Incomplete miscarriage during the first trimester: a comparison of indoor versus outdoor procedure

  • Faiza Iqbal cpsp
  • Sadia Azmat
  • Rabia Jamshaid
  • Zunaira Arshad
  • Anum Saqib
Keywords: Evacuation & curettage, Manual Vacuum Aspiration, Incomplete Miscarriage.


Introduction: Miscarriage is defined as the natural death of a fetus inside the uterus. To remove complete conception material after a miscarriage, vacuum aspiration or dilatation & curettage are methods to remove uterine contents. Controversies exist regarding both procedures. So we conducted this study to confirm the more successful method.

Objective: To compare the effectiveness of manual vacuum aspiration versus traditional evacuation and curettage (E & C) among females presenting with incomplete miscarriage during the first trimester of pregnancy

Materials and Methods: This randomized controlled trial was done at the Department of Obstetrics & Gynecology, Shalamar Hospital, Lahore for 6 months. Then the selected females were divided randomly into 2 equal groups. In group A, females had manual vacuum procedure while in group B, females had evacuation & curettage under general anesthesia. After 12 hours of the procedure, ultrasonography was done to confirm complete evacuation.

Results: The mean age of the patients was 29.87 ± 6.71 years, the mean gestational age was 8.06 ± 2.82 weeks. The effectiveness was noted in 248 (91.85%) patients. Statistically, manual vacuum showed significantly more effective as compared to evacuation & curettage procedure in the management of incomplete miscarriage i.e. p-value = 0.008.

Conclusion: It has been proved that manual vacuum aspiration is more effective than traditional evacuation & curettage in the management of incomplete miscarriage.


