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International Journal of Gynaecology... Jul 2014Manual vacuum aspiration (MVA) and medical abortion were introduced to replace dilation and curettage/evacuation for incomplete abortions, and postabortion contraception...
Manual vacuum aspiration (MVA) and medical abortion were introduced to replace dilation and curettage/evacuation for incomplete abortions, and postabortion contraception was provided in 5 selected public hospitals in Pakistan. In the largest hospital, an Ipas MVA training center since 2007, MVA use reached 21% in 2008. After the International Federation of Gynecology and Obstetrics (FIGO) and UNFPA provided MVA kits, MVA use increased dramatically to 70%-90% in 2010-2013. In 2 of the remaining 4 hospitals in which the Society of Obstetricians and Gynecologists of Pakistan trained doctors in May 2012 and January 2013, the target of having 50% of women managed by MVA and medical abortion (MA) was met; however, in the third hospital only 43% were treated with MVA and MA. In the fourth hospital, where misoprostol and electric vacuum aspiration use was 64% and 9%, respectively, before training, an MVA workshop introduced the technique. Postabortion contraception was provided to 9%-29% of women, far below the target of 60%.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Aftercare; Contraception; Dilatation and Curettage; Female; Gynecology; Hospitals, Public; Humans; Misoprostol; Obstetrics; Pakistan; Pregnancy; Societies, Medical; Vacuum Curettage
PubMed: 24743026
DOI: 10.1016/j.ijgo.2014.03.016 -
Clinical and Experimental Obstetrics &... 2014Evaluating and "cleaning" of the uterine cavity is probably the most performed operation in women. It is done for several reasons: abortion, evaluation of irregular...
Evaluating and "cleaning" of the uterine cavity is probably the most performed operation in women. It is done for several reasons: abortion, evaluation of irregular bleeding in premenopausal period, and postmenopausal bleeding. Abortion is undoubtedly the number one procedure with more than 44 million pregnancies terminated every year. This procedure should not be underestimated and a careful preoperative evaluation is needed. Ideally a sensitive pregnancy test should be done together with an ultrasound in order to confirm a uterine pregnancy, excluding extra-uterine pregnancy, and to detect genital and/or uterine malformations. Three out of four abortions are performed by surgical methods. Surgical methods include a sharp, blunt, and suction curettage. Suction curettage or vacuum aspiration is the preferred method. Despite the fact that it is a relative safe procedure with major complications in less than one percent of cases, it is still responsible for 13% of all maternal deaths. All the figures have not declined in the last decade. Trauma, perforation, and bleeding are a danger triage. When there is a perforation, a laparoscopy should be performed immediately, in order to detect intra-abdominal lacerations and bleeding. The bleeding should be stopped as soon as possible in order to not destabilize the patient. When there is a perforation in the uterus, this "entrance" can be used to perform the curettage. This is particularly useful if there is trauma of the isthmus and uterine wall, and it is difficult to identify the uterine canal. A curettage is a frequent performed procedure, which should not be underestimated. If there is a perforation in the uterus, then this opening can safely be used for vacuum aspiration.
Topics: Blood Loss, Surgical; Female; Humans; Intraoperative Complications; Lacerations; Laparoscopy; Pregnancy; Uterine Perforation; Uterus; Vacuum Curettage; Young Adult
PubMed: 25134300
DOI: No ID Found -
Fertility and Sterility Jun 2024
Comparative Study
Topics: Humans; Female; Hysteroscopy; Morcellation; Vacuum Curettage; Uterine Neoplasms; Pregnancy; Treatment Outcome; Leiomyoma
PubMed: 38346550
DOI: 10.1016/j.fertnstert.2024.02.009 -
The International Journal of... Jun 2022The culture failure rate of conventional karyotyping in products of conception evacuated from early pregnancy loss by traditional electrical vacuum aspiration and/or...
OBJECTIVE
The culture failure rate of conventional karyotyping in products of conception evacuated from early pregnancy loss by traditional electrical vacuum aspiration and/or dilation & curettage remains high. We aim to determine whether obtaining products of conception from early pregnancy loss via another evacuation approach, ultrasound-guided manual vacuum aspiration, could decrease the culture failure rate of karyotyping.
METHODS
For patients with early pregnancy loss, ultrasound-guided manual vacuum aspiration (Case group) and traditional electrical vacuum aspiration and/or dilation & curettage (Control group) were applied as surgical methods for pregnancy loss management respectively. The evacuated products of conception were subjected to cytogenetic karyotyping analysis. The primary outcome was the culture failure rate of karyotyping. Secondary outcomes included the chromosomal abnormality spectrum, maternal cell contamination, and complications from the manual vacuum aspiration procedure.
RESULTS
For the case group, 132 products of conception were genetically analyzed by conventional karyotyping. The culture failure rate was significantly lower than that of the control cohort (2.3% vs 7.4%, p = 0.027). 65.2% of cases were abnormal within the detection scope of karyotyping. The euploid female to male ratio was 0.82 (18:22), suggesting a lower likelihood of maternal cell contamination. The efficacy in achieving complete evacuation was 99.6%. There were no significant complications from the procedure.
