Manual Vacuum Aspiration for First Trimester Pregnancy Loss

manual of arms Vacuum Aspiration for First Trimester motherliness LossDr. SindhooTO DETERMINE THE power OF MANNUAL VACUM ASPIRATION IN MANAGEMENT OF initiative TRIMESTER motherliness LOSSINTRODUCTIONAn estimated 46 million abortions atomic number 18 performed globally each year, with one and only(a)-third of all abortions atomic number 18 performed under unsafe conditions stellar(a) to 13% of all maternal death1. 1012% of these abortions are performed in the early(a) first trimester1, 2. Local data shows an annual abortion straddle of 29 per 1000 in women aged 15-49 years. Incomplete and missed spontaneous abortion being the commonest occurs in approximately 15 % of clinically recognized pregnancies and in 890,000 women per year3. One study dribbleed by Shonali Agarwal and Dolly Gupta reported the faculty of MVA 90% in counselling of first trimester maternal quality loss5. First trimester of pregnancy ranges in the midst of 513 weeks and is associated with 3 to 5 time s lower maternal mortality and morbidity risks than termination during second trimester4. Although the etiologies of first trimester loss are multi factorial and often remain unknown, certain risk factors increase the likelihood of pregnancy loss. Findings such as absence of cardiac activity subsequently 5 wks, gestational sac smaller than expected for dates, an abnormal-appearing yolk, intrauterine hematoma (sub chorionic hemorrhage), vaginal bleeding by and by 7 weeks of gestation are potential markers for subsequent pregnancy loss4.Once a first trimester pregnancy loss has been diagnosed, there are three forms of management expectant, medical checkup, or working(a) evacuation (with electrical or manual of arms mindlessness aspirator). The optimal modality of management is determined by gestational age, whether the pregnancy loss is decelerate or incomplete, maternal hemodynamic stability, the presence of infection, and, most importantly, tolerant preference5.Manual vanit y dreaming (MVA) employs a vacuum pump in which the vacuum is created victimization a hand-held, hand activated p drop deadic syringe. 4,5,6Manual vacuum aspiration is safe, effective, easy to use, portable, and reusable. It is appropriate for use in m all different clinical settings (Including office, emergency room, or the operate room) thus avoiding the need for the use of an operating theatre and the risks of general anesthesia. It does not require lengthy training for victorian operation, and may be performed by a wide range of skilful medical personnel including midwives and nurses. When conducted in the outpatient setting rather than operating room, manual vacuum uterine aspiration can result in secure cost savings, electrical power saving and significant reduction in procedure time (3.7 minutes for MVA vs. 10.2 minutes for DC).The World Health ecesis (WHO) recommends MVA as a preferred method of uterine evacuation2,7.RATIONALEOn robust literature search there was scant relatively sometime(a) data available on energy of MVA but no one foc utilize on efficacy of manual vacuum aspiration in management of first trimester pregnancy loss. This provide me the strong rationale to conduct this study, the account of my study is to set a baseline data which result help to generate the current local statistics of MVA in terms of efficacy on this particular group of women with loss of pregnancy. If we found the significant efficacy of MVA then we will recommend MVA as first line of give-and-take in future in management of first trimester pregnancy loss.OBJECTIVESThe aim of our study is to determine the efficacy of Manual vacuum aspiration in management of first trimester pregnancy loss.OPERATIONAL DEFINITIONFIRST TRIMESTER motherliness LOSSAn abortion is the spontaneous or induced loss of an early pregnancy. Miscarriage occurs within 12 weeks of gestation will be substantiate on ultrasound.EFFICACYIf an empty uterus with no evidence of maintained prod ucts of conception seen within 24 hours on Ultrasound will be label as efficacy positive.MATERIAL AND METHODSSETTINGLiaquat university hospital Jamshoro /Hyderabad duration Six months