Manual Vacuum Aspiration Procedure Research Articles

P-409 Intrauterine adhesion in Ultrasound-guided manual vacuum aspiration (USG-MVA) versus electric vacuum aspiration (EVA): a randomized controlled trial

Abstract Study question Does ultrasound-guided manual vacuum aspiration (USG-MVA) have a lower incidence of intrauterine adhesion (IUA) compared to conventional surgical evacuation? Summary answer The rate of intrauterine adhesion following ultrasound-guided manual vacuum aspiration (USG-MVA) was significantly lower compared to conventional surgical evacuation (EVA). What is known already Miscarriages are common in pregnant women and can be managed through conservative, medical, or surgical approaches. Traditional surgical evacuation for early pregnancy loss involves electric vacuum aspiration (EVA) under general anesthesia. However, manual vacuum aspiration (MVA) offers a cost-effective, portable, and easy-to-administer alternative. MVA has shown high effectiveness and minimal complications. By incorporating ultrasound guidance (USG), MVA can further reduce discomfort and minimize the risk of future intrauterine adhesions (IUA) due to its protective effect on the endometrium. However, the incidence of IUA after USG-MVA is still not known. Study design, size, duration This was a prospective single-centre, randomised controlled trial conducted in a university-affiliated tertiary hospital from May 2019 to September 2022. Patients were randomized into USG-MVA group or the EVA group. 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. Participants/materials, setting, methods Chinese women aged ≥18 with a delayed miscarriage of up to 12 weeks of gestation or an incomplete miscarriage were randomly assigned to receive either USG-MVA or EVA for their miscarriage management. An outpatient hysteroscopy was conducted by a team of experienced gynecologists who had comparable surgical expertise within a timeframe of 6 to 20 weeks from USG-MVA or EVA. These gynecologists were unaware of the women’s initial surgical procedure performed for the first-trimester miscarriage. Main results and the role of chance This study included 303 patients who underwent surgical evacuation, with 152 receiving USG-MVA and 151 receiving EVA. Hysteroscopic assessments were completed by 126 patients in the USG-MVA group and 125 patients in the EVA group. The incidence of IUA was statistically (p < 0.02) lower in the USG-MVA group (19.0% ) when compared to the EVA group (32.0%). Interestingly, although there was no significant difference in menstrual outcomes at 6 months postoperatively between the two groups, a higher number of patients in the EVA group with IUA experienced subsequent miscarriages. Hysteroscopic adhesiolysis was performed during hysteroscopy when it is diagnosed to restore uterine cavity. XX USG-MVA patients underwent hysteroscopic adhesiolysis, compared to 36 patients in the EVA group. Two patients in the EVA group required additional treatment in the operating theatre or as an outpatient, and one patient did not follow-up as scheduled. The EVA group had a higher proportion of patients with hypomenorrhea among those who had previous intrauterine surgeries compared to the USG-MVA group, although this difference was not statistically significant. Overall, USG-MVA appears to be a more effective and safer option for managing early pregnancy loss due to its lower incidence of IUA and potential reduction in subsequent miscarriages. Limitations, reasons for caution Performing USG-MVA, as opposed to a blind MVA procedure, however, requires additional equipment and staff with appropriate training. There is no direct comparison between MVA and EVA with USG. The study only followed patients up to 6 months post-operation, which cannot further assess their fertility outcomes. Wider implications of the findings USG-MVA offers cost savings and increased patient comfort by being performed in an outpatient setting. Shifting procedures from the operating room to ambulatory settings reduces expenses and allows patients to avoid general anesthesia, promoting autonomy and quicker recovery. Trial registration number ChiCTR1900023198

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

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.

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

BackgroundIn Japan, dilatation & curettage (D&C) has been performed under general anesthesia as a surgery for an early pregnancy miscarriage for a long time. In 2016, manual vacuum aspiration (MVA) under general anesthesia was introduced at our hospital and has been used as a surgical treatment for first-trimester pregnancy miscarriage, with its utility to date being reported here. In July 2018, our hospital introduced the MVA procedure under local anesthesia. In this study, we evaluated the efficacy and safety of MVA under general and local anesthesia in first-trimester pregnancy miscarriage surgery in Japanese women.MethodsIn this retrospective observational cohort study, we enrolled 322 pregnant women at less than 12 weeks of gestation, who underwent MVA surgery under local anesthesia (n = 166) or conventional general anesthesia (n = 156). The duration of surgery, blood loss volume, quantity of anesthesia, presence or absence of retained products of conception, and clinical complications were evaluated. In addition, the intraoperative pain and treatment satisfaction were assessed using the visual analog scale (VAS).ResultsThe duration of surgery was significantly shorter in the local anesthesia group. No significant differences were observed between both groups in terms of the blood loss volume and incidence of retained products of conception. In addition, no serious complications were observed in either group. No significant differences were noted between the two groups in the VAS scores for pain and treatment satisfaction.ConclusionsIn this retrospective study, the use of MVA under local anesthesia for early pregnancy miscarriage surgery was found to be equally safe and effective when performed under conventional general anesthesia. This technique allowed the achievement of appropriate pain control with excellent patient satisfaction.

