Manual Vacuum Aspiration for First Trimester Pregnancy Loss

Manual Vacuum Aspiration for First Trimester Pregnancy Loss Dr. Sindhoo TO DETERMINE THE EFFICACY OF MANNUAL VACUM ASPIRATION IN MANAGEMENT OF FIRST TRIMESTER PREGNANCY LOSS INTRODUCTION: An estimated 46 million abortions are performed globally each year, with one-third of all abortions are performed under unsafe conditions leading to 13% of all maternal death1. 10–12% of these abortions are performed in the early first trimester1, 2. Local data shows an annual abortion rate of 29 per 1000 in women aged 15-49 years. Incomplete and missed miscarriage being the commonest occurs in approximately 15 % of clinically recognized pregnancies and in 890,000 women per year3. One study conducted by Shonali Agarwal and Dolly Gupta reported the efficacy of MVA 90% in management of first trimester pregnancy loss5. First trimester of pregnancy ranges between 5–13 weeks and is associated with 3 to 5 times lower maternal mortality and morbidity risks than termination during second trimester4. Although the etiologies of first trimester loss are multi factorial and often remain unknown, certain risk factors increase the likelihood of pregnancy loss. Findings such as absenc e of cardiac activity after 5 wks, gestational sac smaller than expected for dates, an abnormal-appearing yolk, intrauterine hematoma (sub chorionic hemorrhage), vaginal bleeding after 7 weeks of gestation are potential markers for subsequent pregnancy loss4. Once a first trimester pregnancy loss has been diagnosed, there are three forms of management: expectant, medical, or surgical evacuation (with electrical or manual vacuum aspirator). The optimal mode of management is determined by gestational age, whether the pregnancy loss is delayed or incomplete, maternal hemodynamic stability, the presence of infection, and, most importantly, patient preference5. Manual vacuum aspiration (MVA) employs a vacuum pump in which the vacuum is created using a hand-held, hand activated plastic syringe. 4,5,6 Manual vacuum aspiration is safe, effective, easy to use, portable, and reusable. It is appropriate for use in many different clinical settings (Including office, emergency room, or the operating room) thus avoiding the need for the use of an operating theatre and the risks of general anesthesia. It does not require lengthy training for proper operation, and may be performed by a wide range of trained medical personnel including midwives and nurses. When conducted in the outpatient setting rather than operating room, manual vacuum uterine aspiration can result in substantial cost savings, electrical power saving and significant reduction in procedure time (3.7 minutes for MVA vs. 10.2 minutes for DC).The World Health Organization (WHO) recommends MVA as a preferred method of uterine evacuation2,7. RATIONALE: On robust literature search there was scant relatively old data available on efficacy of MVA but no one focused on efficacy of manual vacuum aspiration in management of first trimester pregnancy loss. This provide me the strong rationale to conduct this study, the aim of my study is to set a baseline data which will help to generate the current local statistics of MVA in terms of efficacy on this particular group of women with loss of pregnancy. If we found the significant efficacy of MVA then we will recommend MVA as first line of treatment in future in management of first trimester pregnancy loss. OBJECTIVES: The aim of our study is to determine the efficacy of Manual vacuum aspiration in management of first trimester pregnancy loss. OPERATIONAL DEFINITION: FIRST TRIMESTER PREGNANCY LOSS: An abortion is the spontaneous or induced loss of an early pregnancy. Miscarriage occurs within 12 weeks of gestation will be confirmed on ultrasound. EFFICACY: If an empty uterus with no evidence of retained products of conception seen within 24 hours on Ultrasound will be label as efficacy positive. MATERIAL AND METHODS: SETTING: Liaquat university hospital Jamshoro /Hyderabad DURATION: Six months after approval of synopsis. STUDY DESIGN: Case series study. SAMPLE SIZE: By using WHO sample size calculator taken efficacy of MVA i.e P=90% (5) margin of error (d) = 5.5% confidant interval 95% then the estimated sample size will be at least n=115. SAMPLING TECHNIQUE: Non-probability consecutive sampling INCLUSION CRITERIA: All women with gestational age of ≠¤ 12 weeks confirm from last menstrual period with pregnancy loss (as mention in operational definition) Age 18-35 years Women with any parity Exclusion Criteria: Women who are hemodynamically unstable (systolic B.P Ectopic pregnancy assess on ultrasound Known systemic disease including hepatic or renal dysfunction. Had a history of cervical surgery. DATA COLLECTION PROCEDURE: All patients fulfilling inclusion criteria and not having any of exclusion criteria attending Outpatient department/emergency department of Liaquat university hospital Jamshoro after evaluation by consultant will be included in the study. Informed consent will be taken from each patient about procedure and this study. Approval of the ethical committee will be sought. Patients will undergo elective abortion. All operations will be performed by fourth year residents under supervision of consultant having more than 5 years of post-fellowship experience. Intravenous anesthesia will be used in all the cases. Manual vacuum aspiration will be performed under par cervical block with 10-20 ml of 1% lignocaine using Glick technique3. MVA will be performed using a flexible Ipas Easy Grip cannula attached to a 60 ml syringe (aspirator), with a double locking valve mechanism. To assess the efficacy(as mentioned in operational definition) of MVA. Patients will be fallowed till 24 hours. Demographi c variables of name, gestational age, and parity will be noted. The final outcome in terms of efficacy will be noted after 24 hours will be recorded on approved Performa. DATA ANALYSIS PROCEDURE: Statistical analysis will be performed using statistical software SPSS version 16 on computer. Mean  ± standard deviation will be calculated for age gestational age and parity. Frequency and percentage will be calculated for efficacy. Effects modifier will be controlled through stratification of age gestational age and parity to see the association with outcome i.e (efficacy) by applying Chi-square test taking P≠¤0.05 will be considered statically significant. REFERENCES Wen J, Cai QY, Deng F, Li YP. Manual versus electric vacuum aspiration for first-trimester abortion: a systematic review. BJOG. 2008 Jan;115(1):5-13.Review. PubMed PMID:18053098. Yan J, Saravelos SH, Ma N, Ma C, Chen Z-J, Li T-C. Consecutive repeat miscarriages are likely to occur in the same gestational period. Reproductive BioMedicine;2012;24:634-38. 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 Feb;61(2):149-53.PubMed PMID: 21375164. Allison JL, Sherwood RS, Schust DJ. Management of first trimester pregnancy loss can be safely moved into the office. Rev Obstet Gynecol. 2011;4(1):5-14.PubMed PMID: 21629493; PubMed Central PMCID: PMC3100102. 5. Agarwal S, Gupta D. Comparison of manual vacuum aspiration (mva) versus traditional suction evacuation in first trimester medical termination of pregnancy. Int J Res Med.2013;2(1);11-14. Farooq F, Javed L, Mumtaz A, Naveed N. Comparison of manual vacuum aspiration,and dilatation and curettage in the treatment of early pregnancy failure. J Ayub Med Coll Abbottabad. 2011 Jul-Sep;23(3):28-31. PubMed PMID: 23272429. Harwood B, Nansel T; National Institute of Child Health and Human Development.Management of Early Pregnancy Failure Trial. Quality of life and acceptability of medical versus surgical management of early pregnancy failure. BJOG. 2008 Mar;115(4):501-8. Doi: 10.1111/j.1471-0528.2007.01632.x. Pubmed PMID: 18271887;pubmed Central PMCID: PMC2424403. PROFORMA TO ASSESS THE EFFICACY OF MANUAL VACUUM ASPIRATION IN MANAGEMENT OF FIRST TRIMESTER PREGNANCY LOSS Date: ________________ Reg No: serial No: ___________________ Name: W/O Age: Gestational age: weeks Parity: EFFICACY: YES NO

