Manual vacuum aspiration: complication rates and post-operative experience of women undergoing this method of termination of first trimester pregnancy

Manual vacuum aspiration: complication rates and

post-operative experience of women undergoing this method of termination of

first trimester pregnancy

K. Worsley, S. Robotham, H. Axby

Marie Stopes International, London, UK

Introduction: Manual Vacuum Aspiration (MVA) is the

method of first trimester surgical abortion used in Marie Stopes International (MSI)

centres in the United Kingdom. Complications associated with this form of

surgical abortion are known to be low within MSI centres, yet there has been no

previous survey of clients to assess complication rates particularly for those

who may report post abortion problems to health professionals. This survey

accurately monitors complications and health and well- being of clients at the

time of the procedure, and in the six-week period post procedure.

Objectives: The primary objective of this study is to

determine the complication rates associated with MVA terminations of pregnancy

512 wks of gestation at MSI centres. Secondary objectives are to; elucidate the

experience of women post MVA in terms of bleeding pattern, pain, and onset of

menstruation; understand how often MSI is contacted with post operative problems;

identify methods of contraception chosen, and analyse their possible

implications on the bleeding pattern, post termination.

Design and Methods: The study surveyed clients who had a

MVA for termination of pregnancy up to 12 weeks under conscious sedation or

local anaesthetic. Clients were recruited to participate in the survey at the

time of initial consultation, clinical information was recorded at the time of

the procedure; clients were contacted by telephone at two weeks and six weeks

post termination and asked to describe their bleeding, pain, other related

symptoms and treatment post termination. Local anaesthetic consisted of 2%

lignocaine gel applied to the external cervical os. No routine para-cervical

block, cervical priming or prophylactic antibiotics were used. All clients were

screened for Chlamydia at time of the consultation – and received appropriate

follow up. All gestations were confirmed with a pre-procedure trans-abdominal

ultrasound scan.

Results: The survey recruited 480 clients, and our

preliminary analysis is based on the results of 456 MVA procedures, after

excluding those who had the IUD/IUS fitted for contraception. At the time of the

procedure there were two (0.44%) reported heavy bleeds, both approximately 500

ml blood loss in total. No serious haemorrhage, uterine perforation or

haematometra were reported at the time procedure. Of these clients, 303 (66%)

were followed up two weeks post MVA, and 232 (51%) were followed up at six weeks

post MVA. One woman had a continuing pregnancy (0.33%), four (1.32%) women had

re-evacuation procedures for suspected RPOC; three of these done outside MSI;

Nine women (2.97%) were prescribed antibiotics (seven by GP, and two by MSI).

Conclusions: MVA for surgical termination of pregnancy in

the first trimester is safe and effective with minimal complications.

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