after approval of synopsis.STUDY DESIGNCase series study.SAMPLE SIZEBy victimization WHO sample size electronic computer taken efficacy of MVA i.e P=90% (5) margin of error (d) = 5.5% intimate interval 95% then the estimated sample size will be at least n=115.SAMPLING TECHNIQUE Non-probability consecutive tryINCLUSION CRITERIAAll women with gestational age of 12 weeks confirm from last menstrual period with pregnancy loss (as mention in operating(a) definition)Age 18-35 yearsWomen with any parityExclusion CriteriaWomen who are hemodynamically unassured (systolic B.P Ectopic pregnancy assess on ultrasoundKnown systemic disease including hepatic or renal dysfunction.Had a history of cervical surgery.DATA COLLECTION PROCEDUREAll patients fulfilling inclusion criteria and not having any of exclusion criteria attending Outpatient department/emergency department of Liaquat university hospital Jamshoro after evaluation by consultant will be included in the study. Informed consent will be taken from each patient about procedure and this study. Approval of the ethical committee will be sought. Patients will undergo elective abortion. All operations will be performed by fourth year residents under supervision of consultant having more than than 5 years of post-fellowship experience. Intravenous anesthesia will be used in all the cases. Manual vacuum aspiration will be performed under par cervical block with 10-20 ml of 1% lignocaine using Glick technique3. MVA will be performed using a flexible Ipas Easy manage cannula attached to a 60 ml syringe (aspirator), with a two-fold locking valve mechanism. To assess the efficacy(as mentioned in operational definition) of MVA. Patients will be fallowed work on 24 hours. Demographic variables of name, gestational age, and parity will be illustrious. The last(a) outcome in terms of efficacy will be noted after 24 hours will be recorded on approved Performa.DATA ANALYSIS PROCEDUREStatistical analysis will be performed using statistical software SPSS version 16 on computer. look on standard deviation will be calculated for age gestational age and parity. Frequency and percentage will be calculated for efficacy. effectuate modifier will be controlled through stratification of age gestational age and parity to see the association with outcome i.e (efficacy) by applying Chi-square adjudicate taking P0.05 will be considered statically significant.REFERENCESWen J, Cai QY, Deng F, Li YP. Manual versus electric vacuum aspiration for first-trimester abortion a systematic review. BJOG. 2008 Jan115(1)5-13.Review. PubMed PMID18053098.Yan J, Saravelos SH, Ma N, Ma C, Chen Z-J, Li T-C. Consecutive repeat miscarriages are promising to occur in the same gestational period. Reproductive BioMedicine201224634-38.Tasnim N, Mahmu d G, Fatima S, seedless raisin M. Manual vacuum aspiration a safe and cost-effective backlog of electric vacuum aspiration for the surgical management of early pregnancy loss. J Pak Med Assoc. 2011 Feb61(2)149-53.PubMed PMID 21375164.Allison JL, Sherwood RS, Schust DJ. Management of first trimester pregnancy loss can be safely moved into the office. Rev Obstet Gynecol. 20114(1)5-14.PubMed PMID 21629493 PubMed Central PMCID PMC3100102.5. Agarwal S, Gupta D. Comparison of manual vacuum aspiration (mva) versus traditional suction evacuation in first trimester medical termination of pregnancy. Int J Res Med.20132(1)11-14.Farooq F, Javed L, Mumtaz A, Naveed N. Comparison of manual vacuum aspiration,and distension and curettage in the treatment of early pregnancy failure. J Ayub Med Coll Abbottabad. 2011 Jul-Sep23(3)28-31. PubMed PMID 23272429.Harwood B, Nansel T National Institute of Child Health and Human Development.Management of Early maternal quality Failure Trial. Quality of life and acceptability of medical versus surgical management of early pregnancy failure. BJOG. 2008 Mar115(4)501-8. Doi 10.1111/j.1471-0528.2007.01632.x. Pubmed PMID 18271887pubmed Central PMCID PMC2424403.PROFORMATO ASSESS THE EFFICACY OF MANUAL VACUUM ASPIRATION IN MANAGEMENT OF FIRST TRIMESTER PREGNANCY LOSSDate ________________Reg No serial No ___________________Name W/OAge Gestational age weeksParityEFFICACYYES NO