Manual vacuum aspiration versus routine abortion procedure in hospital settings – does it improve the service?

Manual vacuum aspiration versus routine abortion procedure

in hospital settings – does it improve the service? 

K. Stankova, D.

Tanturovski, I. Alulovski, A. Stankov, G. Tofoski, J. Tofoski 

Department of

Obstetrics and Gynaecology, University Hospital Skopje, Macedonia 


Manual vacuum aspiration (MVA) is a method of evacuation of products of

conception from the uterine cavity which has been used in a number of countries

since more than thirty years ago. Since year 2000 it has been officially

included in the WHO recommendations. It has been introduced at our hospital

since November 2002 as a part of a joint project with the National Abortion

Federation (NAF) of the USA and the Open Society Institute (OSI) in Macedonia. 

Objective: To find out if the use of MVA is an improvement versus the routine

abortion method used at our hospital. 

Material and Methods: The study included

108 patients who underwent MVA as an analysed group (AG) and 104 patients where

the routine procedure was used, as a control group (CG). MVA was done with local

paracervical block, using the standard MVA technique and instruments. The

routine abortion technique consisted of dilation, electrical vacuum aspiration

and sharp curettage, performed in short intravenous anesthesia. Both groups (AG

and CG) were divided into two subgroups, out of which we had 40 patients where

MVA was performed because of a diagnosis of a missed abortion, with a CG of 36

patients, and another subgroup of 68 artificial abortions performed with MVA,

with a CG of 68 standard interventions. The choice of the type of intervention

was done by the patient herself. We compared the effectiveness of the method (duration,

bleeding, discomfort, post intervention complications) and the costs of the

procedure for the hospital and the patient (hospital stay, anesthesia,

laboratory tests, staff). 

Results: There is no significant difference in the

effectiveness and safety of both methods. On the contrary, MVA significantly

reduces the costs for the institution and the patient, in all of the analysed


Conclusions: According to the need of offering an effective service

to the patient which would also consider the cost/benefit principle, introducing

MVA in hospitals might be a reasonable step. Lowering of the intervention costs

gives the opportunity of redistribution of funds and improving hospital abortion

services. Of course, we need further evaluation, including qualitative studies

about the patients’ satisfaction by the method.

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