Prevalence, indicators and complications associated with manual vacuum aspiration at the University of Port Harcourt Teaching Hospital.

Manual vacuum aspiration is employed for the evacuation of retained products of conception or incomplete abortion. A five-year review of manual vacuum aspiration was conducted at the University of Port Harcourt Teaching Hospital from January 2012 to January 2017. The aim of this study is to evaluate prevalence, indicators and complications associated with manual vacuum aspiration at University of Port Harcourt Teaching Hospital. The data was collected from the manual vacuum aspiration book. The study revealed that 1453 patient had Gynaecological Surgeries, out of which 320 had manual vacuum aspiration, putting the prevalence of manual vacuum aspiration at 20.7%. The mean gestational age and patients age were 11.10 3.69 and 30.07 5.62. The distributions of the indications for manual vacuum aspiration were incomplete miscarriage 318 (99.40%), missed abortion 2 (0.60%). No complication was documented for all the manual vacuum aspiration done. There was no significance in the maternal age and or gestational age predicting manual vacuum aspiration. Manual vacuum aspiration was considered a highly effective, simple and necessary gynaecological procedure with little or no complication. Training of medical personnel on manual vacuum aspiration procedure is strongly recommended to ensure a safe and effective uterine evacuation. The statistical analysis was carried out using Chi square test.

Family planning practices of women working in the Cambodian garment industry: a qualitative study

BackgroundWomen working in Cambodian garment factories have unmet needs for family planning (contraception and safe abortion) services, because of their background and living conditions. This study describes their experiences regarding abortion and contraception as part of a larger project to develop an intervention to support comprehensive post-abortion care.MethodsWe conducted semi-structured interviews with women seeking abortion services at private health facilities. In addition, we interviewed the private providers of abortion and contraception services surrounding garment factories. Interviews lasted up to 60 min and were conducted in Khmer and later translated into English. A thematic analysis was undertaken, with medical abortion experiences coded according to the Cambodia comprehensive abortion care protocol.ResultsWe interviewed 16 women and 13 providers between August and November 2018. Most women reported being married and had at least one child. Among factory workers the major reported reasons for abortion were birth spacing and financial constraints. Family, friends, or co-workers were the major information resources regarding abortion and contraception, and their positive or negative experiences strongly influenced women’s attitude towards both. Medical abortion pills were not always provided with adequate instructions. Half of the participants had a manual vacuum aspiration procedure performed after medical abortion. While women knew the side effects of medical abortion, many did not know the adverse warning signs and the signs of abortion completion. Only three women started post abortion family planning, as most of the women expressed fear and hesitation due to concerns about side effects of modern contraception. Fear of infertility was particularly reported among young women without children.ConclusionThis research shows that in this setting not all women are receiving comprehensive abortion care and contraceptive counselling. Provision of accurate and adequate information about abortion methods and modern contraception was the dominant shortfall in abortion care. Future work to address this gap could involve the development of appropriate interventions and informative tools for women in the Cambodian garment industry such as through existing client contact-centres or social media, including creation of videos or posts on topics that come from clients questions.