CONCLUSION
Ultrasound-guided manual vacuum aspiration approach significantly decreased the culture failure rate of karyotyping and decreased maternal cell contamination tendency, enabling a high and accurate cytogenetic diagnosis. It is especially crucial when the cytogenetic analysis is required in the early pregnancy loss clinics.
Topics: Abortion, Spontaneous; Cohort Studies; Cytogenetic Analysis; Female; Humans; Male; Pregnancy; Ultrasonography, Interventional; Vacuum Curettage
PubMed: 35580747
DOI: 10.1016/j.biocel.2022.106226 -
Scandinavian Journal of Primary Health... Nov 1988A questionnaire study was made of the pain and discomfort from vacuum aspiration (vabra) of the cervix/uterus without anaesthetic treatment, and the desire of...
A questionnaire study was made of the pain and discomfort from vacuum aspiration (vabra) of the cervix/uterus without anaesthetic treatment, and the desire of medication/hospitalization in case of a repeated operation. Forty-eight women described a medium pain (4.1 on a scale from 0-9), and a medium discomfort (3.5 on a similar scale). Forty-six women were content to have had the operation carried out by their general practitioner, and 44 women declared that they would prefer to have the operation carried out by their general practitioner if it had to be repeated. The women did not express a desire for hospitalization or anaesthesia. The results indicate that examinations carried out by a general practitioner, who is well known to the patient, cause less strain than examinations carried out elsewhere, and that vacuum aspiration is more gentle to the body than conventional curettage.
Topics: Adult; Aged; Attitude to Health; Biopsy; Dilatation and Curettage; Family Practice; Female; Humans; Middle Aged; Pain; Uterine Diseases; Vacuum Curettage
PubMed: 3231941
DOI: 10.3109/02813438809009321 -
Journal of the Medical Association of... Dec 2011To compare the level of pain between using manual vacuum aspiration and sharp curettage in the patients who had abnormal uterine bleeding that underwent uterine... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To compare the level of pain between using manual vacuum aspiration and sharp curettage in the patients who had abnormal uterine bleeding that underwent uterine curettage under paracervical block with analgesics.
DESIGN
Randomized controlled trial study.
MATERIAL AND METHOD
Between September 2009 to June 2010, 48 women with abnormal uterine bleeding who need to undergone uterine curettage were asked to join the present study and informed consents were signed. Twenty four women were randomly assigned into manual vacuum aspiration (MVA) group and other 24 women into sharp curettage group. The main outcome was the difference of the level of pain before, during and after procedure measured by using the visual analog scale and categorical pain scores. Fisher exact, Student t test and Mann-Whitney U test were used for statistical analysis.
RESULTS
The median visual analog score during MVA-procedure was significantly lower than the median visual analog score during in sharp curettage (median visual analog pain scores (interquartile range) 80 (30-100) vs. 45 (0-80); p < 0.01)). And the median score immediately after procedure in the MVA group was also significantly lower than in the sharp curettage group (median visual analog pain scores (interquartile range) 45 (0-80 vs. 25 (0-70); p = 0.02). The categorical pain score in the MVA group during procedure and immediately after procedure were also significantly lower than in the sharp curettage group. (No pain to mild pain vs. moderated to severe pain; p = 0.03, immediately after procedure: no pain to mild pain vs. moderated to severe pain; p = 0.01).
CONCLUSION
The level of pain in the patients who underwent uterine curettage by using MVA was lower than using sharp curettage. The using MVA may reduce pain compared to sharp curettage. However, more sample size research should be conducted to determine this significant.
Topics: Adult; Analgesics; Anesthesia, Obstetrical; Female; Humans; Middle Aged; Pain Measurement; Pain, Postoperative; Uterine Hemorrhage; Vacuum Curettage
PubMed: 22619908
DOI: No ID Found -
Obstetrics and Gynecology Clinics of... Dec 2013New data have emerged to support changes in first-trimester abortion practice in regard to antibiotic prophylaxis, cervical ripening, the use of manual vacuum... (Review)
Review
New data have emerged to support changes in first-trimester abortion practice in regard to antibiotic prophylaxis, cervical ripening, the use of manual vacuum aspiration, and pain management. This article addresses these new recommendations and reviews techniques in performing manual and electric vacuum uterine aspiration procedures before 14 weeks' gestation, including very early abortion (<7 weeks' gestation), technically difficult abortions, management of complications, and postabortal contraception. The information discussed also applies to miscarriage management.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Antibiotic Prophylaxis; Blood Loss, Surgical; Counseling; Female; Humans; Maternal Age; Medical Records; Misoprostol; Patient Safety; Practice Guidelines as Topic; Pregnancy; Pregnancy Trimester, First; Reproductive Health Services; Vacuum Curettage
PubMed: 24286994
DOI: 10.1016/j.ogc.2013.08.006 -
Journal of the Medical Association of... Jun 2015To compare-the adequacy of endometrium and the post-procedural pain between the manual vacuum aspiration (MVA) and metal curettage method. (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
To compare-the adequacy of endometrium and the post-procedural pain between the manual vacuum aspiration (MVA) and metal curettage method.
