INTRODUCTION: Early miscarriage is a common experience for women and is responsible for the maximum number of pregnancy losses. Approximately one in four women will experience such a loss in her life time6. Local data shows an annual abortion rate of 3% in women aged between 15-49 years, in that incomplete and missed abortion being most common, occurs in approximately 15% of clinically recognized pregnancies in 8,90,000 women per year.
While abortion is legally permitted in many countries, women continue to face profound barriers that restrict their access to safe abortion services and endanger their health. Lack of trained abortion providers, restrictions in service availability and high costs may all present obstacles too great for women to overcome in a timely manner. Maternal deaths due to unsafe abortion are around 10-13% in developing countries. Hence a method which is safe and cost effective has to be found. At present vacuum aspiration, sharp curettage, medical evacuation with misoprostol and expectant management are the available methods. Vacuum aspiration has come up as the most widely used method due to its safety and being less painful than dilatation and curettage (D&C) and medical methods. A high efficacy of vacuum aspiration with success rate between 95-100% has been reported in various trials of study in vacuum aspiration.
AIM OF STUDY:
To compare the efficacy of manual vacuum aspiration against
curettage in first trimester incomplete abortion in terms of type of anesthesia, procedure, and patient morbidity pattern. Anesthesia: The type of anesthesia used is either cervical block or intravenous anesthesia depending upon pain perception by the patient. Procedure: The procedure done for induced abortion is either manual vacuum aspiration or curettage. The efficacy of these two
procedures is compared in terms of blood loss, blood transfusion, retained products, repeat procedure.
Patient Morbidity: Patient’s morbidity is compared in terms of, complications like cervical laceration, uterine perforation, stay in hospital for more than two days.
Study Design: Our study is a case control study conducted at Institute of Social Obstetrics, Govt. Kasturba Gandhi Hospital, Chennai between the period September 2010 and September 2011.
MATERIALS AND METHODS: All women seeking MTP for incomplete abortion in our hospital between September 2010 - September 2011 were admitted.
In these women who belonged to first trimester was taken for our study. Our sample size (CASES) was 100, who underwent manual
vacuum aspiration was compared with 100 Controls who were
offered curettage.
Inclusion Criteria:
1. All pregnant women seeking MTP for incomplete abortion whose age was < 35 yrs.
2. Women who stayed near by the hospital for easy access.
3. Who can come for follow up.
Exclusion Criteria:
1. Patients with medical complications like uncontrolled
hypertension, diabetes.
2. Blood dyscrasias, heart disease.
3. All MTPs attempted outside our institution.
4. Patients with evidence of sepsis.
SUMMARY:
In Our study, with a sample size of 100, abortion was induced using MVA in all CASES and curettage was the procedure used for CONTROLS. The results were compared in terms of anesthesia, procedure, and patient morbidity.
• Out of the 100 patients in cases 89% needed only cervical block compared to controls which is 66%. In cases, 11% needed intravenous anaesthesia compared to the controls that was 34%. The p value is 0.037, which is significant.
• The mean no of pads used by cases were 3.32 compared to
controls that used 3.95. The p value is <0.001 which is significant.
• The no of blood transfusion required in cases were 4% compared to controls, which was 12%. The p value is <0.037 which is significant.
• In cases the % of patients who had retained products were 12% compared to controls which constituted around 42%. The p value is <0.000 which is significant.
• The % of patients requiring repeat procedure was 8% in cases compared to controls which were 21%. The p value is < 0.009 which is significant.
• In cases 9% of patients needed more than 2 days duration of stay compared to controls 24% .The p value is <0.004 which is significant.
• In controls 12% had cervical laceration compared to cases were none of patient had cervical laceration. The p value is <0.000 which is significant.
• It was observed that there was decrease in hemoglobin after the procedure in cases compared to controls group.
• The average pain score in cases were 3.76 compared to controls which were 5.22.
• There is no difference in age group in both cases and controls.
• The first trimester abortion was more in primigravida in both groups.
CONCLUSION:
This study done in our hospital compared the efficacy of MVA against the curettage in first trimester incomplete abortion in terms of type of anesthesia needed, procedure done and patient morbidity for one year. The results are
1. Our study showed that, MVA can be done under local anesthesia (88%) compared to CURETTAGE which required more of IV anesthesia (34%), also the average pain score was less (3.76) when MVA used compared to CURETTAGE (5.22).
2. Our study showed that the average no of pads used was 3. 32 in patients who underwent MVA, compared to the average no of pads used in patients who underwent curettage which was 3.92 which is comparatively higher. Thus concluding the average amount of blood loss was more when curettage is used for abortion compared to MVA.
3. Our study showed that the need for blood transfusion is more when CURETTAGE (12%) is used for attempting abortion
compared to MVA (4%).
4. Our study also showed that the number of patients who had retained products was less when MVA was used for inducing abortion compared to curettage and hence the need for repeat procedure was less when MVA is used for inducing abortion.
5. Comparing the complications in both procedure 12% of patients had cervical laceration who underwent curettage which was NIL in MVA. Also none of the patients in both procedure had uterine perforation.
6. Our study also showed that the decrease in hemoglobin was less when MVA is used as the procedure of choice.
7. The duration of stay in the hospital was less when MVA is used for inducing abortion in first trimester, compared to CURETTAGE.
8. Our study also showed that none of the groups had uterine perforation.
9. Also the duration of procedure was found to be same in both the procedures (8-10 min). Thus concluding that MVA is comparatively better than CURETTAGE in terms of anesthesia, procedure done, and patient morbidity
