RESUMO
Objectives: to compare manual vacuum aspiration [MVA] and uterine curettage [DandC] for first trimester abortions, in terms of the frequency of complications, incomplete procedure, blood loss, duration of patients' hospitalization and patient satisfaction
Methods: in a prospective study, 100 patients in the MVA group A and 100 in the DandC group B were randomly included. Inclusion criteria included patients with missed or incomplete miscarriage at gestational age less than 12 weeks calculated from last menstrual period. In case of incomplete miscarriage, endometrial thickness should be more than 16mm on endovaginal scan. Pre evacuation hemoglobin more than 1 Og /dl, afebrile state. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Both groups were evaluated intra and post operatively as regard to: uterine perforation, blood loss [pre and post hemoglobin], pelvic infection, retained products of conception [incomplete procedure] duration of hospitalization and patients satisfaction
Results: characteristics of the study population at enrollment were similar in two groups regarding age, gestational age in weeks and ultra-sonographic parameters and indications for procedure. However more patients in group A are multigravida whereas more patients in group B are either primigravida or para 1 or 2. Both groups showed the same efficiency in emptying of the uterus with 6 incomplete procedures in group A and 4 incomplete procedures in group B [p value>0.05].1 uterine perforation was observed in group A and 3 in group B [p value<0.02].There were 2 cases of pelvic infection in group A and 4 in group B [p value>0.05]. In the patients who have undergone the uterine curettage, the duration of hospital stay was on average, 18.32 hours [+/- 8.01], and in the patients who underwent vacuum aspiration the mean time was 7 .12 hours [+/- 1.44] [p <0.0001]. All the patients who had manual vacuum aspiration are satisfied with the modality whereas patient satisfaction rate was 95% in group B who had curettage [p value<0.0001]. The decrease in hemoglobin rates was higher in the Group of patients subjected to uterine curettage, i.e. from 12.44mg/dl to 11.39mg/dl as compare to patients subjected to MVA i.e.from12.55mg/dl to 11.92mg/dl [p value<0.0001]
Conclusions: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization