Aspiración manual endouterina (AMEU): Revisión de la literatura y estudio de serie de casos / Manual vacuum aspiration (MVA): a literature review and a case series study

Introducción y objetivo El aborto es la pérdida del producto de la concepción antes de la viabilidad fetal y se considera la principal complicación del embarazo. El objetivo de nuestro trabajo es evaluar los resultados iniciales y en mediano plazo del manejo con Aspiración Manual Endouterina (AMEU) del aborto en el primer trimestre. Métodos Análisis estadístico de serie de casos de 53 pacientes sometidas a AMEU en el Hospital Carlos Van Buren, Valparaíso desde noviembre 2017 a junio 2018 por aborto del primer trimestre. El diagnóstico fue clínico y mediante ultrasonografía. Se efectuó un cuestionario de satisfacción posterior al procedimiento. Resultados Se analizaron 53 pacientes, cuya edad promedio es de 29 años, 19 nulíparas, 34 multíparas, con edad gestacional promedio de 8 semanas. Se analizaron 53 biopsias de contenido intrauterino que resultaron en 53 abortos, de éstos 39 retenidos y 14 incompletos. Se registró un 3% de complicaciones (1 caso de perforación uterina que sólo requirió manejo médico y 1 caso de evacuación incompleta). El cuestionario reveló en una mayoría, el alivio de los síntomas y satisfacción en relación al procedimiento. Conclusión La AMEU es una buena alternativa en el manejo del aborto debido a menores costos, baja tasa de complicaciones y alta eficacia. Los centros que disponen de diversas alternativas para el manejo del aborto deben asegurarse de que la mujer participe activamente en la elección en cuanto a su resolución.

ABSTRACT Introduction and objective Miscarriage is the loss of the product of conception before fetal viability and it is considered the main complication of pregnancy. The main objective of our study is to evaluate initial and midterm reports using Manual Vacuum Aspiration (MVA) as management of first trimester miscarriage. Methods Statistic analysis of a case series of 53 patients submitted to MVA at Hospital Carlos Van Buren, Valparaíso since November 2017 until June 2018 with first trimester miscarriage. The diagnosis was clinical and ultrasonographic. A post procedure satisfaction questionnaire was carried out. Results Fifty-three patients were analyzed, with mean age of 29 years, 19 were nulliparous, 34 multiparous, mean gestational age of 8 weeks. Fifty-three intrauterine biopsies were analyzed, of which 53 were miscarriage, 39 retained sacs and 14 incomplete. We had 3% of complications (1 case of uterine perforation requiring only medical treatment and 1 case incomplete vacuum). The questionnaire revealed in a majority, the relief of symptoms and satisfaction with the procedure. Conclusion MVA is a good alternative in the management of miscarriage due to less costs, low rate of complications and high efficacy. The centres with various alternatives for miscarriage management must ensure that the women actively participates in the election of the resolution.

Tratamento do abortamento incompleto por aspiração manual ou curetagem / Comparative study of manual vacuum aspiration and uterine curettage for treatment of abortion

