroscopy plus MVA or hysteroscopic morcellation. The 2 groups were compared using the χ2 or Fisher's exact test, Student's t test, and multivariable regression analysis. The primary outcome was the duration of the procedure. Secondary outcomes were fluid deficit, rate of complete polyp resection, estimated blood loss, and operative complications. A total of 102 women undergoing endometrial polypectomy were identified. Patients in whom polyps were removed using only a hysteroscopic grasper and/or scissors (n = 31); patients who underwent an additional simultaneous procedure, such as laparoscopy (n = 12); and patients in whom the duration of the procedure was not recorded (n = 2) were excluded. Among the remaining 57 patients, 28 underwent hysteroscopy plus MVA and 29 underwent hysteroscopic morcellation. The mean duration of procedure was longer for hysteroscopic morcellation compared with hysteroscopy plus MVA (32 ± 10 minutes vs 20 ± 6 minutes; p = .04), and this difference remained significant after adjusting for age, body mass index, surgeon, and number and size of polyps. Mean fluid deficit was greater for morcellation than for hysteroscopy plus MVA (277 ± 204 mL vs 51 ± 97 mL; p < .001). Complete polyp resection was possible in all patients; however, the use of a hysteroscopic scissors and grasper was required for 1 patient in the MVA group. Estimated blood loss was minimal in all cases, and there were no operative complications. Hysteroscopy plus MVA is an effective method for removing large or multiple endometrial polyps, with outcomes comparable to hysteroscopic morcellation.

FIRST TRIMESTER MISCARRIAGE;

Objectives: This study was conducted to access the efficacy of misoprostol andmanual vacuum aspiration for the management of first trimester miscarriage. Study Design:Descriptive case series. Setting: This study was conducted in obstetrics and gynecologydepartment of Nishtar hospital Multan. Duration of Study: This study was conducted fromMay, 2015 to October 2015. Material and Methods: Sample including 652 women havinggestational age less than 12 weeks with open os of cervix were taken in the study. Femaleswith previous cesarean section, multiple gestation or with history of asthma, ischemic heartdisease, hepatitis, glaucoma, or known allergy to prostaglandins were excluded. Total womenwere divided into two groups. i.e. 326 in misoprostol while 326 in manual vacuum aspirationgroup. Misoprostol group received misoprostol tablet 400μg vaginally at intervals of four hoursdepending on the degree of cervical dilatation and frequency of uterine contractions. A total of 3doses of misoprostol were given. Six hours after the first dose of misoprostol syntocinon infusionwas started. Infusion rate was 2mIU/min. Dose was increased after every 30 minutes at the rateof 1mIU/min to maximum of 8mIU/min. Manual vacuum aspiration group did not receive anyuterotonics and directly underwent manual vacuum aspiration. Patients were asked to revisit 7days after the procedure. Transvaginal ultrasound was done to access endometrial thicknessin the longitudinal view of the uterus at the maximal AP diameter. Efficacy was measuredin the form of complete abortion. Results: In the study, misoprostol group mean age was31.79±4.86 years while age range was 18-40 years. In manual vacuum aspiration group meanage was 32.38±4.86 years. Majority of patients were between 31-35 years in both groups. Meangestational age was 9.89±1.38 weeks in misoprostol group and 9.871±1.22 weeks in manualvacuum aspiration group, while mean dose in misoprostol group was 2.358±0.65. Conclusion:Regarding management of first trimester miscarriage both options including manual vacuumaspiration and 400μg intra vaginal misoprostol can be considered. Both methods are affectivetreatment options, decision that which method be opted should be based on, availability of twomethods and wishes of the patient.