Publication:

A comparison of manual vacuum aspiration with medical method of abortion in termination of pregnancy up to 9 weeks of gestational age

Background Objective of present study was to compare efficacy and complications of medical method versus manual vacuum aspiration in early pregnancy termination and to determine whether medical method of termination of pregnancy represent a reasonable alternative to surgical method (MVA) in terms of complete evacuation of products of conception and their side effects.

Methods A comparative study was carried out on 184 pregnancies in women who were willing for termination of pregnancy up to 9 weeks (63 days) of gestational age, in Group A: women who opted for medical method for termination, Group B: women who opted for manual vacuum aspiration for termination.

Results Mean age of Group A was 27.63±3.60 years and Group B was 26.87±3.83 years. Majority 169 (92%) of women were Hindu. 165 (90%) of the patients lived in urban area and 176 (96%) were married women. Majority 130 (71%) of them were para 2 and more. Average age of gestation at which termination was performed was 46.79±6.29 days in Group A and 49.13±6.67 days in Group B. Average duration of vaginal bleeding among Group A was found to be 8.9±3.5 days (p value<0.05) and in Group B was 6.837+2.928 days which was significantly longer in Group A. 72 (78.3%) patients considered vaginal bleeding to be heavier than their normal period in Group A where as in Group B 8 (8.7%)perceived it to be heavier (p value <0.001). Incidence of pain, nausea, vomiting, diarrhea and incomplete abortion (78.26%, 32.60%, 16.3%, 19.56% and 4.43%) in group A and (52%, 7.6% ,4.3%, nil and 2.17%) in group B which were found to be higher in Group A as compare to Group B. Patient satisfaction was 95.65% in medical method and 84.78% in MVA group. Success rate was 95.65% for medical and 97.82% for MVA group.

Conclusions Duration and amount of bleeding per vaginum is more in medical method as compare to surgical method. Side effects like pain, nausea, vomiting and diarrhea were more in medical group, but majority of these symptoms were self-limiting. There was high satisfaction rate (95.65%) among medical abortion group because less surgical and anaesthetic complication, offer them more privacy and treatment is taken at home. The effectiveness of medical method of abortion in present study was 95.65% and success rate in MVA was 97.82%. Medical method of abortion for first trimester termination of pregnancy upto 9 weeks of gestation can be better alternative method to surgical evacuation. Medical method of abortion proves to be more effective, safe and economical method that avoid complication associated with surgical evacuation like uterine perforation, cervical laceration and anaesthtic complication. The only disadvantage with medical method of abortion is lack of predictability and variable success rate.