Training among in-service doctors in Manipur and their translation into practice

Introduction: Manipur, the easternmost state of India, suffer from lack of specialist doctors at peripheral public health service points. Among MBBS doctors, many lack knowledge on maternal and child health, resulting in delay identifying high-risk cases, which contribute to increased morbidity and mortality. Under RMNCH + A strategy as a continuum to the previous program, to overcome the shortage of specialist doctors, multi-skilling of doctors in the public health system is being undertaken. Training need assessment, proper conduct of training, mentoring should be ensured so that these service providers gain confidence and are thus able to practice newly acquired skills. Objectives: The aim is to determine the type and pattern of training among Medical Officers and to assess the level of translation of Basic Emergency Obstetric Care (BEmOC) training (knowledge and skills) into practice. Materials and Methods: A cross-sectional study was done from June 2015 to October 2017. A questionnaire-guided interview was done among BEmOC trained in-service doctors. Data collected were analyzed using SPSS-version-21. Descriptive statistics such as percentage, mean, median, and standard deviation were used. Chi-square test and Fisher's exact test were used for testing the significance between the proportions. ANOVA and independent t-test were used for comparing means. A value of P Results: Out of 49 respondents, 82% responded and 61% were male. The mean knowledge score was 21 ± 2.8 with a range of 16–27 and the mean age was 33.2 ± 4.1. Gender, year of training, and performed manual removal of placenta were seen significantly associated with knowledge score. About 81.6% of the doctors conducted normal delivery in the past 6 months. Around 45% of the doctors reported performing manual vacuum aspiration (MVA) procedures in the past 6 months and were confident about it. Conclusion: The mean knowledge score about BEmOC was more than two-third of the total score. After training, the knowledge score seems to decrease as time passes. Males had better knowledge than females. There was no association between age, place of posting, and years of experience with knowledge. Almost half of the participants performed the induction of labor and MVA procedure in the last 6 months.

Successful technique of manual vacuum aspiration for treatment of type 2 cesarean scar pregnancies: evaluation of 40 cases

Objective To demonstrate the effectiveness and safety of the defined manual vacuum aspiration (MVA) technique for treatment of type 2 cesarean scar pregnancies (CSPs). Methods We treated 40 patients with CSP by MVA at the Early Pregnancy Clinic of our hospital between 1 January 2012 and 31 December 2014. The files of patients were reviewed and evaluated retrospectively. Eligibility criteria were hemodynamic stability and at least 2 mm myometrial thickness at the anterior part of the CSP. The key-point of successful MVA procedure is to keep away from entering the cesarean scar cavity directly; instead, CSP is displaced from the implantation site by applying vacuum, only while the cannula is passing near. Results During the study period, the ratio of CSP to total pregnancies was 1/1000. The ratio of CSP to cesarean delivery (CD) was 1/372. In that time period, CSPs were constituted 4.41% of all ectopic pregnancies. Total of 40 patients were treated with dilatation and MVA. Complications such as excessive hemorrhage, persistence of CSP, and any need of extra intervention were not observed. The beta-hCG values of 21 patients (52.5%) decreased below 10 mIU/mL after the first 15 days, and the rest decreased below 10 mIU/mL after 3 weeks following MVA. Conclusions This MVA technique for treatment of CSP is easily applicable and effective method with high success and low complication rates. For appropriately selected patients, we think that this method can be considered as the first- line treatment.

Fertility Desires of Women Following Manual Vacuum Aspiration for Incomplete Abortion at the University Teaching Hospital, Lusaka

Objectives: To explore and determine the fertility desires of women who underwent Manual Vacuum Aspiration (MVA) procedure for the management of incomplete abortion at The University Teaching Hospitals (UTH) Women and new born hospital emergency gynaecology ward.
 Methods: An unmatched case control study design with 142 women who had undergone an MVA enrolled into the study while the 142 controls were sampled from women attending the antenatal clinic with pregnancies below age of viability. Systematic random sampling with a sampling interval of 5 was used to select both cases and controls. Data was collected using an investigator-administered questionnaire. Association between fertility desire (birth interval) and demographic and socioeconomic factors was determined by bivariate analysis. Odds ratios were used to determine statistical significance. Associations with a p-valueof <0.05 were further analyzed by multivariate logistic regression.
 Results: Logistic regression showed that post-MVA most women would like to wait for 2 years or more before the next pregnancy (p<0.001). Multivariate analysis model after adjusting for confounders also showed that exposure to MVA procedure was a statistically significant factor (p<0.001, 95%CI 2.281, 14.153) associated with determining future fertility desire. In bivariate analysis, statistically significant factors included residence, religion, having experienced a miscarriage before and type of contraceptive method chosen after counseling. On average 50% of the cases of abortions were incomplete abortions with most of them managed with MVA procedure and experiences by the women post-MVA were different. Of the 142 women who underwent MVA, 56 described the pain as severe with 89 accepting to undergo a similar procedure in future should need arise while 53 would not. Ninety women preferred to wait for more than two years before the next pregnancy while 45 wanted to try for another pregnancy earlier, which is in conflict with the options for contraception, more preferred short acting methods.
 Conclusion: Manual Vacuum Aspiration had a negative effect on preferred birth interval, with a significant number of women post MVA desiring to wait two or more years before the next pregnancy despite the poor outcome of the index pregnancy. Most of the women cited the pain and the discomfort from the procedure as the main reason for the preferred birth interval. Other independent variables

Fertility desires of women following manual vacuum aspiration for incomplete abortion at the University Teaching Hospital, Lusaka

