Use Of Manual Vacuum Aspiration Research Articles

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.

KNOWLEDGE AND PRACTICE OF POST-ABORTION CARE BY MIDWIVES IN SELECTED PRIMARY HEALTH CARE FACILITIES IN ASHANTI REGION, GHANA

In Ghana, abortion-related mortality is considered a major public health issue that needs to be addressed. Midwives have been trained to safely and effectively provide post-abortion care in the country, yet the expected decline in maternal deaths from abortion complications especially in the rural settings is yet to be realized. Primary Healthcare (PHC) facility is the first point of contact for the rural populace, yet there is minimal evidence on the capacity of midwives serving there to provide post-abortion care. This study assessed the knowledge and practice of post abortion care among midwives in selected primary healthcare (PHC) facilities in Ashanti region of Ghana. A cross sectional descriptive survey design was utilized for the study, and a multi-staged sampling technique was used to select 16 PHCs comprising both government (11) and private (5) owned, from which 112 participants were recruited. A pre-tested structured, self-developed questionnaire was employed to obtain information from the study participants. Obtained data were analyzed using SPSS version 21. A total of 109 questionnaires were accurately completed out of 112 administered, giving a response rate of 97.3%. The midwives’ knowledge of post abortion care (PAC) was mainly in the areas of PAC as treatment for abortion complications 49(36%), while knowledge on the other PAC components was low. Only 63(58%) of the respondents had training on PAC, which was basically on the use of Manual Vacuum Aspiration (MVA) to complete incomplete abortion 52(41%). Among the 70(64%) respondents who indicated that their PHC facilities provide PAC services, only 72(66%) of them actually carried out post abortion care. Reasons advanced by the other 39(36%) who never carried out PAC were lack of; confidence 30(815), skills 27(73%), and knowledge 20(54%). The study recommended the training of midwives serving in PHCs in all components of post-abortion care as a feasible strategy for decentralizing PAC services and reaching out to the neglected rural populace. This aspect of reproductive health need to be re-emphasized in midwifery training curricula, buttress with regular mandatory continuing professional development in the area to improve skills.

VP45.19: Impact of the COVID‐19 pandemic on management of miscarriage and ectopic pregnancy

The current coronavirus (COVID-19) pandemic has become an unprecedented global public health emergency. This has had an impact on early pregnancy care provision with the rationalisation of services to maintain a safe clinical environment for patients and healthcare professionals. Our aim is to assess the treatment and outcomes for miscarriage and ectopic pregnancy during COVID-19 compared to the same time period before the pandemic. Data from a single site dedicated maternity hospital in the UK was collected retrospectively. All women with a final diagnosis of miscarriage and ectopic pregnancy were identified. The data collection period was during the UK “lockdown” period from 23.03.20 to 07.06.20. This will be compared to data collected from 2019. In this study, we compare the efficiency and safety of early pregnancy protocols implemented during COVID-19 on the treatment and outcomes for women diagnosed with miscarriage and ectopic pregnancy. We use a number of different criteria to measure efficiency and safety including primary and subsequent treatment, number of post-diagnosis visits to hospital and unscheduled or emergency admissions. The evolving pandemic and recent easing of lockdown restrictions means the 30-day outcome data is still awaited before analysis can be completed. In line with RCOG and ISUOG guidance, adaptations were made to early pregnancy protocols with a more conservative approach adopted. The aim was to streamline patient visits while ensuring women were safely being cared for. This included the increased use of telephone triage, remote follow-up, increased outpatient medical management of miscarriage as well as the use of manual vacuum aspiration under local anesthesia where appropriate. For ectopic pregnancy, we followed the joint RCOG/BSGE guidance to reserve laparoscopy if the alternate conservative or medical management options were not viable due to the initial concerns around laparoscopy being aerosol-generating. This pandemic has given us an opportunity to reflect on the safety and efficacy of practice.

Manual Vacuum Aspiration in the Treatment of First Trimester Miscarriages: Experience from a Northern Nigerian Teaching Hospital

