Pain relief by paracervical block during manual vacuum aspiration for early miscarriage

M. Ismat Zerin; M. Sharifa Khatun; Zarin T. Tamanna; Musammat R. Tamanna; Rogina Amin; Umme S. Shilpi; Rifat Ara

doi:10.18203/2320-1770.ijrcog20250177

Authors

M. Ismat Zerin Department of Obstetrics and Gynaecology, Kurmitola General Hospital, Dhaka, Bangladesh
M. Sharifa Khatun Department of Obstetrics and Gynaecology, Kurmitola General Hospital, Dhaka, Bangladesh
Zarin T. Tamanna Department of Obstetrics and Gynaecology, Kurmitola General Hospital, Dhaka, Bangladesh
Musammat R. Tamanna Department of Obstetrics and Gynaecology, Kurmitola General Hospital, Dhaka, Bangladesh
Rogina Amin Department of Obstetrics and Gynaecology, Kurmitola General Hospital, Dhaka, Bangladesh
Umme S. Shilpi Department of Obstetrics and Gynaecology, Kurmitola General Hospital, Dhaka, Bangladesh
Rifat Ara Department of Obstetrics and Gynaecology, Kurmitola General Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20250177

Keywords:

Early miscarriage, Paracervical block, MVA, Pain relief

Abstract

Background: Early miscarriage is a common clinical problem that requires safe and effective management. Manual vacuum aspiration (MVA) under paracervical block is a minimally invasive procedure that helps to minimize pain during the procedure. This study aims to determine the safety and effectiveness of paracervical block in reducing pain during MVA for early miscarriage.

Methods: A cross-sectional prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital, Bangladesh from January to June 2019. A total of 52 women with early miscarriages undergoing MVA were included. The procedure was done with a paracervical block given beforehand. Visual analog scale (VAS) was used to assess pain levels immediately after the procedure and 30 minutes later following the procedure.

Results: The average age of the patients (57%) was 20-30 years. The mean gestational age was 6-10 weeks, and 65.4 percent of patients had incomplete abortion. Immediately after MVA, 69.23% of patients had mild pain severity (VAS 0 to 3), though this rose to 80.77% at 30 minutes post procedure. The mean VAS scores was 2.92±1.38 immediately after procedure and 2.57±1.44 after 30 minutes of the procedure. The procedure was considered acceptable by most patients (86.54%) with few adverse effects.

Conclusions: During paracervical block for early miscarriage, MVA is a safe, effective and well tolerated means for pain relief and patient satisfaction.

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References

Elina Hemminki MD. Treatment of miscarriage: current practice and rationale. Obstet Gynecol. 1998;91(2):247-53. DOI: https://doi.org/10.1016/S0029-7844(97)00606-6

Natalia A, Galadanci H, Ibrahim SA, Mohammad Z. Comparison of effectiveness of pain management during Manual Vacuum Aspiration using single-agent analgesic and combination: A randomized double-blind controlled trial. Open J Obstet Gynecol. 2015;5(05):244. DOI: https://doi.org/10.4236/ojog.2015.55036

Abd Elzaher M, Bedew M. Manual vacuum aspiration: a safe and cost-effective substitute for dilatation and curettage on the surgical management of first-trimester abortion. J Am Sci. 2013;9(6):581-5.

Milingos DS, Mathur M, Smith NC, Ashok PW. Manual vacuum aspiration: a safe alternative for the surgical management of early pregnancy loss. BJOG: Int J Obstet Gynaecol. 2009;116(9):1268-71. DOI: https://doi.org/10.1111/j.1471-0528.2009.02223.x

Gebru AA, Yesuf AH, Demelew T, Demelew T. Health policy analysis on unsafe abortion in Ethiopia. Int J Biotechnol All Fields. 2016;4(11):376-97.

Castleman L, Mann C. Manual vacuum aspiration (MVA) for uterine evacuation: Pain management. Chapel Hill, NC, Ipas. 2002.

Tangsiriwatthana T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M. Paracervical local anaesthesia for cervical dilatation and uterine intervention. Cochrane Database Syst Rev. 2013;(9):CD005056. DOI: https://doi.org/10.1002/14651858.CD005056.pub3

Jesmin N. Efficacy and Safety of Para Cervical Block in Manual Vacuum Aspiration (MVA)-in Low Resource Setting. Bangl J Obstet Gynaecol. 2016;31(2):70-4. DOI: https://doi.org/10.3329/bjog.v31i2.34213

Kumar V, Chester J, Gupta J, Shehmar M. Manual vacuum aspiration under local anaesthetic for early miscarriage: 2 years experience in a university teaching hospital in UK. Gynecol Surg. 2013;10:241-6. DOI: https://doi.org/10.1007/s10397-013-0804-6

Samal SK, Rathod S, Padhi M. A comparative study between manual vacuum aspiration and electrical vacuum aspiration for the first trimester medical termination of pregnancy. Int J Reprod Contracept Obstet Gynecol. 2014;3(1):139-43. DOI: https://doi.org/10.5455/2320-1770.ijrcog20140327

Gomez PI, Gaitán H, Nova C, Paradas A. Paracervical block in incomplete abortion using manual vacuum aspiration: randomized clinical trial. Obstet Gynecol. 2004;103(5 Part 1):943-51. DOI: https://doi.org/10.1097/01.AOG.0000123269.86525.c4

Egziabher TG, Ruminjo JK, Sekadde-Kigondu C. Pain relief using paraceevical block in patients undergoing manual vacuum aspiration of uterus. East Afr Med J. 2002;79(10):530-4. DOI: https://doi.org/10.4314/eamj.v79i10.8815

Stubblefield PG. Control of pain for women undergoing abortion. Int J Gynecol Obstet. 1989;30:131-40. DOI: https://doi.org/10.1016/0020-7292(89)90113-6

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):149-53.

Van Praagh IG, Povey WG. The use of paracervical block anesthesia for dilatation and curettage. Canad Med Assoc J. 1966;94(6):267.

Donati S, Medda E, Proietti S, Rizzo L, Spinelli A, Subrizi D, Grandolfo ME. Reducing pain of first trimester abortion under local anaesthesia. Eur J Obstet Gynecol Reprod Biol. 1996;70(2):145-9. DOI: https://doi.org/10.1016/S0301-2115(95)02583-9

Keder LM. Best practices in surgical abortion. Am J Obstet Gynecol. 2003;189(2):418-22. DOI: https://doi.org/10.1067/S0002-9378(03)00107-8