Manual Vaccum Aspiration : An alterative to the standard surgical curettage , First experience in Iraq


  • Azhar A. AL-Adhub F.I.C.O.G. , D.O.G. , Member of British Fertility Society and ESHRE


     Manual vacuum aspiration ( MVA ) or Karmah Cannula is a soft flexible Cannula invented by Harvey Karman in early 1970s . This can be performed under local anesthesia in the setting of a treatment room and office .

The aim of this study:  To assess the efficacy of MVA in the management of first trimester early fetal demise , missed abortion up to 13 weeks and incomplete miscarriage, and it if can be used as successful alternative to traditional method of sharp surgical curettage

Material and method: This was an interventional  prospective study including 200 patients  who were scheduled to undergo MVA for 1st trimester early fetal demise and incomplete miscarriage . The study population consist of 200 patients who were diagnosed as having missed abortion by ultrasound abdominal and Trans-vaginal ultrasound. The study conducted between January 2014 – until January 2016 . The efficacy assessed by completion of evacuation evaluated immediately by ultrasound conducted in the same clinic and second look ultrasound after one week of the procedure .

Result: Efficacy of the procedure was 99% and incomplete uterine evacuation was seen in 1% of patients .     No significant rate of complication like uterine perforation , infection , or excessive vaginal bleeding .

More than 99% of cases has a successful procedure and did not required any further surgical or medical treatment 98% of women were satisfied with the procedure and they will recommend it to others .

This study proved that MVA is super to the traditional use of D & C with metallic tools by avoidance of hospital stay and general anesthesia and will decrease the daily work load for medical staff.

Conclusion :

     Manual vacuum Aspirator ( MVA ) is safe , effective and minimally invasive procedure with low rate of complication .

Moreover , it can be carried our safely and effectively in office or medical clinic and no need for hospital admission , occupying the operating theatre and medical staff involvement. It even cost effective in comparism with surgical dilatation and curettage which is held under general anesthesia in operating theatre  of Hospitals .

Recommendation: This study may change the traditional use of dilatation and curettage with metallic tools and replaced by MVA with avoiding of general anesthesia and the need for access to the theater




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