Background: Manual vacuum aspiration (MVA) is one of the most common gynaecological procedures in clinical practice. It provides a cheap, safe and effective means of reducing maternal morbidity and mortality. Aim: The aim of the study is to review the effectiveness of manual vacuum aspiration in management of first trimester miscarriages in Aminu Kano Teaching Hospital, Kano. Materials and Method: This study was a two-year retrospective analysis (between 01/01/2017 to 31/12/2018) on the use of manual vacuum aspiration in management of first trimester miscarriages in Aminu Kano Teaching Hospital (AKTH), Kano. There were 154 cases of first trimester miscarriage during the study period but 104 case files were retrieved with complete information for analysis. Relevant data extracted were analysed using SPSS version 20. Results: One hundred and four (104) cases were analysed within the study period. Seventy-eight (75%) of the patients were aged 20-34 years; 97 (93.3%) were married and 52 (50.0%) were multigravidas. MVA was performed mainly for incomplete abortion (N=74; 71.2%). Fifty-four (51.9%) of the procedures were done by registrars and 44 (41.3%) by house-officers. Ninety-one (87.5%) of the cases had no complication; post-abortal bleeding was documented in 9 (8.7%) cases. Only 68 patients presented with histology report during their follow up visit in gynaecology clinic. 97% out of this reported product of conception, while 3% reported molar gestation. Conclusion: The most common indication for MVA in this study was incomplete abortion and most of the cases were not associated with any complication. MVA is very effective in management of first trimester miscarriage in our center. Histology report is however important as this will help to differentiate between gestational trophoblastic disease and incomplete miscarriage.

A 5-Year Retrospective Study on the Use of Manual Vacuum Aspiration in the Federal Teaching Hospital Abakaliki

Introduction: Since the inception of our hospital in 2011, manual vacuum aspiration has been in use for the treatment first trimester miscarriages. Hence there is a need for operational review on its use. Aim: The aim of this study is to evaluate the determinants and outcome of Manual Vacuum Aspiration (MVA) use in our hospital. Method: This was a retrospective study on the use of MVA for various indications in our facility over a 5-year period. Results: There were 625 (19.7%) manual vacuum aspirations among 3179 gynaecological patients seen during the period. The age range of the women was from 15 to 48 years and the mean age was 28.5 ± 5.3 years. Incomplete abortion was the commonest indication for the use of MVA and accounted for 89.9% of cases. Other indications for the use of MVA include missed miscarriage (1.8%), and blighted ovum (1.8%). The complications were uterine perforation (0.3%), infection (3.7%) and severe anaemia (10.7%). The mean total hospital stay was 1.6 ± 0.6 days. Overall, 267 (42.7%) patients were managed as a day case. Conclusion: Manual vacuum aspiration is an effective tool in the management of early pregnancy complications. It is a safe, easily performed and possibly cost-effective procedure, with advantages for both the patient and the health care system.

The Use of Manual Vacuum Aspiration in the Treatment of Incomplete Abortions: A Descriptive Study from Three Public Hospitals in Malawi.

Malawi has a high maternal mortality rate, of which unsafe abortion is a major cause. About 140,000 induced abortions are estimated every year, despite there being a restrictive abortion law in place. This leads to complications, such as incomplete abortions, which need to be treated to avoid further harm. Although manual vacuum aspiration (MVA) is a safe and cheap method of evacuating the uterus, the most commonly used method in Malawi is curettage. Medical treatment is used sparingly in the country, and the Ministry of Health has been trying to increase the use of MVA. The aim of this study was to investigate the treatment of incomplete abortions in three public hospitals in Southern Malawi during a three-year period. All medical files from the female/gynecological wards from 2013 to 2015 were reviewed. In total, information on obstetric history, demographics, and treatment were collected from 7270 women who had been treated for incomplete abortions. The overall use of MVA at the three hospitals during the study period was 11.4% (95% CI, 10.7–12.1). However, there was a major increase in MVA application at one District Hospital. Why there was only one successful hospital in this study is unclear, but may be due to more training and dedicated leadership at this particular hospital. Either way, the use of MVA in the treatment of incomplete abortions continues to be low in Malawi, despite recommendations from the World Health Organization (WHO) and the Malawi Ministry of Health.

'It's a very complicated issue here': understanding the limited and declining use of manual vacuum aspiration for postabortion care in Malawi: a qualitative study.

Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions are an important contributor to Malawi's maternal mortality and morbidity, where abortion is illegal except to save the woman's life. Postabortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended PAC innovations. Hence, drawing on Greenhalgh et al. 's (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) diffusion of healthcare innovation framework, this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi. Semi-structured interviews with 17 PAC providers in a central hospital and a district hospital indicate that a range of factors coalesce and influence PAC and MVA use in Malawi. Factors pertain to four main domains: the system (shortages of material and human resources; lack of training, supervision and feedback), relationships (power dynamics; expected job roles), the health workers (attitudes towards abortion and PAC; prioritization of PAC) and the innovation (perceived risks and benefits of MVA use). Effective and sustainable PAC policy must adopt a broader people-centred health systems approach which considers all these factors, their interactions and the wider socio-cultural, legal and political context of abortion and PAC. The study showed the value of using Greenhalgh et al. 's (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) framework to consider the complex interaction of factors surrounding innovation use (or lack of), but provided more insights into rejections of innovations and, particularly, a low- and middle-income country perspective.