Journal on “The Storm” by Kate Chopin Essay

The storm sets in motion the chain of events that leads to the characters adultery. Do you think the storm excuses the characters in any way from responsibility for their actions?In her short story The Storm, Kate Chopin creates a situation where two people give in to their sexual desire with the help of the outside setting. Although the threatening appearance of the storm does incite the deep rooted emotion; the couple is not excused from their treacherous act since they are well aware of their sin. As the story begins, Bobinot and Bibi are sitting inside of a store watching the approaching storm, worrying about Calixta at home. However at home, Calixta is not aware of the coming downpour or her wicked act about to take place. It is not until it grows dark that she realizes the situation and closes the windows and gathers the laundry. That is when Alcee comes along riding on his horse, which exposes Calixta to a decision: to let this man in for shelter during the storm, or let him drench in the rain. Eventhough Calixta and Alcee were old lovers they are now married to other people. They had not seen each other very often since her marriage, and never alone. Her decision to let the man in is the beginning of the rising storm foretells the events that are to come. Once she chooses to allow him to enter her house, she begins to panic and worry, not only that what she was getting herself into was wrong, but also about her family who was still stuck out in the storm. The storm caused each person to make a quick decision, for Bibi and Bobin the quick decision was where to go once the storm had begun, for Alcee the quick decision to ask his married ex lover for shelter, and Calixta was given the most complex decision, which was whether or not to let Alcee come in. Another factor that attributes to the symbolism in this story is that as the storm grows more intense, so do the actions of Calixta. The fact that at first when she let Alcee in, she was worried for her husband and son only adds to her immorality. She cares about her family, and they worry for her; her marriage may not e perfect but also not a failure. When Calixta and Alcee encounter their betrayal act, it is their sexual desire that drives them, the natural force just like the storm. As more tension in the storm builds up, more tension increases between the two inside the house. The storm does not only destroy the characters property, but it also destroys the trust and faith on which th eir marriages are based on. When they finish, Calixta watched Alcce ride away, He turned and smiled at her with a beaming face; and she lifted her pretty chin in the air and laughed aloud. They do not feel ashamed of their action; they even feel glad with their physical satisfaction. After Bobinot and Bibi come home she is pleased that they return safely but she does not show any regret on what she has done. She appears cheerful and full of energy. Bobinot thought she would be worried because of the storm and had brought her a can of shrimps to make her feel better, however they laughed so much and so loud that anyone might have heard them as far away as Laballieres. Only a liar and betrayer could do such deceitful action and then laugh as if nothing happens. As for Alcee, he comes home and writes his wife a loving letter telling her not to hurry back, and says he misses her and their kid. He also is a liar but in his case, his wife also enjoys being away from him. Since the marriage does not seem to be a success, it is understandable how he would cheat on his wife. But for Calixta, she has a loving husband and a caring son; she could not have committed this crime without shame. In some cases the environment makes extraordinary things happen, whereas in normal circumstances people would not act the same way. However, it is in the human will that they choose to make a decision; it is their heart which is whether weak or strong to refuse a temptation. Unlike the natural forces that are uncontrollable, peoples minds are of their own and thus they should be considerate of their moral and wrong doings. Work Cited Chopin, Kate. The Storm. Rpt. in Compact Literature ReadingReacting Writing. By Kirszner and Mandell. 6th ed. 2007.

