Manual vacuum aspiration: complication rates and
post-operative experience of women undergoing this method of termination of
first trimester pregnancy
K. Worsley, S. Robotham, H. Axby
Marie Stopes International, London, UK
Introduction: Manual Vacuum Aspiration (MVA) is the
method of first trimester surgical abortion used in Marie Stopes International (MSI)
centres in the United Kingdom. Complications associated with this form of
surgical abortion are known to be low within MSI centres, yet there has been no
previous survey of clients to assess complication rates particularly for those
who may report post abortion problems to health professionals. This survey
accurately monitors complications and health and well- being of clients at the
time of the procedure, and in the six-week period post procedure.
Objectives: The primary objective of this study is to
determine the complication rates associated with MVA terminations of pregnancy
512 wks of gestation at MSI centres. Secondary objectives are to; elucidate the
experience of women post MVA in terms of bleeding pattern, pain, and onset of
menstruation; understand how often MSI is contacted with post operative problems;
identify methods of contraception chosen, and analyse their possible
implications on the bleeding pattern, post termination.
Design and Methods: The study surveyed clients who had a
MVA for termination of pregnancy up to 12 weeks under conscious sedation or
local anaesthetic. Clients were recruited to participate in the survey at the
time of initial consultation, clinical information was recorded at the time of
the procedure; clients were contacted by telephone at two weeks and six weeks
post termination and asked to describe their bleeding, pain, other related
symptoms and treatment post termination. Local anaesthetic consisted of 2%
lignocaine gel applied to the external cervical os. No routine para-cervical
block, cervical priming or prophylactic antibiotics were used. All clients were
screened for Chlamydia at time of the consultation – and received appropriate
follow up. All gestations were confirmed with a pre-procedure trans-abdominal
ultrasound scan.
Results: The survey recruited 480 clients, and our
preliminary analysis is based on the results of 456 MVA procedures, after
excluding those who had the IUD/IUS fitted for contraception. At the time of the
procedure there were two (0.44%) reported heavy bleeds, both approximately 500
ml blood loss in total. No serious haemorrhage, uterine perforation or
haematometra were reported at the time procedure. Of these clients, 303 (66%)
were followed up two weeks post MVA, and 232 (51%) were followed up at six weeks
post MVA. One woman had a continuing pregnancy (0.33%), four (1.32%) women had
re-evacuation procedures for suspected RPOC; three of these done outside MSI;
Nine women (2.97%) were prescribed antibiotics (seven by GP, and two by MSI).
Conclusions: MVA for surgical termination of pregnancy in
the first trimester is safe and effective with minimal complications.