Decrease in Use of Manual Vacuum Aspiration in Postabortion Care in Malawi: A Cross-Sectional Study from Three Public Hospitals, 2008–2012

ObjectivesTo investigate the use of manual vacuum aspiration in postabortion care in Malawi between 2008–2012.MethodsA retrospective cross-sectional study was done at the referral hospital Queen Elisabeth Central Hospital, and the two district hospitals of Chiradzulu and Mangochi. The data were collected simultaneously at the three sites from Feb-March 2013. All records available for women admitted to the gynaecological ward from 2008-2012 were reviewed. Women who had undergone surgical uterine evacuation after incomplete abortion were included and the use of manual vacuum aspiration versus sharp curettage was analysed.ResultsAltogether, 5121 women were included. One third (34.2%) of first trimester abortions were treated with manual vacuum aspiration, while all others were treated with sharp curettage. There were significant differences between the hospitals and between years. Overall there was an increase in the use of manual vacuum aspiration from 2008 (19.7%) to 2009 (31.0%), with a rapid decline after 2010 (28.5%) ending at only 4.9% in 2012. Conversely there was an increase in use of sharp curettage in all hospitals from 2010 to 2012.ConclusionUse of manual vacuum aspiration as part of the postabortion care in Malawi is rather low, and decreased from 2010 to 2012, while the use of sharp curettage became more frequent. This is in contrast with current international guidelines.

English

Abortion is considered not only a major reproductive health matter, but also as a health risk factor for mothers’ well-being which also threaten mother’s lives and comfort. This study seeks to assess the incidence of abortion with particular reference to factors responsible for spontaneous abortion among women admitted into gynaecology wards of three selected hospitals in Maiduguri, Borno State, from January to June, 2012. This study involved 126 women admitted into gynaecology wards of University of Maiduguri Teaching Hospital (UMTH), State Specialist Hospital and Nursing Home in Maiduguri, Borno State from January to June, 2012, respectively. Data were collected using questionnaire items that comprised open and close-ended questions items. Women who were illiterate were interviewed during their hospitalization period and their records were also used for more data. The data were analyzed using frequency distribution count. The study shows that of 126 women, 65 (51.6%) were between the ages of 31 to 40 years, the Gravida status of women that presented more were Gravida 3 to 4 (40.5%) with 51 women. On the causes of present abortion, maternal causes presented more with about 26 (20.6%) of the women. On the management of spontaneous abortion, it is managed expectantly, medically (use of prostaglandin and uterotonic drugs) and surgically by the use of manual vacuum aspiration and dilation and curettage were found to be in us. Based on the information obtained from the study, it was recommended that efforts should be concentrated on providing quality services for the management of post abortion complications. Key words: Abortion, spontaneous abortion, recurrent spontaneous abortion.

Contribution of obstetrics and gynecology societies in West and Central African countries to the prevention of unsafe abortion

Unsafe abortion is a major public health issue in low-resource countries. In the countries of West and Central Africa, abortion-related maternal mortality rates are extremely high, the prevalence of modern contraceptive use is very low, and the unmet need for family planning is also high. The International Federation of Gynecology and Obstetrics (FIGO) Initiative for the Prevention of Unsafe Abortion and its Consequences has contributed substantially toward increasing awareness of the problem of abortion, bringing abortion-related issues to the attention of the professional societies, individual gynecologists and obstetricians, Ministries of Health, healthcare providers, and to the community in general. The promotion of quality postabortion care including the use of manual vacuum aspiration, misoprostol, and postabortion contraception has greatly improved access to services; however, there is still a long way to go.

Expanding the use of manual vacuum aspiration for incomplete abortion in selected health institutions in Yaoundé, Cameroon

Preference for manual vacuum aspiration (MVA) and its use for the treatment of incomplete abortion were evaluated among 52 healthcare professionals in 7 Yaoundé hospitals in Cameroon. All but one healthcare professional preferred MVA; however, this technique was available at all times in only two hospitals. In some hospitals, MVA use was only available during the day, while in others it was not available at all. Based on these findings, MVA kits were obtained from the International Federation of Gynecology and Obstetrics (FIGO) for training and to supply selected hospitals. The result was a dramatic increase in the use of MVA in all of the hospitals that received the kits. In one hospital, no kits were received; however, the staff had been sensitized to the problem and the equipment belonging to one of the physicians was put into service. The successful experience of this pilot project provides a rationale for expanding MVA use for incomplete abortion to the entire country.

