Manual vacuum aspirator: a safe and effective tool for decentralization of post miscarriage care.

OBJECTIVE To compare the efficacy and safety of Manual Vacuum Aspiration (MVA) performed as outpatient versus inpatient procedure in terms of success rate, blood loss, hospital stay and procedure related complications. STUDY DESIGN A quasi-experimental study. PLACE AND DURATION OF STUDY Maternal and Child Health Centre (MCHC), Unit-I, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from December 2009 to December 2010. METHODOLOGY Cases with early pregnancy failure (incomplete, missed and an embryonic) at gestational age less than 12 weeks were allocated to MVA as outpatient or elective procedure performed in the operation theatre. Studied variables were noted as above. RESULTS A total of 177 women were eligible for study, out of whom 78 underwent MVA as outpatient procedure and 99 as indoor procedure. The baseline characteristics were comparable in both groups except significantly high multipara in the indoor group. Complete evacuation was achieved in 96.1% in outpatient vs. 79.7% in indoor cases (p=0.001). Outpatient group had a shorter hospital stay (median 3 hours, IQR-1 vs. 10 hours, IQR-4; p < 0.001), though the median hospital cost was less but statistically insignificant (Rs. 800, IQR-25 vs. 735, IQR-1265; p=0.728). Blood loss was comparable in both groups (median 60 ml, IQR-20 vs. 60 ml-IQR-30; p=0.350). There were two uterine perforations noted in the inpatient group (2.02%) vs. none in outpatient setting. CONCLUSION Outpatient based manual vacuum aspiration is a safe and effective tool for management of early pregnancy loss. A decentralized approach proved useful in reducing hospital stay.