Objective: To study the efficacy of Manual Vacuum Aspiration for management of incomplete and missed
Study Design: Descriptive case series.
Place and Duration of Study: CMH Rawalpindi, from July 2012 to July 2014.
Material and Methods: Out of 32068 outdoor patients 312 with first trimester incomplete and missed miscarriages were included in this study on the basis of history, physical examination and ultrasound findings. Written informed consent was obtained from all patients. Data were obtained from hospital management system (HMS) computer record in case of morning OPD and from a separate register kept for patients reporting in gynaecology emergency after working hours i.e. from 2 pm till 8 am next morning. Patients not willing for msanual vacuum aspiration, twin pregnancy, molar pregnancy and those in second trimester of pregnancy were excluded. Manual vacuum aspiration was done under paracervical block/cervical infilteration with Lignocaine. Amount of blood loss was estimated on the basis of clinical experience and collection in kidney tray (one kidney tray having capacity of 800ml). Loss estimated as mild, moderate and severe. Severe blood loss approximately >500 ml. Infection was diagnosed when there was fever and/or foul vaginal discharge .Sample size calculated with the help of WHO sample size calculator by non-probability sampling technique. Data analysis was done with the help of SPSS version 10 and presented as percentages and frequencies.
Results: Blood loss during the procedure was mild in 99 (31.73%) patients, moderate in 208 (66.66%) patients and severe in 9 (2.88%), patients. Despite ensuring good analgesia 191 (61.21%) patients felt some degree of pain. Infection occurred in 6 (1.92%) patients. Cervical injury or uterine perforation occurred in none.
Conclusion: The use of Manual vacuum aspiration in patients with incomplete and missed miscarriages was effective and safe for uterine evacuation.
Keywords : Efficacy, Manual vacuum aspiration, Incomplete miscarriage.