Changes in the use of manual vacuum aspiration for postabortion care within the public healthcare service network in Honduras

Honduras is one of the 17 priority countries included in the International Federation of Gynecology and Obstetrics (FIGO) Initiative for the Prevention of Unsafe Abortion and its Consequences. The priority category enables the country to request emergency funding to acquire services or commodities that could contribute toward achieving the objectives laid out in its plan of action. These objectives include improving postabortion care by increasing the use of manual vacuum aspiration (MVA) as an outpatient procedure with minimal human and material resources. Since the Ministry of Health lacked funding, use of the emergency fund was approved for the purchase and distribution of MVA kits nationwide to ensure continuity and the hope of increasing MVA use. Eleven hospitals participating in this initiative provided data for analysis of the outcome. These data show no increase in MVA use; however, as discussed in the article, further investigation provided valuable information on the reasons behind these results.

Contribution of the Central American and Caribbean obstetrics and gynecology societies to the prevention of unsafe abortion in the region

Unsafe abortion is a very important public health issue in the Central America and Caribbean region, where the use of modern contraceptive methods remains low and the restrictive legal framework reduces access to safe abortion. The International Federation of Gynecology and Obstetrics (FIGO) Initiative for the Prevention of Unsafe Abortion and its Consequences is contributing toward resolving this problem by strengthening collaboration between medical societies, representatives of each country’s Ministry of Health, and local and international agencies. In the 8 countries that decided to join this initiative in 2008, progress has been achieved in improving access to modern contraceptive methods, increasing the use of manual vacuum aspiration and misoprostol, and updating guidelines on postabortion care.

Improving manual vacuum aspiration service delivery, introducing misoprostol for cases of incomplete abortion, and strengthening postabortion contraception in Bangladesh

The Obstetrical and Gynaecological Society of Bangladesh was an important advocate in mobilizing government authorities to adopt new techniques for postabortion care and provide long-acting contraceptives post abortion. With the support of the International Federation of Gynecology and Obstetrics (FIGO), the Society provided commodities and training to increase the use of these techniques in 7 private and public hospitals and clinics. Data from two of these institutes for the January 2012 to June 2013 period showed a rapid decrease in the use of dilation and curettage, an increase in the use of manual vacuum aspiration (MVA) and misoprostol, and the progressive adoption of long-acting reversible contraceptives, permanent contraception, and injectable contraceptives in one of these two hospitals. The Directorates General of Health and Family Planning incorporated training in the use of MVA and misoprostol in their national operation plans. The success in these hospitals shows that the proposed changes have been well accepted by providers and clients.

Introduction of misoprostol for the treatment of incomplete abortion beyond 12 weeks of pregnancy in Benin

Improving the care of women who have undergone a spontaneous or induced abortion is an important step in reducing abortion-related morbidity and mortality. Both the International Federation of Gynecology and Obstetrics (FIGO) and the World Health Organization recommend the use of manual vacuum aspiration (MVA) and misoprostol rather than sharp curettage to treat incomplete abortion. MVA was introduced into the public healthcare service in Benin in 2006 and since 2008 misoprostol has been available in 3 large maternity hospitals. The present study opted to use an oral dose of 800μg and not to limit to pregnancies of up to 12weeks, but to include women with second trimester abortions. After 5years, results show that around three-quarters of the women treated with misoprostol at 13–18weeks of pregnancy required MVA to complete uterine evacuation and approximately one-quarter had severe bleeding, confirming that the indication of misoprostol for incomplete abortion should be limited to pregnancies of up to 12weeks.

Exploring the Role of Midwives in Uganda’s Postabortion Care: Current Practice, Barriers, and Solutions

Annually, upward of 100,000 Ugandan women receive care after a spontaneous or induced abortion. Abortion-related complications account for up to 26% of maternal deaths. Pilot projects have trained Ugandan midwives in the use of manual vacuum aspiration (MVA) for postabortion care (PAC), but to date there is no published literature exploring midwifery training and PAC practices. To better understand how PAC is provided in public Ugandan hospitals, the midwife’s training and role in PAC and the perceived barriers to providing PAC, interviews with midwives were conducted at 3 public hospitals. A framework analysis of emergent and a priori themes was conducted. Fewer than half of midwives interviewed had received formal PAC training. Current clinical practice in PAC includes MVA, dilatation and curettage, and medical management with misoprostol. Participants identified barriers to providing PAC, which include shortage of staff and equipment, transportation, cultural issues, and gender inequality. Solutions include increased staffing on maternity wards, training more midwives to perform MVA, and improved planning and communication with National Medical Stores. Community sensitization and support for young pregnant women is needed.