OBJETIVOS: Comparar aspiração manual intra-uterina (AMIU) com curetagem uterina (D&C) em abortamentos no primeiro trimestre no que se refere a eficiência para eliminar restos ovulares do método de aspiração manual intra-uterina com a dilatação e curetagem, ocorrência de complicações (perfuração uterina, laceração cervical, hemorragia pós-tratamento), tempo duração dos procedimentos e tempo de internação das pacientes. MÉTODOS: Cinqüenta pacientes no grupo AMIU e 50 pacientes no grupo D&C foram incluídas prospectivamente de maneira aleatória. Critérios de inclusão: abortamento espontâneo, idade gestacional de até 13 semanas, colo pérvio, espessura endometrial maior que 15 mm, estado afebril, hemoglobina superior a 10 g/dl. Amostras sangüíneas foram colhidas antes e após os procedimentos cirúrgicos para controle dos níveis de hemoglobina; anestesia foi realizada em todos os casos. O tempo para realização de cada procedimento cirúrgico foi cronometrado. RESULTADOS: Os grupos eram semelhantes quanto à idade gestacional (9,93±2,40; 9,73±2,58, p 0,71), espessura endometrial antes da cirurgia (22,14±4,80; 22,68±5,68, p 0,65). Não foram observadas complicações cirúrgicas ou anestésicas em nenhum grupo. Os tempos de realização do procedimento e internação foram significativamente menores nas pacientes do grupo AMIU (3,71; 10,18 min, p < 0,001) (14,18; 23,06 h, p 0,03). O decréscimo nos níveis de hemoglobina após o procedimento cirúrgico foi maior no grupo D&C (p= 0,02). CONCLUSÃO: A AMIU possibilita menor perda sangüínea, requer menor tempo de realização do procedimento e menor tempo de internação hospitalar. Entretanto, ambos os procedimentos cirúrgicos mostraram-se eficientes para o tratamento de abortamentos incompletos no primeiro trimestre da gestação, não havendo complicações após a realização dos tratamentos.

OBJECTIVES: To compare manual vacuum aspiration (MVA) and uterine curettage (D&C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. RESULTS: Groups were similar regarding gestational age (9.93 ± 2.40 vs 9.73 ± 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 ± 4.80 vs 22.68 ± 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D&C group (p = 0.02). CONCLUSION: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments.

Triaging patients with post-abortion complications: a prospective study in Nepal.

The first manual vacuum aspiration (MVA) services unit in Nepal was established in 1995 at the country's largest national maternity hospital in Kathmandu. This research sought to assess and evaluate the safety, acceptability, and effectiveness of MVA services. This prospective study was conducted during 12 months in 1998, and follow-up was made at six weeks. Two groups of patients were compared: 529 patients treated in the MVA unit and 236 patients who were clinically eligible for treatment in the MVA unit but were treated instead in the main operation theatre (OT) owing to the unavailability of services in the MVA unit during the hours of their admission. The two groups differed with respect to some of their background characteristics but were similar in their clinical characteristics. The MVA group received contraceptive counselling and services and had significantly shorter stays in hospital. However, the direct cost incurred by the patients, regardless of the type of facility they used, was about the same. Follow-up at six weeks revealed that the MVA patients had significantly fewer complaints and were generally more satisfied with the services they had received than their counterparts. Slightly more than half of the women in the MVA group were using contraception at the time of follow-up compared to no women in the OT group. It is concluded that the MVA unit provided safe, effective, and efficient services to about 50% of all the patients admitted to the hospital with post-abortion complications. An additional 25% of the post-abortion patients could be served if the unit were kept open 24 hours a day, saving resources and time for patients and hospital staff. As a parallel development, both MVA and main OT services would need to be more effectively integrated with outside antenatal and family-planning clinics to address the reproductive health needs of women, thereby reducing the number of patients requiring post-abortion care.

Avaliaçäo de diferentes técnicas de esvaziamento uterino como fator de risco para neoplasia trofoblástica invasora e metastática / Evaluation of different technics of uterine evacuation as a risk factor for invasive and metastatic trophoblastic neoplasms

Avaliou-se a influência da forma de esvaziamento uterino: curetagem ou vacuoaspiraçäo e do uso de ocitócico sobre a incidência de neoplasia trofoblástica gestacional invasora/metastática entre pacientes com diagnóstico de abortamento molar. O estudo inclui 42 pacientes com diagnóstico histopatológico de mola hidatiforme completa benigna e com altura uterina superior a 12cm. Vinte e cinco casos foram esvaziados por curetagem uterinas e 17 por vacuoaspiraçäo. Do mesmo grupo de 42 pacientes, 27 receberam ocitocina para promover a dilataçäo do colo uterino e/ou expulsäo parcial da mola e 15 näo foram tratadas com ocitócico. A análise estatística mostrou que o uso de ocitócico prévio ao esvaziamento uterino é fator agravante do risco de evoluçä para neoplasia invasora, particularmente se associada a curetagem uterina