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Background The World Health Organization does not recommend dilatation and sharp curettage (D&C) for the surgical treatment of miscarriage during the first trimester because this may cause Asherman’s syndrome due to endometrial damage; therefore, suction remains the primary treatment option. While manual vacuum aspiration (MVA) has been widely used since the 1990s outside Japan, the use of an MVA device (Women’s MVA system) was approved in Japan in October 2015. Here, we examined the efficacy of the MVA kit in women surgically treated for miscarriage. Methods This retrospective cohort study was conducted between 2014 and 2018 at the International University of Health and Welfare Hospital in Japan. Women who underwent surgical treatment for miscarriage within 12 weeks of pregnancy were identified and enrolled in the study. A total of 404 women were included who underwent the following procedures: 121 D&C, 123 electric vacuum aspiration (EVA), and 160 MVA. For each participant, the duration of surgery, amount of bleeding, amount of anesthetic used, incomplete abortion requiring repeat procedures, and intraoperative/postoperative complications were evaluated. Results The duration of surgery was 13.7 ± 7.2, 11.2 ± 4.2, and 6.9 ± 4.3 min in the D&C, EVA, and MVA groups, respectively ( p  = 1.00). The amount of anesthetic used was not significantly different among all groups. Bleeding of ≥ 100 mL was confirmed in three (2.4%), one (0.8%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively ( p  = 0.50). Incomplete abortion was identified in three (2.4%), two (1.6%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively ( p  = 0.61). However, severe intraoperative/postoperative complications were not observed in any group. Conclusions Surgical treatment for miscarriage performed using the MVA kit has safety and efficacy similar to those of conventional methods, such as D&C and EVA.

Background This study aimed to evaluate the safety and feasibility of manual vacuum aspiration (MVA) for the removal of endometrial polyp-like lesions, an approach potentially simpler and less resource-intensive than conventional hysteroscopic techniques. Methods We conducted a prospective case series including 29 patients with suspected endometrial polypoid lesions based on ultrasound findings. After informed consent, transcervical resection (TCR) using a 26Fr rigid resectoscope was performed to visualize the uterine cavity. MVA was then applied to aspirate the endometrial tissue, including polyp-like lesions, immediately followed by TCR to check for residual tissue. Clinical data were collected for each patient, and the study was approved by the institutional review board. Results Complete removal by MVA alone was achieved in 25 of 29 patients (86.2%). In 4 cases (13.8%) with lesions > 20 mm and thick stalks, additional TCR was required for complete resection. The number of aspirations in complete cases ranged from 1 to 3. No perioperative complications occurred. Conclusions MVA is a safe, simple, and cost-effective technique for removing small-to-moderate endometrial polyp-like lesions. Except for particularly large polyps, MVA may represent a viable alternative to hysteroscopic resection, reducing the need for specialized equipment.

Background Intrauterine adhesion (IUA) can arise as a potential complication following uterine surgery, as the surgical procedure may damage the endometrial stratum basalis. The objective of this study was to assess and compare the occurrence of IUA in women who underwent ultrasound-guided manual vacuum aspiration (USG-MVA) versus electric vacuum aspiration (EVA) for managing first-trimester miscarriage. Methods This was a prospective, single-centre, randomised controlled trial conducted at a university-affiliated tertiary hospital. Chinese women aged 18 years and above who had a delayed or incomplete miscarriage of ≤ 12 weeks of gestation were recruited in the Department of Obstetrics and Gynaecology at the Prince of Wales. Recruited participants received either USG-MVA or EVA for the management of their miscarriage and were invited for a hysteroscopic assessment to evaluate the incidence of IUA between 6 and 20 weeks after the surgery. Patients were contacted by phone at 6 months to assess their menstrual and reproductive outcomes. Results 303 patients underwent USG-MVA or EVA, of whom 152 were randomised to ‘USG-MVA’ and 151 patients to the ‘EVA’ group. Out of the USG-MVA group, 126 patients returned and completed the hysteroscopic assessment, while in the EVA group, 125 patients did the same. The incidence of intrauterine adhesion (IUA) was 19.0% (24/126) in the USG-MVA group and 32.0% (40/125) in the EVA group, showing a significant difference ( p  < 0.02) between the two groups. No significant difference in the menstrual outcomes at 6 months postoperatively between the two groups but more patients had miscarriages in the EVA group with IUA. Conclusions IUAs are a possible complication of USG-MVA. However, USG-MVA is associated with a lower incidence of IUA postoperatively at 6–20 weeks. USG-MVA is a feasible, effective, and safe alternative surgical treatment with less IUA for the management of first-trimester miscarriage. Trial registration The study was registered with the Centre for Clinical Research and Biostatics- Clinical Trials Registry (CCRBCTR), which is a partner registry of the WHO Primary Registry-Chinese Clinical Trials Registry (ChiCTR) (Unique Trial Number: ChiCTR1900023198 with the first trial registration date on 16/05/2019)

Purpose Ultrasound-guided manual vacuum aspiration (USG-MVA) is a feasible and effective outpatient treatment to treat early pregnancy loss. Methods This was a prospective observational study at a university-affiliated hospital. All women undergoing either a USG-MVA or electric vacuum aspiration (EVA) were invited to return 3–6 months later for follow-up at which women completed a questionnaire to document their post-evacuation menstrual and reproductive history, and underwent a hysteroscopy if they were not pregnant. The severity of intrauterine adhesion (IUA), if present, was graded (Stage I-III) according to the American fertility society classification. Results A total of 292 women had a hysteroscopy after their initial surgical evacuation, USG-MVA 169(57.9%) versus EVA 123(42.1%). Women undergoing EVA as opposed to a USG-MVA had a 12.9% higher incidence of IUA (24.1% vs. 37.0%, p  = 0.042) equivalent to 1.84 times higher risk (95% CI 1.01–3.34; p  = 0.048). Women having EVA continued to show an increased but not statistically significant trend towards an increased risk of IUA after adjusting for the type of miscarriage (aOR = 1.3; 95% CI 0.66–2.50; p  = 0.46). Conclusion There were no significant differences in their reproductive outcomes and fewer women post-USG-MVA complained of hypomenorrhea. IUA may still occur in women undergoing USG-MVA but it is lower than the rate in women undergoing EVA. Clinical trials registry The trial was registered with the Centre for Clinical Research and Biostatistics – Clinical Trials Registry (CCRBCTR), a partner registry of the WHO Primary Registry-Chinese Clinical Trials Registry (ChiCTR) with a Unique Trial Number: CUHK_CCRB00541 on 22 Dec 2016.

Manual vacuum aspiration (MVA) is a painful procedure often conducted without analgesia. The World Health Organization (WHO) recommends a paracervical block (PCB) as the mode of pain relief during MVA. Few studies have assessed patient perspectives on pain control during MVA. We investigated the perspectives of health workers and patients on MVA under PCB. This study was nested within a pilot randomized controlled trial (RCT) evaluating the Chloe SED (syringe extension device) for PCB provision. Eleven providers and 61 patients were enrolled. All providers had MVA experience. They had not provided pain relief on 20% of occasions, and only one had previously administered PCB for MVA. Both patients and providers indicated MVA was painful and deserving of analgesia. Pain was the most common reason for difficulty completing an MVA. Providers noted that PCB made the procedure more tolerable. For patients, efficacy, remaining conscious, and same-day discharge were key considerations when selecting pain relief. Notably, 84% of patients expressed satisfaction with MVA under PCB. PCB is a vital component of the MVA care package. Considering patient and provider perspectives is essential to optimizing a humane and effective procedural experience.

Aim To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center. Material and methods A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated. Results In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% ( n  = 61) of CSPs were cured with MVA, 24.1% ( n  = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96 mm vs. 17,34 ± 9,87 mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic ınflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure ( p  < 0.05). Conclusion The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases.

