MANAGEMENT OF EARLY PREGNANCY LOSS: MANUAL VACUUM ASPIRATION VERSUS DILATATION AND CURETTAGE

Abstract

Objective: To compare the safety and cost effectiveness of manual vacuum aspiration (MVA) with dilatation and curettage (D&C) in first trimester pregnancy losses.

Study Design: Randomized control trial.

Place and Duration of Study: Conducted in Obstetrics and Gynaecology department of Combined Military Hospital Lahore from July 2014 to June 2015.

Material and Methods: The study involved 120 women divided into two groups of 60 each through consecutive sampling with one undergoing MVA and the other D&C. All women with gestational age <12 weeks with a diagnosis of anembryonic pregnancy, failed medical induction, incomplete or missed miscarriage were included in the study.

Results: The general characteristics of the groups were the same. In the MVA group the mean duration of procedure was 13.4 (± 2.7) min with mean hospital stay being 14.2 (± 2.4) hours. The D&C group had a mean duration of procedure of 24.6(± 5.3) min with mean hospital stay being 28.9 (± 4.8) hours. The mean cost of MVA was Rs 4820 ± 270.76 versus Rs 14,280 ± 927.38 for D&C. In MVA and D&C groups incomplete evacuation occurred in 3(5%) patients and 1(1.7%) patient respectively. The incidence of infection was 5% in MVA group and 3.3% in D&C patients. The rest of the complications occurred only in the D&C group, with 1(1.7%) patient having uterine perforation, 1 (1.7%) having haemorrhage and 1(1.7%) having anaesthesia complications.

Conclusion: MVA is as safe and effective as D&C for the management of miscarriage. Moreover MVA is cost effective as both hospital stay and procedure times are shorter.