1. Manual Vacuum Aspirator- A Safe and Cost Effective Tool for Decentralization of Post Abortion Care N Tasnim, G Mahmud, S Fatima Maternal and Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad. Pakistan Introduction Objective To assess safety and efficacy of office based Manual Vacuum Aspiration (MVA) in comparison with inpatient based elective procedure. Materials and Methods A single-centre randomized controlled trial was conducted at MCH centre, PIMS, Islamabad from January 2009 to January 2010. Inclusion Criteria Anembryonic pregnancy Incomplete miscarriage Missed miscarriage Exclusion Criteria Bleeding disorders Hemodynamic instability Hemoglobin <8g/dl Medical disorders Severe anxiety Molar and septic induced abortion A total of 177 women with gestational age less than 12 weeks met the inclusion criteria. Cases which presented in odd dated days underwent MVA in operation theatre while those in even dated days underwent MVA as outdoor procedure. Statistical Analysis Data was analyzed through SPSS version 15. Chi square and student t-test were used for categorical and continuous variables respectively. Results Baseline characteristics Day care group n=78 Indoor group n=99 p-value Age(yrs) mean±SD 27.15±4.727.2±5.200.949 Gestational age (wks) mean±SD 9.927±1.2589.727±1.4580.338 Parity,n(%) -Primigravida -Multigravida -Grandmultigravida 25(32.0) 38(48.7) 15(19.2) 32(32.3) 60(60.6) 7(7.07) 0.043 Indication for procedure,n(%) -Incomplete miscarriage -Missed miscarriage -An embryonic pregnancy 37(47.4) 28(35.8) 13(16.6) 45(45.5) 38(38.3) 16(16.2) 0.944 Co-existing risk factors,n(%) Low risk patients High risk patients -Previous I LSCS -Previous II LSCS -Previous III LSCS -Diabetes mellitus -Previous pelvis surgery 76(97.4) 1(1.28) 0(0) 1(1.28) 0(0) 88(88.8) 2(2.02) 4(4.04) 1(1.01) 3(3.03) 0.401 Ultrasound parameters mean±SD -Crown-rump length (CRL),mm -Gestational sac diameter,mm -RPOCs,mm 51.21±9.50 26.36±6.74 52.94±9.19 46.27±10.85 29.49±8.94 58.39±6.55 0.69 0.08 0.06 Complete evacuation rate (success rate) P<0.05 Outcome measures assessed were complete evacuation rate of the procedure, mean blood loss, mean hospital stay, mean hospital cost and procedure related complications (uterine perforation, hemorrhage, infection and vagal shock) Safety and effectiveness of MVA as an outdoor procedure Day care group n=78 Indoor group n=99 p-value Hospital stay(hrs) mean±SD 2.72±0.50712.30±6.89<0.05 Hospital cost(Rs) mean±SD 779.49±49.3041428.03±1363.72<0.05 Mean blood loss(ml) mean±SD 59.62±16.7858.99±27.68>0.05 Uterine perforation 0(0)2(2.02)0.207 Evacuation rate was significantly higher in women undergoing MVA as daycare procedure. The remaining cases required sharp curettage for the completion of process in both the groups. Hospital stay and cost was significantly reduced in the day care group as compared to indoor group whereas the mean blood loss was comparable in both the groups. Only 2 cases of uterine perforation were noted in the indoor group. Conclusion MVA in office setting is safe, cost-effective and reduces hospital stay as compared to inpatient based management. The intervention provides an excellent opportunity for decentralization of post abortion care. Incorporation of evaluation of patients’ satisfaction and choice would further strengthen the model. References Day care groupIndoor group 100% Paracervical block +systemic analgesia 100% Paracervical block +systemic analgesia 95.9% Paracervical block +systemic analgesia 95.9% Paracervical block +systemic analgesia 4.04% General anesthesia 4.04% General anesthesia Type of anesthesia used Manual vacuum aspiration (MVA) is a preferred surgical option for the management of first trimester pregnancy losses. It is superior in terms of being light weight, inexpensive and can be performed under local anesthesia and does not require electricity. It is especially valuable in low resource settings where electricity and surgical suites and not widely available 1. Management of early pregnancy failure has moved from operating room to ambulatory setting, however the experience is limited and concerns are enormous 2,3. There is only limited data on use of MVA for surgical management of early pregnancy loss and no local data is available with regards to its use in office setting. Tasnim N, Mahmud G, Fatima S, Sultana M. Manual vacuum aspiration: a safe and cost-effective substitute of electric vacuum aspiration for the surgical management of early pregnancy loss. J Pak Med Assoc 2011;61:149-53. Dalton VK et al. Patient preferences, satisfaction, and resource use in office evacuation of early pregnancy failure. Obstet Gynecol 2006 Jul; 108:103. Westfall JM, Sophocles A, Burggraf H. Manual Vacuum Aspiration for first-trimester abortion. Arch Fam Med. 1998;7:559-62.