Objectives: To explore and determine the fertility desires of women who underwent Manual Vacuum Aspiration (MVA) procedure for the management of incomplete abortion at The University Teaching Hospitals (UTH) Women and new born hospital emergency gynaecology ward.
 Methods: An unmatched case control study design with 142 women who had undergone an MVA enrolled into the study while the 142 controls were sampled from women attending the antenatal clinic with pregnancies below age of viability. Systematic random sampling with a sampling interval of 5 was used to select both cases and controls. Data was collected using an investigator-administered questionnaire. Association between fertility desire (birth interval) and demographic and socioeconomic factors was determined by bivariate analysis. Odds ratios were used to determine statistical significance. Associations with a p-valueof <0.05 were further analyzed by multivariate logistic regression.
 Results: Logistic regression showed that post-MVA most women would like to wait for 2 years or more before the next pregnancy (p<0.001). Multivariate analysis model after adjusting for confounders also showed that exposure to MVA procedure was a statistically significant factor (p<0.001, 95%CI 2.281, 14.153) associated with determining future fertility desire. In bivariate analysis, statistically significant factors included residence, religion, having experienced a miscarriage before and type of contraceptive method chosen after counseling. On average 50% of the cases of abortions were incomplete abortions with most of them managed with MVA procedure and experiences by the women post-MVA were different. Of the 142 women who underwent MVA, 56 described the pain as severe with 89 accepting to undergo a similar procedure in future should need arise while 53 would not. Ninety women preferred to wait for more than two years before the next pregnancy while 45 wanted to try for another pregnancy earlier, which is in conflict with the options for contraception, more preferred short acting methods.
 Conclusion: Manual Vacuum Aspiration had a negative effect on preferred birth interval, with a significant number of women post MVA desiring to wait two or more years before the next pregnancy despite the poor outcome of the index pregnancy. Most of the women cited the pain and the discomfort from the procedure as the main reason for the preferred birth interval. Other independent variables that affected fertility desire included residence, religion and also level of education.

Efficacy and Safety of Para Cervical Block in Manual Vacuum Aspiration (MVA) - in Low Resource Setting

Objective (s): To determine the safety and effectiveness of para-cervical block for cervical dilatation and uterine evacuation by MVA.Materials and methods: This descriptive (cross-sectional) study was conducted in a low resource set-up at Homna, Upzilla Health Complex Comilla between January 2016 and June 2016. Forty five patients of 1st trimester incomplete abortion of 12 weeks gestation were the target population for manual vacuum aspiration (MVA) for this study. All patients received para cervical block before MVA procedure. Three minutes after application of block, suction and evacuation of uterus was done. Perioperative oral analgesic (Ibuprofen) and anxiolytic (diazepam) were used 30 minutes before procedure in all patients. Before the procedure, all the women were asked to evaluate the level of pain on a visual analog scale ranged from 0-10. Thirty minutes after the procedure, the patient was asked to describe the pain that she had been feeling during MVA by using the same visual analog scale. Visual analog scale was described by: no pain (0 points), slight pain (1-3 points), moderate pain (4-6 points) and severe pain (7-10 points). Patients were followed up for 7 days and were evaluated for complications before leaving the facility and on the 7th day after procedure. A routine USG of lower abdomen was done on 7th post-evacuation day in all patients, which revealed completeness of the procedure. Informed consent was taken from all the patients.Results: All were first trimester incomplete abortion cases. MVA was performed with para cervical block. Para cervical block reduced pain sensation on cervical dilatation. According to VAS 30 (66.67%) patients had mild pain, 3(6.67%) patients had moderate pain and 12(26.67%) patients had no pain during the procedure. Six (13.33%) patients had mild pain and others had no pain after the procedure. There was no severe pain before or after the procedure. Thirty (75.56%) patients discharged before 4 hours and 11 (24.44%) patients discharged after 4 hours of the procedure. No patients had any complications like pervaginal bleeding, infection or retention of product. The cost was minimum and patient’s satisfaction was high.Conclusion: Paracevical block is effective in reducing pain sensation during MVA with a reasonable cost of the procedure.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 70-74

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 & Gynaecology, Dhaka Medical College & 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

Integration of comprehensive abortion‐care services in a Maternal and Child Health clinic in Cambodia

