Surgical Management of Incomplete Abortion by Manual Vacuum Aspiration (MVA)

Abstract

This cross sectional study was carried out on incomplete abortion cases in Obstetrics and Gynaecology (ObG) Department, Sir Salimullah Medical College and Mitford Hospital (SSMC & MH), Dhaka, Bangladesh. It was carried out from 1st January 2012 to 30th June 2012 to assess the effectiveness of MVA in terms of completeness, duration, cost and complication of the procedure and duration of hospital stay. Incomplete abortion cases attending the ObG indoor were considered as study population. A total of 50 patients were collected by purposive sampling. Inclusion criteria were: i) Incomplete abortion up to 12 weeks of gestation, ii) Failed medical abortion and iii) Incomplete MR. Exclusion criteria were: i) Induced abortion, ii) Septic abortion with fever, iii) Haemodynamically unstable patients. Counseling was done to provide emotional support during the procedure. Pain management was done by paracervical block, analgesia and or mild sedation. During MVA, measures taken to prevent infection. Complication like excessive pervaginal bleeding and incomplete evacuation was assessed by ultrasonogram. Duration of hospital stay and total cost were assessed. Limitation of the study: short sample, short follow-up, small population not enough for a reproducible data. Further study needed in future. Mean age of the patients was 21-30 years. Most of them were grand multipara (36%), 70% belong to below average income group, 44% of them never used contraceptives. Many of the incomplete abortion cases presented with 9-10 weeks (66%) of gestation with per vaginal bleeding (96%). Lower abdominal pain (66%), passage of fleshy mass (14%). 88% of them are mildly anaemic and 12% were severely anaemic. Eighty two percent (82%) of them were haemodynamically stable and 18% were haemodynamiclly unstable. The mean time of the procedure was 6-10 minutes. Most of the patients (82%) did not need any resuscitation after the procedure. For 25% cases, analgesics had to be used. Four percent (4%) cases had complication like incomplete evacuation and excessive p/v bleeding after the procedure.