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? ???? ???? ?????? ??????Sudan International UniversityFaculty of MedicineDepartment of Obstetrics and GynecologyDilatation and curettage versus manual vacuum aspiration treatment of early abortion at Maternity Hospital and Sharg Al Nile Hospital 2018Partial fulfillment for M.B.B.S degreeBy: Mohand Adam Salih MohamadeinMohamed Ibrahim Awad AmasiabAlmustafa Emad Abdakazim Supervisor:1st January 2018 — 31 June 2018Table of content Content Page Introduction 1Objectives3Literature Review                                            4Methodology5Ethical Considerations6Work Plan7Budget8References List99Introduction                                                                                             :Pregnancy is often defined as implantation and development of the embryo in the endometrial lining of the uterus. After implantation takes place inside the uterine endometrium is called decidua. The placenta is formed partly from decidua and partly from outer layers of the embryo.Abortion is a pregnancy that ends spontaneously before the fetus has reached a viable gestational age or fetus weight less than 500g. At present, the legal definition of abortion in the UK is spontaneous loss of pregnancy at or before 24 weeks gestation. Some studies suggested that 10-20% of all pregnancies worldwide end in abortion nearly half of these abortions are unsafe and often illegal. Types of AbortionClinically, abortion can be classified into different types based on the clinical presentation and investigation findings.Threatened abortion:A threatened Abortion defined as painless vaginal bleeding occurring before 24 weeks gestation, Cervix is closed, normal human chorionic gonadotropin for gestational age. The bleeding may resolve spontaneously in few days, or it may continue over several days or weeks, the diagnosis is based on clinical examination(closed cervix), ultrasound play role in reassuring that the fetus is alive and developing normallyInevitable Abortion: Painful bleeding , the cervix is open but no product pass , the gestational sac may be felt , the process now is irreversible and uterus will expels the product of conception. It may be complete or incomplete.Incomplete abortion: It occurs when some products of conception passed and some are left in the uterine cavity. The diagnoses is made clinically if tissue is seen passing through an open cervical os or in ultrasound.Complete abortion: Uterus pass all the product of conception. The diagnoses is made clinically when bleeding is stops and pain disappear, or on ultrasound when the uterine cavity is empty. Septic abortion: Infection accompanies abortion, the woman will present with offensive vaginal discharge, and fever. These case should be admitted for intravenous antibiotic and surgical evacuation.Management optionsTraditional treatment consisting of surgical evacuation of the uterus remains the treatment of choice in unstable patients. Recent studies suggest that expectant or medical management is appropriate in selected patients. These methods are all safe and effective.The most common method for the first trimester is vacuum aspiration or suction curettage. Vacuum uterine aspiration allows for the simple evacuation of the uterus through a cannula attached to either an electric or manual vacuum source.Although the success rate of medical abortion using modern regimens of Mifepristone and Misoprostol typically exceeds 95%, aspiration is sometimes necessary for management of continuing pregnancy, a persistent gestational sac or heavy prolonged bleeding. Manual vacuum aspiration offers an alternative to dilatation and curettage in management of these situations.MVA is safe and effective method for completing first-trimester abortions and the simple technique can considerably improve post-abortion care in hospitals. It is highly recommended for management of first trimester incomplete abortion in not only primary health centers but also in secondary and tertiary centers. Some studies have shown that dilatation and curettage which requires the use of anesthesia in the theatre is the most common method used in hospital for abortion and management of incomplete abortion due lack of training and availability of MVA equipment in such health facilities.Problem statement                                                                                                   : Manual vacuum aspiration a safe and  cost effective substitute for dilatation and curettage which requires a trained personnel, operating room, presence of an anesthetist and sometimes blood transfusion. Despite careful and skilled intervention, even in best hands complications can occur.  Justification                                                                                                             :Abortion is universal, some studies show that 10-20% of all pregnancies worldwide end in abortion, Hence there is a need to early post abortion care.the safety and efficacy of procedure used is therefore of global public health importance to avoid complications, Some of them are life threatening (e.g. septic shock) and are also likely to cause life-long problems like infertility.The safe method to prevent this complication is surgical termination by Manual vacuum aspiration.Objectives                                                                                                               :General : To compare dilatation and curettage and manual vacuum aspiration as methods of treatment of early abortion.Specific :To know the duration of each ProcedureTo know the duration of hospital stay To identify the complicationTo estimate the amount of blood loss on account of ProcedureTo determine in which one antithesis is use    Literature Review                                                                                            :The research was done to compare the efficacy and safety of manual vacuum aspiration with dilatation and curettage in the management of first trimester abortion. Study Design is prospective randomized study was conducted between January 2010 to December 2012, to Four hundred women presenting with spontaneous abortion with gestational age <12 weeks were included in the study, these patients underwent either MVA group (n=200) or D&C group (n=200). Primary outcome measures were efficacy and secondary outcome measures were duration of hospital stay, operating time and cost.Results: Overall, (MVA) was 97 % effective in terminating pregnancy through 12 weeks of gestation. The mean duration of procedure was significantly higher (p<0.001) in D&C (14.3±3.8 minutes) as compared to (6.3±1.6 minutes) in MVA. The duration of hospital stay was significantly lower (p<0.001) in MVA group (3.5±0.9 hours) as compared to (19.2±3.1 hours) in D&C group. Similarly the cost of procedure was also significantly lower (p<0.001) in MVA group ($48.8±6.5) compared to ($ 146.1±13.7) in D&C group. Methodology                                                                                                          : Study design:Prospective (Observational Hospital based study) Study setting:Omdurman Maternity Hospital and Sharg Al Nile Hospital Study population:This study was carried on all patients attended to gynecology casualty with bleeding in early pregnancy agreed to be included in the study and to assess maternal condition till her discharge from Hospital. The study group was categorized according to their course of management into two groups:  Group 1: Cases treated with D&C. Group 2: Cases treated with MVA.Study duration:1st January 2018 — 31 June 2018Sample size:All patients with early abortion patients who agreed to be include in this study The study sample consisted of 120 patients, 60 Cases treated with D&C and 60 Cases treated with MVA.Sampling technique:Random sampleData collection tools:Questionnaire Variables: Independent variable: Methods of treatment of early abortionDependent variables: Duration of Procedure, duration of hospital stay, complication, amount of blood loss, and use of antithesis.Data Analysis The data will analyzed by computer program (SPSS) and presented in tables, graphs; chart and the test of significant will calculated by (P value).Ethical considerations                                                                                  : The ethical clearance from the institutional review board at Sudan international university.Permission from faculty authorities Permission from Omdurman Maternity Hospital and Sharg Al Nile HospitalVerbal consent from patients Work plan                                                                                                                :Gantt chart: Work activitiesJanFebMarAprMayJunJulSamplingData collectionData analysisInterpretationFinishing research Budget                                                                                                                        :Cost (SDG)Budget breakdown 400stationary 120Typing180Photocopies465Transportation 500Unseen 1665Total  Reference list                                                                                                             :