MATERIAL AND METHOD
The present research was a clinical experiment. A randomized controlled trial study was done with older than 35-year oldfemales with abnormal intrauterine bleeding who attended the out-patient gynecology department of Maharat Nakhon Ratchasima Hospital between December 1, 2013 and April 30, 2014. Patients were allocated with simple randomization technique into two groups, the experimental group was using MVA and the control group was using conventional metal uterine curettage. Pain levels were assessed according to the visual analogue scale. All tissue samples were examined by pathologists. Statistics used were percentage and Chi-square.
RESULTS
Percentages of tissue adequacy for pathological examination of control and experiment groups were 87.88 and 90.91, respectively. There was no significant difference between the two methods (p-value = 0.572). The patients with severe pain in the experiment group were less than that of the control group. The relative risk is 0.47 (95% CI = 0.30-0.72).
CONCLUSION
MVA caused less pain than the metal curette method, while both provided the same rate of adequacy of endometrial tissue sampling for pathological diagnosis. The MVA offered more humanized health care for gynecological patients who required such procedure. Further researches focusing on the cost-effectiveness or medical complications could benefit a practice guideline and the health care system for this patient group.
Topics: Adult; Aged; Curettage; Endometrium; Female; Humans; Metals; Middle Aged; Outpatients; Pain Measurement; Pilot Projects; Thailand; Vacuum Curettage
PubMed: 26219154
DOI: No ID Found -
Hong Kong Medical Journal = Xianggang... Jun 2023Manual vacuum aspiration is increasingly accepted as an alternative to medical or surgical evacuation of the uterus after first-trimester miscarriage. This study aimed...
INTRODUCTION
Manual vacuum aspiration is increasingly accepted as an alternative to medical or surgical evacuation of the uterus after first-trimester miscarriage. This study aimed to assess the efficacy of ultrasound-guided manual vacuum aspiration (USG-MVA) in the management of first-trimester miscarriage.
METHODS
This retrospective analysis included adult women with first-trimester miscarriage who underwent USG-MVA in Hong Kong between July 2015 and February 2021. The primary outcome was the efficacy of USG-MVA in terms of complete evacuation of the uterus, without the need for further medical or surgical intervention. Secondary outcomes included tolerance of the entire procedure, the success rate of karyotyping using chorionic villi, and procedural safety (ie, any clinically significant complications).
RESULTS
In total, 331 patients were scheduled to undergo USG-MVA for first-trimester miscarriage or incomplete miscarriage. The procedure was completed in 314 patients and well-tolerated in all of those patients. The complete evacuation rate was 94.6% (297/314), which is similar to the rate (98.1%) achieved by conventional surgical evacuation in a previous randomised controlled trial in our unit. There were no major complications. Samples from 95.2% of patients were suitable for karyotyping, which is considerably higher than the rate of suitable samples (82.9%) obtained via conventional surgical evacuation in our previous randomised controlled trial.
CONCLUSION
Ultrasound-guided manual vacuum aspiration is a safe and effective method to manage first-trimester miscarriage. Although it currently is not extensively used in Hong Kong, its broader clinical application could avoid general anaesthesia and shorten hospital stay.
Topics: Pregnancy; Adult; Humans; Female; Abortion, Spontaneous; Pregnancy Trimester, First; Vacuum Curettage; Retrospective Studies; Ultrasonography, Interventional
PubMed: 37226490
DOI: 10.12809/hkmj2210127 -
Obstetrical & Gynecological Survey Oct 2003Subgaleal hemorrhage is a rare condition of the neonate often associated with instrumental delivery. It is a potentially fatal condition that is often underreported and... (Review)
Review
Subgaleal hemorrhage is a rare condition of the neonate often associated with instrumental delivery. It is a potentially fatal condition that is often underreported and underdiagnosed. The vacuum extractor is being advocated as the instrument of first choice for assisted vaginal delivery, but appears to be associated with an increased incidence of subgaleal hemorrhage. It is widely believed that the vacuum cup will dislodge before causing serious fetal trauma. Because of the ease of application, vacuum extractors could be used potentially in circumstances in which forceps would not be attempted, allowing an operator of average experience to perform rotational deliveries. The worrisome increase in the incidence of subgaleal hemorrhage associated with vacuum extraction leads to the issuance of warnings from governmental authorities in Canada and the United States. This review discusses the anatomy of this lesion, etiology, clinical presentation, management, and possible prevention.
Topics: Birth Injuries; Canada; Craniocerebral Trauma; Disseminated Intravascular Coagulation; Female; Hemorrhage; Humans; Incidence; Infant, Newborn; Pregnancy; Risk Factors; Scalp; United States; Vacuum Curettage; Vacuum Extraction, Obstetrical
PubMed: 14515066
DOI: 10.1097/01.OGX.0000086420.13848.89