1. Saad AF, Rahman M, Costantine MM, Saade GR. Blunt versus sharp uterine incision expansion during low transverse cesarean delivery: a metaanalysis. Am J Obstet Gynecol 2014;211(6):684. e1-. e11. DOI: 10.1016/j.ajog.2014.06.050.
2. Asıcıoglu O, Gungorduk K, Asıcıoglu BB, Yıldırım G, Gungorduk OC, Cemal A. Unintended extension of the lower segment uterine incision at cesarean delivery: a randomized comparison of sharp versus blunt techniques. Am J Perinatol 2014;31(10):837-44. DOI: 10.1055/s-0033-1361934.
3. Horsager R, Roberts SW, Rogers VL, Santiago-Muñoz PC, Worley KC, Hoffman BL. Williams obstetrics, study guide: McGraw Hill Professional; 2014.
4. Briscoe KE, Haas DM. Developing a core outcome set for cesarean delivery maternal infectious morbidity outcomes. Am J Perinatol 2020;37(04):436-52. DOI: 10.1055/s-0039-1681095.
5. Er P, Na IJR. The outcomes of extending uterine incision transversely or cephalocaudally in patients with previous cesarean section: a prospective randomized controlled study. Offic Pub Perinat Med Found 2017;25(1):1-5. DOI: 10.2399/prn.17.0251001
6. Bligard KH, Durst JK, Stout MJ, Martin S, Cahill AG, Macones GA, et al. Risk factors and maternal morbidity associated with unintentional hysterotomy extension at the time of cesarean delivery. Am J Perinatol 2019;36(10):1054-9. DOI: 10.1055/s-0038-1676112
7. Wikipedia. Vacuum aspiration. 2016 [cited 2016]; Available from:
8. Dugas C, Slane VH. Miscarriage. Online: NCBBI; 2020 [cited 2020]; Available from:
9. Shaikh Z, Abbassi RM, Rizwan N, Abbasi S. Morbidity and mortality due to unsafe abortion in Pakistan. Int J Gynecol Obstet 2010;110(1):47-9. DOI: 10.1016/j.ijgo.2010.01.028.
10. Ammon Avalos L, Galindo C, Li DK. A systematic review to calculate background miscarriage rates using life table analysis. Birth Defects Res Part A: Clin Mol Teratol 2012;94(6):417-23. DOI: 10.1002/bdra.23014.
11. Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SE, Horne AW. The role of infection in miscarriage. Hum Reprod Update 2016;22(1):116-33. DOI: 10.1093/humupd/dmv041.
12. Nguyen BT, Chang EJ, Bendikson KA. Advanced paternal age and the risk of spontaneous abortion: an analysis of the combined 2011–2013 and 2013–2015 National Survey of Family Growth. Am J Obstet Gynecol 2019; 221(5):476. e1-. e7. DOI: 10.1016/j.ajog.2019.05.028.
13. Hurley EG, DeFranco EA. Influence of paternal age on perinatal outcomes. Am J Obstet Gynecol 2017;217(5):566. e1-. e6. DOI: 10.1016/j.ajog.2017.07.034.
14. Schreiber CA, Creinin MD, Atrio J, Sonalkar S, Ratcliffe SJ, Barnhart KT. Mifepristone pretreatment for the medical management of early pregnancy loss. New Engl J Med 2018;378(23):2161-70. DOI: 10.1056/NEJMoa1715726.
15. Colleselli V, Nell T, Bartosik T, Brunner C, Ciresa-Koenig A, Wildt L, et al. Marked improvement in the success rate of medical management of early pregnancy failure following the implementation of a novel institutional protocol and treatment guidelines: a follow-up study. Arch Gynecol Obstet 2016;294(6):1265-72. DOI: 10.1007/s00404-016-4179-6.
16. Fonseca W, Misago C, Fernandes L, Correia L, Silveira D. [Use of manual vacuum aspiration in reducing cost and duration of hospitalization due to incomplete abortion in an urban area of northeastern Brazil]. Rev Saude Pub 1997;31(5):472-8. DOI: 10.1590/s0034-89101997000600005.
17. 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;23(3):28-31. PMID: 23272429
18. El Ghafar MA. Comparative study of dilatation and curettage, manual and electric vacuum aspiration as methods of treatment of early abortion in Beni Suef, Egypt. Int Res J Med Medical Sci 2013; 1(1):43-50.
19. 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. Hypertension 2011;1:2. PMID: 21375164
20. Salam R, Neelofer R, Naserullah P. Comparative Study of Manual Vacuum Aspiration and Dilatation & Evacuation for the Surgical Management of Early Miscarriages: A Randomized Controlled Trial. P J M H S 2016;10(1):183-5.
21. Khani B, Karami N, Khodakarami N, Solgi T. Comparison of Incomplete Abortion Treatment between Manual Vacuum Aspiration and Curettage. J Isfahan Med School 2010;27(102).
22. Say L, Brahmi D, Kulier R, Campana A, Gülmezoglu AM. Medical versus surgical methods for first trimester termination of pregnancy. The Cochrane Library 2002. DOI: 10.1002/14651858.CD003037.
23. Greenslade F, Benson J, Winkler J, Henderson V, Wolf M, Leonard A. Summary of clinical and programmatic experience with manual vacuum aspiration. IPAS Adv Abortion Care 1993;3(2):1-4. DOI:10.2307/2137992
24. Grimes DA, Schulz KF, Cates WJ. Prevention of uterine perforation during curettage abortion. JAMA 1984;251(16):2108-11. PMID: 6708260
25. Das CM, Srichand P, Khursheed F, Shaikh F. Assessment of efficacy and safety of Manual Vacuum Aspiration (MVA). JLUMHS 2010;9(03):130.
26. Dalton VK, Harris L, Weisman CS, Guire K, Castleman L, Lebovic D. Patient preferences, satisfaction, and resource use in office evacuation of early pregnancy failure. Obstet Gynecol 2006;108(1):103-10. DOI: 10.1097/01.AOG.0000223206.64144.68.
How to Cite
Iqbal F, Azmat S, Jamshaid R, Arshad Z, Saqib A. Incomplete miscarriage during the first trimester: a comparison of indoor versus outdoor procedure. JRMC [Internet]. 30Sep.2020 [cited 2Oct.2022];24(3):235-9. Available from: