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Benefits of manual vacuum aspiration for abortion
International Journal of Gynecology & Obstetrics
... MVA has also been found to be effective in terms of completeness of uterine evacuation, shorter time during procedure, less complications and shorter duration of hospital stay (15,16). The procedure was designed to be used in low resource setting since it is associated with lower costs compared to Electric Vacuum Aspiration (17). Nevertheless some women may get incomplete uterine evacuation (4) and in some instances, there can be uterine perforation due to di culty in performing the procedure because of IPP (18). ...
... The proposal was presented to and approved by the Department of Obstetrics and Gynaecology; Mbarara University of Science and Technology and obtained clearance to carry out this research. Scienti c and ethical approval were obtained from the Faculty Research Committee (FRC), Research Ethic Committee (MUREC-08/ [11][12][13][14][15][16][17][18][19][20], Mbarara University of Science and Technology and Uganda National Council for Science and Technology (UNCST, Ref. No. HS1462ES). Administrative clearance was sought from the o ce of the Hospital Director, Mbarara Regional Referral Hospital through the Head of department of Obstetrics and Gynaecology. ...
Background: Intra-procedural pain (IPP) is common among women undergoing Manual Vacuum Aspiration (MVA) for incomplete abortion. Globally, the proportion varies between 60% to 90% while in Sub-Saharan Africa including Uganda, the proportion varies between 80% to 98%. IPP management during MVA include Para-cervical block (using 1% lidocaine) or an opioid (using 100mg of intravenous pethidine).
Objectives: This study determined the proportion and factors associated with IPP among women undergoing MVA for incomplete abortion at MRRH.
Methods: We conducted a cross sectional study among 207 women who underwent MVA for incomplete abortion from 17th December 2020 to 28th May 2021. An interviewer-administered structured questionnaire was used, and pain assessment was done using VAS considering an IPP as a pain score of 6 or more. The participant characteristics were summarized. The proportion of women with IPP was calculated. We performed multivariable logistic regression to determine the factors associated with IPP.
Results: We consecutively enrolled 207 women with a mean age of 25.8 ±5.8 years. The proportion of women with IPP undergoing MVA at MRRH was 82.6% (95% C.I: 76.8 — 87.2). The factors significantly associated with IPP were age and cervical dilatation. The odds of IPP increased with decreasing age of the women; compared to older women (aged >30 years), teenagers (age<20 years); OR=8 (95% CI=1.85-34.61) (p=0.005), while women aged 20-24 years; OR=3.45 (95% CI=1.47-8.20) (p=0.004), and those aged 25-30 years; OR=2.84 (95% CI=1.20-6.74) (p=0.018). Women with cervical dilatation of 1-2 cm had the odds of IPP increased; OR=2.27 (95% CI=1.11-4.62) (p=0.024), compared to a cervical dilation of 3-4 cm.
Conclusion: Majority of women undergoing MVA at MRRH experienced IPP. Younger women and those with cervical dilatation 1-2cm are more likely to experience IPP. We recommend improvement of pain control among women undergoing MVA.
... Manual vacuum aspiration (MVA), a portable handheld vacuum aspirator connected to a semi-flexible plastic cannula, can be performed in a clinic or a hospital procedure room [8,9].The Common techniques of pain control in such case are analgesic drugs or Para cervical block [10,11]. MVA has been clinically proven to be as effective as sharp curettage when employed in the management of firsttrimester abortions. ...
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.
... Despite careful and skilled intervention, even in best hands complications like haemorrhage, incomplete evacuation, perforation and infection can occur [19]. Manual vacuum aspiration (MVA), a portable handheld vacuum aspirator connected to a semi-flexible plastic cannula, can be performed in a clinic or a hospital procedure room [8, 15, 22]. Common techniques of pain control in such case are analgesic drugs or Para cervical block [9, 14]. ...
Abstract: Objective: To compare the efficacy and safety of manual vacuum aspiration (MVA) with dilatation and
curettage in the management of first trimester abortion. Study Design: A prospective randomized study was
conducted between January 2010 to December 2012, at the Obstetrics and Gynecology department, Salman Bin
Abdulaziz University Hospital. Four hundred women presenting with spontaneous miscarriage with gestational age
<12 weeks were included in the study, these patients underwent either MVA group (n=200) or D&C group (n=200).
Primary outcome measures were efficacy and secondary outcome measures were duration of hospital stay, operating
time and cost. Results: Overall, (MVA) was 97 % effective in terminating pregnancy through 12 weeks of gestation.
The mean duration of procedure was significantly higher (p<0.001) in D&C (14.3±3.8 minutes) as compared to
(6.3±1.6 minutes) in MVA. The duration of hospital stay was significantly lower (p<0.001) in MVA group (3.5±0.9
hours) as compared to (19.2±3.1 hours) in D&C group. Similarly the cost of procedure was also significantly lower
(p<0.001) in MVA group ( 146.1±13.7) in D&C group. Conclusion: MVA is as effective
as conventional dilatation and curettage for treatment of early pregnancy failure while it causes less time consuming,
requires a shorter hospital stay and thus costs less. It does not require general anesthesia and complication rate is less
than dilatation and curettage.
... Manual vacuum aspiration (MVA), a portable hand-held vacuum aspirator connected to a semi-flexible plastic cannula, can be performed in a clinic or a hospital procedure room [6][7][8]. Common techniques of pain control in such case are analgesic drugs or paracervical block [9,10]. MVA has been clinically proven to be as effective as and safer than sharp curettage when employed in the management of first-trimester abortions. ...
This study compared the hospital charges, duration of in-hospital procedures, clinical course and complications between manual vacuum aspiration (MVA) and sharp curettage.
A prospective observational study was conducted during the May 2007-April 2008 period in Songklanagarind Hospital, Thailand. Forty cases of pregnancy ≤9 weeks of gestation, with conditions of an incomplete abortion, a blighted ovum or missed abortion were treated with either MVA or sharp curettage. Both groups were compared in terms of demographic and obstetric data, hospitalization cost, clinical course and complications.
The obstetric data of both groups showed that the median parity was two, with a median gestation age of 8 weeks. The median total hospital expenditure was 54.67 USD for patients using the MVA technique and 153.97 USD for the sharp curettage group (p < 0.01). The median duration of in-hospital care in the MVA group was significantly less than that of the sharp curettage group, 4 versus 20 h, respectively (p < 0.01). 90 % of patients in the MVA group had only one visit compared with 72.5 % in the sharp curettage group (p = 0.04). No complications needing further curettage or treatment in either group were noted.
The use of MVA in the management of a first-trimester abortion is practical, safe, cheap and time-saving.
Introduction
Intra-Procedural Pain (IPP) is common among women undergoing Manual Vacuum Aspiration (MVA) for incomplete abortion. Globally, the proportion varies between 60% to 90% while in sub-Saharan Africa including Uganda, the proportion varies between 80% to 98%. Intra-procedural pain management during MVA includes a para-cervical block (using 1% lidocaine) or an opioid (using 100 mg of intravenous pethidine). The study aimed to determine the proportion and factors associated with IPP among women undergoing MVA for incomplete abortion at Mbarara Regional Referral Hospital (MRRH).
Methods
we conducted a cross-sectional study among 207 women who underwent MVA for incomplete abortion between December 2020 and May 2021. An interviewer-administered structured questionnaire was used, and pain assessment was done using the Visual Analogue Scale (VAS) considering an IPP as a pain score of 6 or more. The participant characteristics were summarized. The proportion of women with IPP was calculated. We performed multivariable logistic regression to determine the factors associated with IPP.
Results
we consecutively enrolled 207 women with a mean age of 25.8 ± 5.8 years. The proportion of women with IPP undergoing MVA at MRRH was 82.6%, 95% C.I 76.8 - 87.2. The factors significantly associated with IPP were age and cervical dilatation. The odds of IPP increased with decreasing age of the women; compared to older women aged >30 years, teenagers aged <20 years; aOR: 8, 95% CI 1.85-34.61; p=0.005, while women aged 20-24 years; aOR: 3.45, 95% CI 1.47-8.20; p=0.004 and those aged 25-30 years; aOR: 2.84, 95% CI 1.20-6.74; p=0.018. Women with cervical dilatation of 1-2 cm had the odds of IPP increased; aOR: 2.27, 95% CI 1.11-4.62; p=0.024 compared to a cervical dilation of 3-4 cm.
Conclusion
majority of women undergoing MVA at MRRH experienced IPP. Younger women and those with cervical dilatation 1-2 cm are more likely to experience IPP. We recommend optimised and personalised pain management strategies for women undergoing MVA.
Objectives
Manual uterine aspiration (MUA) is a currently underused management option for early pregnancy loss (EPL) in the emergency department (ED). This study addresses the safety and efficiency of MUA in the ED.
Methods
We performed a single-site retrospective observational chart review of pregnant women presenting to the ED with vaginal bleeding and ED pathology submissions for products of conception (POC) between 2012 and 2016. Patients were excluded for gestational age >14 weeks, no evidence of pregnancy loss, uterine cavity anomaly, hemodynamic instability, or hemoglobin <80 g/L. We compared the frequencies of complications (need for blood transfusion, repeat ED visit, failed initial management, admission to hospital) and ED utilization time between 4 management options: expectant, misoprostol, MUA, and electric vacuum aspiration (EVA) outside the ED, as well as time to procedure between MUA and EVA.
Results
A total of 162 patients were included with 123 (76%) having a pathology report positive for POC. The mean patient and gestational ages were 30 ± 7 years and 66 ± 17 days, respectively. One hundred and nine patients were managed expectantly, 9 were given misoprostol, 23 underwent MUA, and 21 underwent EVA. Composite complication rates were 40%, 33%, 9%, and 10% (P = 0.001), and mean ED times were 5.4, 4.9, 7.3, and 6.0 hours (P = 0.01), for expectant, misoprostol, MUA, and EVA, respectively. The mean time to procedure was 5.1 hours for MUA and 23.1 hours for EVA (p=0.002).
Conclusions
Integrating MUA in the ED has the potential to reduce health care resource utilization while improving patient care.
Manual vacuum aspiration is an effective and safer surgical method of uterine evacuation for an abortion. Nonetheless, it can present some life-threatening complications like uterine perforations. In a uterine perforation the suction cannula is thought to be usually involved in the perforation and the resulting intraabdominal organ damage. We presented a case of a young muilti-parous Cameroonian woman who was underwent a manual vacuum aspiration for a first trimester incomplete abortion, and which was complicated by a fundal uterine perforation with exteriorisation of small bowels through the vagina.
The curettage by endouterine manual aspiration (EMA) is considered as an adequate
surgical method for the management of the incomplete abortion and the missed abortion
with age lower to twelve weeks, also for the endometrial biopsy. It is a safe, inexpensive,
effective and ambulatory procedure carried out with paracervical-Block Anesthesia. It
has good tolerance and adequate acceptability in the patients. The aim is to present
basic aspects of EMA and to indicate general technical and scientific guidelines, which
are necessary to know the appropriate and qualified execution of the procedure. It is
an important therapeutic strategy, which is being proposed as the replacement of the
instrumental uterine curettage as much for developed as for developing countries. Rev.
Cienc.biomed. 2014;5(1):148-165
KEYWORDS
Abortion spontaneous; Abortion; Abortion incomplete; Vacuum curettage.
Background:
Misoprostol is effective for cervical priming before manual vacuum aspiration (MVA). Aim of study was to determine whether sublingual misoprostol with a shorter interval of 2 hours before MVA would be as effective as its standard vaginal administration.
Study design:
This randomized control trial included 82 women randomly assigned to receive 400 mcg of misoprostol, either sublingually or vaginally. MVA was performed 2 hours and 3 hours after in sublingual and vaginal group, respectively.
Results:
Cervical dilatation of 8 mm was achieved within 2 hours in sublingual group. Mean time taken for procedure (14.4 ± 5.3: sublingual group and 16.2 ± 5.7: vaginal group), and blood loss was comparable (12.2 ± 9.7 ml in sublingual group and 13.7 ± 8.5 ml in vaginal group).
Conclusion:
2 hour of cervical priming with 400 mcg of sublingual misoprostol before MVA was as good as 3 hours with vaginal administration of the same dose.
The information provided here gives a sense of the value of comparing population studies between the Republic and Northern Ireland, albeit incomplete comparisons in this case since the studies were conducted independently. We share enough that is both common and unique in our attitudes, health profiles and health systems to enable fruitful comparisons for both sides. Future opportunities for comparison should be more explicitly incorporated into the planning stages of such studies. We hope that this report will provide a catalyst for joint survey planning, such that information forthcoming can inform and benefit policy and practice in the pursuit of good health and well-being in the coming years in both the Republic of Ireland and Northern Ireland.
