Manual versus electric vacuum aspiration for first‐trimester abortion: a systematic review

Abstract

Background As an alternative to electric vacuum aspirations (EVA), there is an increasing interest in using manual vacuum aspiration (MVA).Objective To compare the safety, efficacy and acceptability of MVA with those of EVA for first-trimester abortion.Search strategy We searched MEDLINE, EMBASE, Cochrane Library and Chinese Biomedical Database in all language, together with reference lists of retrieved papers.Selection criteria Randomised controlled trials comparing MVA with EVA for first-trimester abortion were included. The outcomes are complete abortion rate, uterine perforation rate, blood loss, pain perception and acceptability.Data collection and analysis Two reviewers independently extracted the data. Results from the trials were combined to calculate relative risks (RRs) or risk differences for dichotomous outcomes and weighted mean differences (WMDs) for continuous outcomes, together with 95% CIs.Main results Ten trials were included, involving 1660 women. Generally, the methodological quality was poor. There were no statistically significant differences, comparing MVA with EVA, in complete abortion rate (RR 1.00; 95% CI 0.99-1.02) and participants' satisfaction (RR 1.02; 95% CI 0.87-1.20). In participants with less than 50 days of gestational age, less blood loss (WMD -1.84; 95% CI -2.45 to -1.23) and less severe pain perception (RR 0.04; 95% CI 0.01-0.12) were reported during the MVA procedure, whereas the operation time was shorter (WMD 0.32; 95% CI 0.02-0.63) in the EVA procedure.Author's conclusions There is some evidence that MVA is as effective and acceptable as EVA and might be safer than EVA.Keywords Abortion, electric vacuum aspirations, manual vacuum aspiration, meta-analysis, randomised controlled trial, systematic review.Please cite this paper as: Wen J, Cai Q, Deng F, Li Y. Manual versus electric vacuum aspiration for first-trimester abortion: a systematic review. BJOG 2008;115:5-13.

A comparative study between manual vacuum aspiration and electrical vacuum aspiration for the first trimester medical termination of pregnancy

“…The operating time for MVA was significantly longer than EVA in our study. Similar observations were made by Wen et al 7 in BJOG 2007 in the meta analysis of 10 studies with a gestational age of less than 50 days and by Nasira et al 8 in 2011 (Operating time (min) mean ± SD 10.71 ± 2.770 for MVA and 9.59 ± 2.880 for EVA, P<0.01).…”

The Incidence of Menstrual Regulation Procedures and Abortion in Bangladesh, 2010

“…This is a minimum estimate because some women in this situation would not have obtained treatment. This rate is much higher than that found when the procedure is performed by trained personnel in hygienic settings,* [4][5][6] and is an indicator of the extent to which unsafe MR is taking place.…”

“…The ratio of induced abortions to live births was 18 per 100 nationally; Khulna and Rajshahi had the highest abortion ratios (34 and 25, respectively), while Barisal, Chittagong and Sylhet had the lowest (6)(7)(8)(9)(10)(11)(12)(13)(14). This measure is an indicator of the likelihood that, once pregnant, a woman will have an induced abortion: The national ratio of 18 per 100 births means that approximately one woman has an induced abortion for every five who give birth.…”

“…* The MR program is considered to contribute significantly to protecting women's health; 1 manual vacuum aspiration, which is recommended by the World Health Organization, 2,3 has a very low rate of complications and mortality when performed by trained staff in hygienic conditions. [4][5][6] However, unsafe induced abortions are still widely performed in Bangladesh. The national rate of MRs and induced abortions combined was 28 per 1,000 women aged 15-44 in 1995 (based on indirect estimation techniques), 7 the same rate as in South-central Asia in that year.…”

First Trimester Procedural Abortion in Family Medicine

“…A recent meta-analysis examined the complication rates of EVA versus MVA for firsttrimester procedural abortion and concluded that MVA may be marginally safer. 25 In addition, complication rates are increased by including patients with pregnancies at 12 to 14 weeks gestation. For example, all 12 cases of postabortion vaginal bleeding requiring hospitalization occurred in this gestational age range.…”