Bringing uterine evacuation skills back into primary care: impact of the family medicine residency training initiative in miscarriage management

We evaluated the impact of the Residency Training Initiative in Miscarriage Management (RTI-MM) on the self-report use of manual vacuum aspiration (MVA). The RTI-MM was designed to facilitate implementation of office-based miscarriage management (MM) using MVA in family medicine residency settings. The RTI-MM is site level, multidimensional and based on diffusion of innovations, implementation science, and systems change theories.

Unsafe abortion and abortion care in Khartoum, Sudan

Unsafe abortion in Sudan results in significant morbidity and mortality. This study of treatment for complications of unsafe abortion in five hospitals in Khartoum, Sudan, included a review of hospital records and a survey of 726 patients seeking abortion-related care from 27 October 2007 to 31 January 2008, an interview of a provider of post-abortion care and focus group discussions with community leaders. Findings demonstrate enormous unmet need for safe abortion services. Abortion is legally restricted in Sudan to circumstances where the woman's life is at risk or in cases of rape. Post-abortion care is not easily accessible. In a country struggling with poverty, internal displacement, rural dwelling, and a dearth of trained doctors, mid-level providers are not allowed to provide post-abortion care or prescribe contraception. The vast majority of the 726 abortion patients in the five hospitals were treated with dilatation and curettage (D&C), and only 12.3% were discharged with a contraceptive method. Some women waited long hours before treatment was provided; 14.5% of them had to wait for 5-8 hours and 7.3% for 9-12 hours. Mid-level providers should be trained in safe abortion care and post-abortion care to make these services accessible to a wider community in Sudan. Guidelines should be developed on quality of care and should mandate the use of manual vacuum aspiration or misoprostol for medical abortion instead of D&C.

Aetiology, clinical features and treatment outcome of Intrauterine adhesion in Ilorin, Central Nigeria

Intrauterine adhesion is a cause of menstrual disorder and reproductive failure. It could be a long term sequelae of unsafe abortion which is a common reproductive health problem in developing countries. To determine the predisposing factors, mode of presentation and outcome of management of intrauterine adhesion in University of Ilorin Teaching Hospital. The record of patients with intrauterine adhesion newly diagnosed and managed in the Hospital over a five-year period was analyzed for their age, parity, predisposing factors, clinical presentation, methods of diagnosis and treatment outcome. A total of 136 patients were newly diagnosed and managed for intrauterine adhesion during the period under review. This constituted 1.3% of new gynaecological patients and 4.0% of consultations for infertility. Endometrial curettage on account of pregnancy complications accounted for 92 (67.6%) patients, and this was mostly for induced abortion. Hypomenorrhoea and secondary amenorrhoea were the commonest presenting menstrual abnormalities occurring in 48 (35.3%) and 53 (39.0%) patients respectively. Normal menstruation resumed in 99 (72.8%) patients following treatment. The incidence of intrauterine adhesion among gynaecological patients in this study is lower than those from previous reviews elsewhere in the country. However, dilatation and curettage for induced abortion still remains the commonest cause in our center. Measures to prevent unwanted pregnancy are needed and there should be increased advocacy for the use of manual vacuum aspiration for uterine evacuation procedures.

Scaling Up Post-Abortion Care in Guatemala: Initial Successes at National Level

This article describes a programme to scale up post-abortion care services in 22 of the 33 public sector district hospitals in Guatemala from July 2003 to December 2004. The main interventions included strengthening the knowledge and technical capacity of staff, expanding post-abortion care, enhancing related infrastructure, distributing informational materials andinstituting an abortion surveillance system. A facilitator supported the work through week-long, monthly visits at each hospital. Attention was also devoted to building institutional consensus in support of post-abortion care at government, district hospital and hospital staff levels. Duringthis period, 13,928 women with incomplete abortions were admitted to the 22 hospitals. Use of manual vacuum aspiration for treatment of incomplete first trimester abortion increased from 38% to 68% of cases (p<0.0001). Provision of family planning counselling also increased, from 31% to 78% of women (p<0.0001), and the proportion of women selecting a contraceptivemethod before leaving hospital from 20% to 49% (p<0.0001). Infection was associated with 71% of the incomplete abortions, of which 90% were septic. There were nine deaths and 768 women suffered severe complications, the level of which remained unchanged during the study period. Guatemala still has much to do to institutionalise post-abortion care fully and reduce deaths and complications, but our efforts to date will be valuable to others.