The health benefits of regular cardiovascular exercise are well-known. Such exercise, however, has traditionally been defined as vigorous physical activity, such as jogging, swimming, or aerobic dance. Exercise of moderate intensity also promotes health, and many U.S. adults may be experiencing the health benefits of exercise through lifestyle activities of moderate intensity, such as yard work, housework, or walking for transportation. Until recently, public health surveillance systems have not included assessments of this type of physical activity, focusing on exercise of vigorous intensity. We used an enhanced surveillance tool to describe the prevalence and amount of both moderate-intensity and vigorous-intensity physical activity among U.S. adults.
We analyzed data from the 2001 Behavioral Risk Factor Surveillance System, a state-based, random-digit-dialed telephone survey administered to U.S. adults aged 18 years and older (n = 82,834 men and 120,286 women). Physical activity behavior was assessed using questions designed to quantify the frequency of participation in moderate- or vigorous-intensity physical activities performed during leisure time or for household chores and transportation.
Overall, 45% of adults (48% of men and 43% of women) were active at recommended levels during nonworking hours (at least 30 minutes five or more days per week in moderate-intensity activities, equivalent to brisk walking, or at least 20 minutes three or more days per week in vigorous activities, equivalent to running, heavy yard work, or aerobic dance). Less than 16% of adults (15% of men and 17% of women) reported no moderate or vigorous activity in a usual week.
Integrating surveillance of lifestyle activities into national systems is possible, and doing so may provide a more accurate representation of the prevalence of recommended levels of physical activity. These results, however, suggest that the majority of U.S. adults are not active at levels associated with the promotion and maintenance of health.
Although the prevalence rates of childhood obesity have seemingly been stable over the past few years, far too many children and adolescents are still obese. Childhood obesity, and its associated metabolic complications, is rapidly emerging as one of the greatest global challenges of the 21st century. About 110 million children are now classified as overweight or obese.
In this review we first describe the most recent data on the prevalence, severity, and racial/ethnic differences in childhood obesity. Obesity is associated with significant health problems in the pediatric age group and is an important early risk factor for much of adult morbidity and mortality.
We review the metabolic complications associated with childhood obesity. Particular emphasis is given to the description of studies regarding the impact of varying degrees of obesity on the cardiometabolic risk factors in youth. We further describe studies in obese adolescents that have examined the importance of ectopic lipid deposition in the visceral abdominal depot and in insulin sensitive tissues in relation to the presence of insulin resistance. We end by describing studies that have examined beta-cell function in obese adolescents with normal glucose tolerance.
The growing number of obese children and adolescents worldwide is of great concern. Many obese children and adolescents already manifest some metabolic complications, and these children are at high risk for the development of early morbidity. Understanding the underlying pathogenesis of this peculiar phenotype is of critical importance.
Designated providers in specialized clinics perform the majority of approximately 1.1 million first-trimester abortions carried out in the United States each year. Our objective was to assess the first-trimester surgical abortion practices of National Abortion Federation (NAF) members.
We mailed questionnaires to NAF administrators and providers at their 364 active-member facilities in 2002.
Two hundred eighty-nine (79%) facilities responded; we received administrative questionnaires from 273 facilities and 293 individual clinicians. NAF facilities provided at least 325,000 first-trimester surgical abortions in the United States in 2001. The majority of providers are obstetrician-gynecologists (63%), male (62%) and at least 50 years old (64%). Half of clinicians (49%) selectively utilize manual vacuum aspiration. Almost half (47%) routinely use a metal curette to verify procedure completion; these providers are more likely to be over 50 years of age or to have 20 years or more of abortion experience. Other practices are more uniform, including routine tissue examination (93%), postoperative antibiotics (88%) and contraceptive provision (oral contraceptives, 99%; depot medroxyprogesterone acetate, 79%).
Most perioperative practices for first-trimester abortions are similar among these respondents, in accord with evidence-based guidelines. The aging of skilled practitioners raises concerns about the future availability of surgical abortion.
