Manual vacuum aspiration versus routine abortion procedure
in hospital settings – does it improve the service?
K. Stankova, D.
Tanturovski, I. Alulovski, A. Stankov, G. Tofoski, J. Tofoski
Obstetrics and Gynaecology, University Hospital Skopje, Macedonia
Manual vacuum aspiration (MVA) is a method of evacuation of products of
conception from the uterine cavity which has been used in a number of countries
since more than thirty years ago. Since year 2000 it has been officially
included in the WHO recommendations. It has been introduced at our hospital
since November 2002 as a part of a joint project with the National Abortion
Federation (NAF) of the USA and the Open Society Institute (OSI) in Macedonia.
Objective: To find out if the use of MVA is an improvement versus the routine
abortion method used at our hospital.
Material and Methods: The study included
108 patients who underwent MVA as an analysed group (AG) and 104 patients where
the routine procedure was used, as a control group (CG). MVA was done with local
paracervical block, using the standard MVA technique and instruments. The
routine abortion technique consisted of dilation, electrical vacuum aspiration
and sharp curettage, performed in short intravenous anesthesia. Both groups (AG
and CG) were divided into two subgroups, out of which we had 40 patients where
MVA was performed because of a diagnosis of a missed abortion, with a CG of 36
patients, and another subgroup of 68 artificial abortions performed with MVA,
with a CG of 68 standard interventions. The choice of the type of intervention
was done by the patient herself. We compared the effectiveness of the method (duration,
bleeding, discomfort, post intervention complications) and the costs of the
procedure for the hospital and the patient (hospital stay, anesthesia,
laboratory tests, staff).
Results: There is no significant difference in the
effectiveness and safety of both methods. On the contrary, MVA significantly
reduces the costs for the institution and the patient, in all of the analysed
Conclusions: According to the need of offering an effective service
to the patient which would also consider the cost/benefit principle, introducing
MVA in hospitals might be a reasonable step. Lowering of the intervention costs
gives the opportunity of redistribution of funds and improving hospital abortion
services. Of course, we need further evaluation, including qualitative studies
about the patients’ satisfaction by the method.