To document the pilot experience of provision of safe abortion/post-abortion services implemented in 2002 at the Mother Child Health clinic in Sihanoukville, Cambodia, and to profile clients and assess their uptake of post-abortion contraception. The initial package of safe abortion/post-abortion clinics (SAPAC) services included counselling on family planning and prevention of sexually transmitted infections, pain management, Manual Vacuum Aspiration procedure and standard universal precautions at an affordable price (US$12.5). SAPAC services became operational in August 2002. The data of medical records from 1 August 2002 to 31 December 2005 (2224 clients) were analysed. The mean number of clients per month attending SAPAC services ranged from 26 in 2002 to 64 in 2005. Fifty-three per cent were housewives, 24% worked in sales or services, 8% in factories, 11% in bars or karaoke lounges and 3% were brothel-based sex workers. Ninety-three per cent of clients came for induced abortion and 7% sought post-abortion care. Pain management was used in 99% of cases. The overall rate of complications during intervention was 2.1% and dropped from 9.4% in 2002 to 1.3% in 2005. After SAPAC implementation, fewer women in Sihanoukville sought abortion services without any quality control and a safer technique was used. On average, 40% of patients took up contraception after the abortion. Integrating comprehensive abortion-care services at a peripheral government health facility is feasible. There is a demand for such services provided at an affordable price in Sihanoukville, Cambodia.

Manual versus electric vacuum aspiration for first‐trimester abortion: a systematic review

As an alternative to electric vacuum aspirations (EVA), there is an increasing interest in using manual vacuum aspiration (MVA). To compare the safety, efficacy and acceptability of MVA with those of EVA for first-trimester abortion. We searched MEDLINE, EMBASE, Cochrane Library and Chinese Biomedical Database in all language, together with reference lists of retrieved papers. Randomised controlled trials comparing MVA with EVA for first-trimester abortion were included. The outcomes are complete abortion rate, uterine perforation rate, blood loss, pain perception and acceptability. Two reviewers independently extracted the data. Results from the trials were combined to calculate relative risks (RRs) or risk differences for dichotomous outcomes and weighted mean differences (WMDs) for continuous outcomes, together with 95% CIs. Ten trials were included, involving 1660 women. Generally, the methodological quality was poor. There were no statistically significant differences, comparing MVA with EVA, in complete abortion rate (RR 1.00; 95% CI 0.99-1.02) and participants' satisfaction (RR 1.02; 95% CI 0.87-1.20). In participants with less than 50 days of gestational age, less blood loss (WMD -1.84; 95% CI -2.45 to -1.23) and less severe pain perception (RR 0.04; 95% CI 0.01-0.12) were reported during the MVA procedure, whereas the operation time was shorter (WMD 0.32; 95% CI 0.02-0.63) in the EVA procedure. There is some evidence that MVA is as effective and acceptable as EVA and might be safer than EVA.

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.

Improving Abortion Care in Zambia

In this commentary, the impact of the introduction of manual vacuum aspiration (MVA) for incomplete abortion patients and for early uterine evacuation is discussed for the University Teaching Hospital in Lusaka, Zambia. This 3-year training and service delivery program was begun in 1988 after it was clear that 15% of maternal deaths were due to illegally induced abortion. The prior procedure of dilation and curettage (D and C) required use of the main operating room and general anesthesia, which resulted in severe congestion and treatment delays. As a result of the new MVA procedure, congestion has decreased substantially, treatment is safer and more timely, and the staff's ability to provide abortions has increased. Family planning counseling is provided to postabortion patients in a more thorough fashion, and the savings in time has improved the quality of patient-staff interactions. Specifically, the patient flow has improved from a 12-hour wait to a 4-6 hour wait and rarely requires overnight hospitalization. The demand for the main operating room had decreased which frees space, time, and commodities for other gynecological treatment. The shorter procedure and release time means a minimal loss of earnings and productivity, and allows for greater privacy in explaining absences to families, schools, or employers. The improved quality of are is reflected in the figures for number treated, i.e., in 1989, 74% were treated with MVA for incomplete abortion 12 weeks and pregnancy termination 8 weeks compared with 26% treated with D and C. In 1990, the figures were 86% with MVA and 14% with D and C. The likelihood of complications from hemorrhage and sepsis have also been reduced. The MVA procedure is also less traumatic for the patient. The increased access to safe legal abortion services is reflected in the ratio of induced to incomplete abortions between 1988-1990 (1:25 to 1:5). Family planning counseling is provided by a full-time counselor who counsels preabortion and postabortion and schedules 2-week follow-up appointment. These achievements have been made in spite of a declining economy and difficulties in the health sector. Unfortunately, conditions throughout Zambia are such that access to safe abortion is restricted. Effort is underway to expand this MVA training and service delivery in provincial hospitals and to conduct research on other effective strategies to reduced unsafe abortion and improve family planning care.