Complications with manual vacuum aspiration
| Patient | Complication | Outcome |
|---|---|---|
| 1 | MVA for uterine evacuation 4 weeks post-EMA. Presented with moderate bleeding despite further misoprostol and antibiotics. Scan showed retained products measuring 4×2.5×3 cm with very high flow. Brisk loss of 200 ml as soon as instrumented. Controlled with bimanual compression and Syntometrine® | Moderate loss continued for 2 hours. Remained in the unit 5.75 hours, longer than any other case. Histology showed necrotic decidua and scanty villi |
| 2 | Para 3, 7 weeks. Initial failed dilatation due to rigid cervix and pain. Further misoprostol and completion of MVA with ultrasound guidance 1–2 hours later. Ultrasound demonstrated that the initial failure had been associated with a false passage at the point of retroflexion. Procedure completed with ultrasound guidance and IUS fitted | High pain score (9) at initial attempt. At follow up the IUS was missing and perforation confirmed. In retrospect it was unwise to have inserted the IUS when false passage had occurred even though it was possible to complete with ultrasound guidance |
| 3 | Para 0, 9 weeks 4 days. Cervical rigidity. Not possible to dilate beyond 6–7 mm. Performed through a 7 mm suction catheter which blocked repeatedly | High pain score (7). Incomplete – 3×2 cm area of retained products managed conservatively |
| 4 | Para 0, 7 weeks 5 days. Rigid cervix and prolonged bleeding | Uterus empty at follow-up scan |
| 5 | Prolonged bleeding. Small amount of retained products did not resolve despite misoprostol and antibiotics | Repeat MVA with antibiotic cover. Bleeding settled |
| 6 | Possible allergic reaction. Stridor and a rash followed administration of misoprostol and diclofenac. Settled with hydrocortisone and antihistamine | Moderate fresh blood loss at MVA (<150 ml) settled with Syntometrine |
EMA, early medical abortion; IUS, intrauterine system; MVA, manual vacuum aspiration.