Pregnancy and Childbirth
Conditions
Interventions
medical management
surgical management using Manual vacuum aspiration
Sponsors
victor tetty otieno
Eligibility
Sex/Gender
Female
Inclusion criteria
Inclusion criteria: Women with first trimester incomplete abortion admitted in gynaecology ward who are; 1. Hemodynamically stable with no signs of hypovolaemia or shock due to excessive bleeding. 2. In first trimester of pregnancy with weeks of amenorrhea at =12 weeks. 3. Having Per vaginal bleeding with retained products of conception suggestive of incomplete abortion. 4. No contraindication for misoprostol use like allergy to prostaglandins and previous uterine scars. 6. No major organ disease like renal, cardiovascular, nervous, liver, hematological or immunosuppressive disease.
Exclusion criteria
Exclusion criteria: Women with evidence of infection: temperature 38 degrees Celsius, Pulse Rate >100, Respiratory rate >20 respirations/min 2 .Women with structural uterine abnormalities like unicornuate or bicornuate uterus and uterine septum. 3. Women with previous fresh uterine scars (less than 18 months) since they are at increased risk of uterine rupture 4. Patients with =2 previous scars as this increases the risk of uterine rupture. 5. Patients with more than three abortions as this would alter the findings on satisfaction and secondary outcomes.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Primary outcome (effectiveness) was assessed by complete uterine evacuation within 48 hours. This was done by history of no vaginal bleeding or abdominal pain, physical exam of the abdomen to rule out tenderness and pelvic exam by speculum to check for no retained products. Trans-abdominal ultrasound scan was used to confirm complete evacuation by ruling out retained products of >30mls. If the retained products was >30mls, this was captured as failure of the primary method to cause complete evacuation. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Duration of bleeding while on the ward. Mild - less than 6 hours of bleeding Moderate - between 7- 12 hours of bleeding Severe – more than 12 hours. 2. Infections using vitals, pelvic examination by speculum and digital examination, laboratory findings of CBC and imaging studies like abdominal pelvic ultrasound. Temperature 38degrees Celcius, Pulse rate >100/min, offensive smelling yellowish or pus like vaginal discharge, adnexal tenderness, cervical motion tenderness and elevated white blood cells pointed towards an infection. 3. Pain using Likert scale Use of seven circles progressively increasing in size for the patient to pick the circle that is proportionate to her pain. Smallest being the least pain while greatest maximum pain. Mild pain – Likert scale between1-3 Moderate – Likert scale between 4-5 Severe – Likert scale between 6-7 4. If they would recommend the method determined by interview. 5. Hospital stay or need for readmission if admitted for more than 48 hours. 6. Need for second method if there is primary failure. 7.Trauma to genitourinary tract evidenced by abdominal examination, pelvic examination and trans-abdominal pelvic ultrasound scan. 8.Satisfaction Satisfaction with the method determined through satisfaction tool (Powell; 2010). The parameters used to asses this were: a) Level of pain of less than 3 on Likert scale ( 1 point) b) If they recommended the method (1 point) c) Completion of abortion (1 point) d) Any complications (syncope, blood transfusion, severe headaches and dizziness, infection, genitourinary trauma). 1 point if there was no any complication. This was then awarded scores between 0/4 to 4/4 and this determined satisfaction. =1/4 – very dissatisfied 2/4 – somewhat dissatisfied. 3/4 – somewhat satisfied 4/4 –very satisfied | — |
Countries
Uganda
Contacts
Public Contactpwaveno Bamaiyi
Director Post graduate studies KIU
Outcome results
None listed