To evaluate the role of check curettage following MVA for the first trimester abortions in terms of its efficacy in reducing bleeding pain abdomen and retained products of conception

1. Dr.Mangala Devi K.R.
MS OBG
K C Raju Multispeciality Hospital
The Role of Check curettage with MVA in
the management of first trimester
abortions
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2. Introduction
Incidence in India
• Total abortions:6.7 million
• Legal abortions: 1 million.
• First Trimester: 80 %
Unsafe abortions are responsible for 13% of Maternal deaths
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3. Methods of first tri abortion
MVA is the recommended method of termination
methods
Medical D&C EVA MVA
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4. Manual Vacuum Aspiration
MVA is aspiration of the
uterine contents
through the cervix with
a handheld syringe as
a source of suction
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5. COMPLICATIONS
• Retained products of conception-esp when performed < 6
wks GA
• Excessive blood loss
• Infection
• Injury to cervix
• Perforation of uterus
• Uterine adhesions
Baird et al –manual vaccum aspiration : expanding womens acccess to safe
abortion services. 2001 IPAS pg 4-6
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6. Advantages
Success rate 99%Success rate 99%
Complication rate
0.5%
Complication rate
0.5%
Cheaper & quieterCheaper & quieter
No electricityNo electricity
Performed by
medical and
paramedical
Performed by
medical and
paramedical
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7. Manual Vaccuum Aspiration
Objective
To evaluate the role of check curettage
following MVA for the first trimester abortions
in terms of its efficacy in reducing bleeding
pain abdomen and retained products of
conception
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8. Manual Vacuum asipration
Materials and Methods
Study Design: Randomised case control study
Study Period: Feb 2012 to Feb 2013
Study subjects : A total of 117 patients who
obtained abortion in this clinic for elective
indicated reasons
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9. Manual Vaccuum Aspiration
Patients: A total of 117 patients who obtained
abortion in this office between February 2012
to February 2013.
• Main outcome measures : Presence of
complications of incomplete evacuation such
as bleeding, pain abdomen and retained
products of conception on usg.
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10. Inclusion criteria
• Singleton pregnancy
• Intra uterine pregnancy
• Gestational age less than 12 weeks
• Elective indicated abortions
Manual Vacuum Aspiration
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11. Manual Vacuum Aspiration
Exclusion Criteria
Multiple pregnancies
Ectopic pregnancy
Pelvic infections
Bleeding Disorders
Other medical conditions
Gestational age >12weeks
Incomplete/septic abortions
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12. Manual Vaccuum Aspiration
Investigations
• Hb%
• Blood Grouping and Rh Typing
• Random Blood sugar
• HIV,Hbsag,VDRL
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13. Methodology
• Consent
• Priming of cervix
• Anaesthesia
• Choosing of cannula
• Charging syringe
• “No touch Technique”
• Release of pressure valves
• Aspiration of contents
• Completion of procedure:Check curettage/no curettage
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14. Manual Vaccuum Aspiration
Statistical Methods
• Chi Square test
• Fischers Exact test
• Two tailed p value obtained
Statistical software
• SPSS
• Microsoft word and EXcel
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15. Follow -Up
• Symptoms: Pain abomen/Bleeding
• Ultrasound : a. ET> 1.5 cms
b. Any endometrial
thicknes with tissue distorting
central
endometrial echo
c. Gestational sac
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16. Age Distribution
0
5
10
15
20
25
30
35
40
45
50
group 1
group2
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17. Gestational Age Distribution
0
2
4
6
8
10
12
group 1
group 2
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18. curettage no curettage
0
10
20
30
40
50
60
8 6
51 52
bleeding no bleeding
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19. curettage no curretage
0
10
20
30
40
50
60
7 5
52 53
RPOC CLEAR
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20. curettage no curettage
0
10
20
30
40
50
60
7 6
52 52
PAIN NO PAIN
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21. Conclusion
• Manual vacuum aspiration is sufficient for
complete evacuation of first trimester abortion
and check curettage in addition is not necessary
• A safe choice for women who need first
trimester abortions and check curettage could
lead to perforations and adhesions.
• USG guidance: alternative
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22. References:
• John M Westfall et al.Manual Vacuum aspiration for first trimester
abortion.Arch.fam.med/vol 7 ,Nov 1998:559-562.
• Kamei Helen et al.Manual vacuum aspiration and Electrical
vacuum aspiration-A comparative study for first trimester
MTP.Journal of Obstet and Gynecol of India.Jan-feb 2011,53-56.
• WHO.safe Abortion: Technical & Policy guidance for health
system.Geneva.WHO;2003:10-17.
• Binkin et al.trends in Induced Legal abortion mortality and
morbidity.Clin O Obstet Gynecal.1986:3:83-93.
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23. • Aggarwal.s(2011).Cervical priming with
misoprostol before manual vacuum aspiration
versus electric vacuum aspiration for first
trimester surgical abortion.International
Journal of gynecology and
Obstetrics,112(1),34-39.
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