A Male Dominant Society - 1816 Words

In order to create a logical and reason based argument that the modern society is still tilted towards a male dominant society, or what the sociologists refer to as a patriarchal society, it is pivotal that a thorough understanding of the characteristics of a patriarchal society is developed. When a strong grasp of the ideas of a patriarchal society is developed then we will be in a position to argue that it is in fact the commoditization of the female sexuality through media and other popular mediums that is fueling this ‘persistence’ of male dominance. Whatever the case is, sociologists are agreed on one fact that prostitution and pornography are not helping women’s case in ‘demands’ of equal rights and status in the society. Patriarchal system The term patriarchy literally means ‘rule of the father’, the origin of the term comes from the Greek word ‘patrairkhes’ which translates into ‘father of a race’ or ‘chief of a race’ (Ferguson 1999). 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The Roaring Twenties, the Jazz Ages and the Age of...

In the 1920’s there were many name like the roaring twenties, the jazz age, and age of paranoia. Flappers and bootleggers were found at this time. They smuggled rum in small flasks inside their boots; this is where they get the name bootleggers from. All of the men who smuggled the rum in their boots had a run-in with the cops; this is how the sport NASCAR came around. Flappers were women who cut their hair short and wear skirts about their knees. The well known things of the 1920s were the roaring twenties, the jazz age, and the age of paranoia. 1st topic The roaring twenties http://www.thegreatdepressioncauses.com/causes.html The great depression was a major part of the Roaring twenties. When the stock market crashed in†¦show more content†¦3rd topic During the age of paranoia 1920s, the rebirth of the Ku Klux Klan (KKK) was started back in a church by a pastor; the KKK was first found in 1866, and settled down in 1890s. The name of the KKK was derived from the Greek word kyklos, which means circle. Also, part of the Paranoia was two Italians, Sacco and Vanzetti they were convicted of robbery and murder; they were the main people accused because there was not from American. However the final time in court they were rejected and sentenced to death. Most people feared the unknown, but we should not be judged by the color of our skin but by the content of our characters (doc. Martin Luther King Jr. I have a dream speech). It was not fair for people to falsely accuse Sacco and Vanzetti, just because of there race and there different skin color. Furthermore, the Emergency Quota Act (EQA) also known as Emergency Immigration Act of 1921, this act was put in place since they wanted to limited the numbers of immigrants who would be admit ted from any country annually to 3% (but soon the act dropped 1%) of the number of residents from that same country who lived in the United States (http://www.princeton.edu/). The age of paranoia was a respectable name from this event because the paranoia was the fear of the unknown. They fear the unknown for the reason that they did not know what to except next and how toShow MoreRelatedThe Roaring Twenties3168 Words   |  13 Pagesisolationist minds of Americans in the roaring twenties focused on the dream of total freedom as they strove towards liberation in their daily lives, and were represented by the authors of the modernist fiction era. Throughout the 1920s decade, Americans were a part of the fevered frenzy that accompanied the dream of total freedom; a dream that encompassed the ideas of rebellion and equality. Lucy Moore, author of Anything Goes; a Biography of the Roaring Twenties, describes how Walter Fabian utilizedRead MoreThe Studio System Essay14396 Words   |  58 Pages(Rutgers Univ. Press, New Jersey), 1995. Academy Awards Database -- http://www.oscars.org/awards_db/index.html William Cameron Menzies Filmography -- http://us.imdb.com/M/person-exact?Menzies%2C+William+Cameron Hollywoods Golden Age: An Overview Any deep understanding of American film history pivots on an understanding of the studio system, or what scholars often refer to as Americas specific mode of film production, typically placed in the years 1930-48.