Background In December 2020, Argentina passed Law 27.610, legalizing elective abortion up to 14 + 6 weeks and beyond in cases of rape or health risks. This study aims to analyze the sociodemographic characteristics of users who opted or were referred for manual vacuum aspiration (MVA) services at an a ambulatory medical center in Argentina before and after the legal reform, and to assess the safety and effectiveness of outpatient MVA procedures for pregnancies up to 14 + 6 weeks. Methods Observational study using clinical data from patients up to 14 + 6 weeks gestation ( n  = 1,861) who sought or were referred for outpatient MVA abortion at a public healthcare facility in Rosario, Argentina (2017–2023). We analyze changes in users’ sociodemographic characteristics before and after the legal reform and assess the safety and effectiveness of ambulatory MVA abortion by gestational age (< 13 weeks vs. 13–14 weeks). A logistic regression tested associations between sociodemographic, procedural, and reproductive factors, and receiving MVA after 12 weeks. Results Of the 1,861 MVA abortions, 85% ( n  = 1,590) were provided before 13 weeks’ gestation, and 15% ( n  = 271) occurred between 13–14 weeks. After the legal reform, more users accessed outpatient MVA services beyond 12 weeks (7% vs. 22%; p  < 0.05: before and after the legal change, respectively), including individuals with lower education levels (46% vs. 54%; p  < 0.05:), informal employment (34% vs. 47%; p  < 0.05), without healthcare insurance (72% vs. 90%; p  < 0.05), and nulliparity (18% vs. 30%; p  < 0.05). The success rate of ambulatory MVA abortion was 99.9%, with 0.4% ( n  = 7) adverse events; no statistically significant differences by gestational age groups (< 13 weeks vs. 13–14 weeks). The legal reform was positively associated with accessing MVA abortion after 12 weeks. Conclusions The legal reform improved access to safe ambulatory MVA abortion services up to 14 + 6 weeks’ gestation, particularly for socially disadvantaged users. MVA abortion, both before 13 weeks and at 13–14 weeks, demonstrated a high success rate (99.9%) with minimal adverse events.

Objective: To compare the safety and efficacy of Improvised S2Q manual vacuum aspiration and Pipelle sampling as a diagnostic procedure for the evaluation of women presenting with abnormal uterine bleeding. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital, Lahore Pakistan, from Oct 2021 to Aug 2022. Methodology: A total of 148 females over 35 years of age with abnormal uterine bleeding, who needed endometrial sampling, were divided into two groups of 74 participants each. Group-A underwent endometrial sampling by Improvised S2Q manual vacuum aspiration, while Group-B underwent endometrial sampling by Pipelle sampler. Results: Mean age of patients was 47.36±8.34 years in Group-A and 48.20±8.96 years in Group-B, while the mean BMI was 30.59±4.67 kg/m2 and 27.39±2.50 kg/m2 in Groups A and B, respectively. The volume of specimen obtained was found to be higher in the Improvised S2Q manual vacuum aspiration-Group as compared to the pipeline sampling-Group. The operating time in the Improvised S2Q manual vacuum aspiration-Group was 3.37±0.49 minutes, while in the pipeline sampling-Group, it was 3.20±0.55 minutes. No difference was found in the two procedures for side effects (tachycardia, pain/cramps) and complications (significant blood loss, perforation, infection), added analgesia or histopathology report. Conclusion: Improvised S2Q manual vacuum aspiration can be used as an alternative low-cost procedure for endometrial sampling in women with abnormal uterine bleeding.Keywords: Biopsy, Curettage, Endometrium, Manual vacuum aspiration, Pipeline sampling.

Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions are an important contributor to Malawi’s maternal mortality and morbidity, where abortion is illegal except to save the woman’s life. Postabortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended PAC innovations. Hence, drawing on Greenhalgh et al.’s (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581–629.) diffusion of healthcare innovation framework, this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi. Semi-structured interviews with 17 PAC providers in a central hospital and a district hospital indicate that a range of factors coalesce and influence PAC and MVA use in Malawi. Factors pertain to four main domains: the system (shortages of material and human resources; lack of training, supervision and feedback), relationships (power dynamics; expected job roles), the health workers (attitudes towards abortion and PAC; prioritization of PAC) and the innovation (perceived risks and benefits of MVA use). Effective and sustainable PAC policy must adopt a broader people-centred health systems approach which considers all these factors, their interactions and the wider socio-cultural, legal and political context of abortion and PAC. The study showed the value of using Greenhalgh et al.’s (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581–629.) framework to consider the complex interaction of factors surrounding innovation use (or lack of), but provided more insights into rejections of innovations and, particularly, a low- and middle-income country perspective. Le Malawi présente l’un des taux les plus élevés de mortalité maternelle dans le monde. Les avortements à risque contribuent fortement à la mortalité maternelle au Malawi, pays où l’avortement est illégal sauf en cas de danger pour la vie de la femme. Les soins après-avortement (PAC) ont pour objectif de réduire les conséquences néfastes des avortements dangereux, en partie grâce au traitement des avortements ncomplets. Malgré les recommandations à l’échelle mondiale et nationale des politiques de PAC pour l’aspiration manuelle intra-utérine (MVA) dans le traitement de l’avortement incomplet, l’utilisation en est limitée au Malawi et semble diminuer face au recours au curetage qui est utilisé de préférence. On a peu d’indices sur les causes du rejet des innovations recommandées par les PAC. Par conséquent, en se basant sur le programme de Greenhalgh et al de diffusion des innovations des soins de santé (2004. Diffusion des innovations dans les organismes de service: revue systématique et recommandations des organismes de service. Milbank Quarterly 82: 581–629.) programme de diffusion des innovations dans les soins de santé, cette étude qualitative a pour objet d’enquêter sur les facteurs qui contribuent à l’utilisation limitée et en baisse des MVA au Malawi. Des entretiens semi-structurés menés auprès de 17 prestataires de PAC dans un hôpital central et un hôpital de district indiquent que divers facteurs s’ajoutent et influencent le recours aux PAC et MVA au Malawi. Ces facteurs se rapportent à quatre domaines principaux: le système (pénuries en ressources matérielles et humaines, manque de formation, de supervision et de retours), les relations (dynamique du pouvoir, attentes des rôles professionnels), les travailleurs de la santé (attitudes envers l’avortement et les PAC; priorisation des PAC) et l’innovation (risques et avantages perçus dans l’utilisation des MVA). La politique efficace et durable des PAC doit adopter une approche plus large d’une santé centrée sur les gens qui prenne en considération tous ces facteurs, leurs interactions et un contexte socio-culturel, legal et politique plus étendu pour l’avortement et les PAC. L’étude a démontré la valeur du recours au cadre Greenhalgh et al.(2004. Diffusion des innovations dans les organismes de service: revue systématique et recommandations… Milbank Quarterly 82: 581–629.), qui permet d’examiner l’interaction complexe des facteurs qui entourent l’utilisation (ou non) de l’innovation, mais elle a permis un meilleur éclairage dans le rejet des innovations, en particulier une perspective concernant les pays à revenu faible et moyen. 马拉维是全球孕产妇死亡率最高的国家之一。不安全流产是 马拉维孕产妇死亡和患病的重要原因, 流产在该国为非法行 为, 仅用于挽救妇女生命。流产后照护 （PAC） 旨在降低不安 全流产后的不良后果, 其方法包括处理不全流产。