Cost effectiveness of managing 107 incomplete abortions by manual vacuum aspiration (MVA) is compared with management of 92 incomplete abortions by evacuation by curettage (E by C) at Muhimbili Medical Centre (September-November 1992). Pre-evacuation waiting times, duration of procedures and duration of hospital stay were less for MVA as compared to E by C. The total pre-evacuation waiting time, the durations of the procedure and hospital stay were 15.59 days (55.11%), 10.96 (46.41%) hours and 21.23 (40.53%) days less for MVA as compared to E by C. The direct costs revealed a cost differential of MVA over E by C of Tshs 776.9 (US$2.6). MVA is more cost effective than contemporary E by C and its introduction on a wider scale in our health care delivery system is recommended.
EDITORIAL COMMENT: When this paper was reviewed the question was raised that the period of gestation is an obvious factor which can determine birth‐weight and the authors were asked how this may have affected their results The authors response was as follows:
The mean gestation at delivery in the 2 groups was not different statistically ‐ controls n = 41, mean = 39.96 weeks, standard deviation = 1.37 weeks; exercisers n = 58, mean = 39.48 weeks, standard deviation = 1.94 weeks. We were interested in the finding in our study that preterm delivery occurred in 4 of 58 exercisers and only 1 of 41 controls. However, the number of preterm deliveries in this study is small (a total of 5) and as the calculation of sample size was based on a shift in mean birth‐weight, this is the outcome which should be emphasized.
Clearly, gestation is a very important determinant of birth‐weight. However, in terms of trying to determine whether exercisers deliver earlier, it would not help to put gestation in our analysis of variance and covariance. Gestational age would need to be the dependent variable for such an exercise and, for meaningful results, would require a larger study.
Summary: The aim of this study was to assess the effect on birth‐weight of continuing a programme of vigorous exercise into late pregnancy. ‘Potential exercisers’ were women who had been doing vigorous exercise prior to pregnancy and intended to continue exercising during pregnancy. Controls were healthy pregnant women who did not do regular vigorous exercise. Both groups kept 2, 7‐day food ± exercise diaries at 25 and 35 weeks. The primary outcome variable was birth‐weight. Women who continued doing at least 30 minutes of vigorous exercise at least 3 times weekly at 25 weeks and either maintained this minimum level or had delivered by 35 weeks were classified as ‘exercisers’. Women doing more than 4 sessions of vigorous exercise weekly at 25 weeks had babies whose mean birth‐weight was 315 g lower than the mean birth‐weight of babies born to controls.
This study compared the perceptions of body image and psychological well-being between exercising and non-exercising pregnant women. A prospective longitudinal study was conducted with 65 nulliparous women (mean age years = 30.3, range = 23-39) who were allocated to 2 groups based on level of recreational exercise participation; 25 exercisers were compared with 18 non-exercisers. A self-report exercise history questionnaire and a 10 item Body Cathexis Scale were completed on two occasions during the pregnancy, at approximately 17 weeks and 30 weeks of gestation. The General Health Questionnaire (GHQ-28) was administered in late pregnancy. There was a significant difference between the exercise group and the non-exercise group in late pregnancy for some items on the Body Cathexis Scale. The exercise group had a lower level of probable caseness on the GHQ-28 with reduced frequency of somatic symptoms, anxiety and insomnia, and a higher level of psychological well-being.
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.
ACOG committee opinion Exercise during pregnancy and the postpartum period American College of Obstetricians and Gynecologists
- Obstetric Committee
- Practice
Committee on Obstetric Practice. ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists. Int J Gynecol Obstet 2002;77(1):79–81.
Exercise in Pregnancy (RCOG Statement 4). www.rcog.org.uk. http://www.rcog.org.uk/womens-health/clinical-guidance/exercise-pregnancy
- Royal College
Royal College of Obstetricians and Gynecologists. Exercise in Pregnancy (RCOG Statement 4). www.rcog.org.uk. http://www.rcog.org.uk/womens-health/clinical-guidance/exercise-pregnancy. Published 2006.
Committee on Obstetric Practice. ACOG committee opinion. Exercise during pregnancy and the postpartum period
Committee on Obstetric Practice. ACOG committee opinion. Exercise during
pregnancy and the postpartum period. Number 267, January 2002. American
College of Obstetricians and Gynecologists. Int J Gynecol Obstet 2002;77(1):79-81.
/$ -see front matter © 2011 International Federation of Gynecology and Obstetrics
/$ -see front matter © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijgo.2011.03.007