Comparison of manual vacuum aspiration, and dilatation and curettage in the treatment of early pregnancy failure

Objectives: To compare the efficacy, safety and cost effectiveness of Manual Vacuum Aspiration [MVA] with dilatation and curettage [DNC] in the management of early pregnancy failure. Methods: One hundred patients of spontaneous abortion, incomplete or missed, with gestational age <12 weeks were included in the study. Using a Random Number Table, these patients were assigned to undergo either DNC or MVA. Results: The distribution of age, parity and gestational age was similar in both groups. The mean duration of procedure was significantly higher [p<0.0001] in DNC [8.98 +/- 2.64 minutes] as compared to 5.88 +/- 2.43 minutes in MVA. The duration of hospital stay was significantly lower [p<0.0001] in MVA group [3.48 +/- 1.2 hours] as compared to 7.42 +/- 1.93 minutes in DNC group. Similarly the cost of procedure was also significantly lower [p=0.0001] in MVA group [PKR 1410 +/- 243.4] compared to PKR 3460 +/- 908.24 in DNC group. Conclusion: MVA is as effective as conventional dilatation and curettage for treatment of early pregnancy failure while it causes less blood loss, is less time consuming, requires a shorter hospital stay and thus costs less. It does not require general anaesthesia and complication rate is less than dilatation and curettage. Keywords: manual vacuum aspiration, dilatation and curettage, early pregnancy failure

Intrauterine growth retardation in pregnancy associated with hypertensive disorders

A prospective study was carried-out in 1995, to know the prevalence of intrauterine growth retardation with associated risk factor of hypertension and their outcome. Total of 1642 antinatal patients delivered. Out of these 100 patients were diagnosed as cases of IUGR, while, 48 of these had associated hypertension. Twenty-three patients were delivered pre-maturely and 25 patients delivered at term. Ninteen patients were delivered vaginally, 6 cases with elective and 23 with emergency caesarean section. Twenty-two babies weighed between 2-2.5 Kg., 19 were between 1.5-2 Kg. and 7 weighed less than 1.5 Kg

Cervical Incompetence: a cause of recurrent abortion

A prospective study was carried-out in 1996, to find out the prevalence of cervical incompetence in pregnant patients coming to outpatient department and emergency and the effectiveness of cervical cerclage applied to the cases of documented cervical incompetence. Total No. of patients included were 1506. Out of them 19 [1.26-%] patients presented with cervical incompetence. Eight presented with advanced cervical effacement and dilatation, they subsequently expelled their babies, 5 patients had some degree of dilatation ranging from 1 - 3cm and 6 were diagnosed on ultrasound after clinical suspicion. So 11 patients were applied McDonald's stitch; at the gestational age of 15 -20 weeks in 7 patients and 26 - 28 weeks in 4 patients. The mean interval to delivery in the group with no cervical dilatation was 20 weeks, whereas, in cases of cervical dilatation it was 2-11 weeks. Complications were PROM [18%] premature contraction [9%], cervical laceration [9%] and cervical dystocia [9%]