全球和马拉 维的PAC政策均推荐采用手动负压吸引术 （MVA） 处理不全 流产, 但MVA在该国的使用率很低, 且呈下降趋势, 刮宫术使 用率更高。哪些因素使得推荐的PAC新方法不被采用, 目前证 据有限。本定性研究参考Greenhalgh等 （2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581–629.） 的医疗 创新扩散框架, 探讨造成马拉维MVA使用受限且减少的影响 因素。在一家中心医院和一家地区医院对17位PAC提供者进 行半结构化访谈, 结果提示, 有多个因素共同影响PAC 和 MVA 在马拉维的使用。这些因素来源于四个主要方面：体系 （物资和人力资源短缺；缺少培训、监督和反馈）, 关系 （权 力动力；预期工作角色）, 卫生工作者（对流产和PAC的态 度；PAC 的优先顺序）和创新 （对MVA 的风险和获益的认 知） 。有效且可持续的PAC政策必须以人为本, 采取更广的卫 生体系方法, 考虑上述因素, 因素间的相互作用, 以及流产和 PAC的社会文化、法律和政治环境。本研究显示, Greenhalgh 等的框架有助于探讨影响创新应用 （或缺乏创新应用） 的因 素之间复杂的相互作用, 本研究还提供了关于创新不被应用的 更多见解, 尤其是中低收入国家的观点。 Ethiopia’s health extension Malawi tiene uno de los más altos índices de mortalidad materna en el mundo. Los abortos inseguros son un importante contribuyente a la mortalidad y morbilidad materna de Malawi, donde el aborto es ilegal excepto para salvar la vida de la mujer. El cuidado postaborto (CPA) tiene como objetivo reducir las consecuencias adversas de los abortos inseguros, en parte mediante el tratamiento de abortos incompletos. Aunque las políticas mundiales y nacionales del CPA recomiendan la aspiración manual (AM) para el tratamiento del aborto incompleto, su uso en Malawi es bajo y parece estar disminuyendo, prefiriendo el uso de curetaje afilado. Hay evidencia limitada en cuanto a lo que influye en el rechazo de las innovaciones recomendadas del CPA. Por eso, haciendo referencia al marco de difusión de innovaciones de salud de Greenhalgh et al. (2004. Difusión de innovaciones en organizaciones de servicio: revisión sistemática y recomendaciones. Milbank Quarterly 82: 581-629), este estudio cualitativo buscó investigar los factores que contribuyen a la limitada y disminuida utilización de la AM en Malawi. Entrevistas semi-estructuradas con 17 proveedores de CPA en un hospital central y un hospital de distrito indican que una serie de factores se unen e influyen en el uso del CPA y la AM en Malawi. Los factores se refieren a cuatro dominios principales: el sistema (escasez de recursos materiales y humanos, falta de entrenamiento, supervisión y retroalimentación), las relaciones (dinámicas de poder, expectativas de roles en el trabajo), los trabajadores de la salud (actitudes hacia el aborto y el CPA; priorización del CPA) y la innovación (percepción de los riesgos y beneficios del uso del AM). Una política eficaz y sostenible del CPA debe adoptar un enfoque más amplio de los sistemas de salud centrados en las personas que considere todos estos factores, sus interacciones y el contexto sociocultural, legal y político más amplio del aborto y del CPA. El estudio mostró el valor de usar el marco de Greenhalgh et al. (2004. Difusión de innovaciones en organizaciones de servicio: revisión sistemática y recomendaciones. Milbank Quarterly 82: 581-629) para considerar la interacción compleja de los factores que rodean el uso de la innovación (o la falta de uso), pero proporcionó más ideas sobre los rechazos de las innovaciones y, en particular, una perspectiva de país de ingresos bajos y medios.

Objective: To compare the efficacy of Manual Vacuum Aspiration (MVA) with Dilatation and Curettage (DNC) in miscarriages of the first trimester. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology CMH, Peshawar Pakistan, from Feb to Aug 2018. Methodology: A total number of 182 Adult female (20-35 years of age) patients having miscarriage during the first trimester who were either primigravida or with previous history of spontaneous vaginal delivery were included in this study. Patients were assigned randomly into Manual vacuum aspiration (MVA) and Dilatation and Curettage (DNC) groups using the draw randomization technique. Data regarding the efficacy of both procedures and procedural success rate was measured in all patients. Results: A total of 182 Adult female patients, with a mean age of 30.53+5.23 years, having miscarriage in the first trimester, were evaluated. The mean gestational age at the time of abortion was 8.64+1.30 weeks, and the mean parity of study females was 1.96±0.82. The procedure was successfully done in 87(95.6%) patients in the MVA Group versus 84(92.3%) in the D&C Group (p-value 0.35). Conclusion: Manual vacuum aspiration (MVA) is an effective and safe method of abortion with a success rate comparable to that of Dilatation and Curettage (D&C).