Use of Manual Vacuum Aspiration in the treatment of ... · • No need for electricity, general...
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Use of Manual Vacuum Aspiration in the treatment of incomplete abortions and post abortion care in MalawiBy Maria Lisa Odland, MD, PhD-student Global Health; NTNU, Trondheim, NorwayCollege of Medicine, Blantyre, Malawi
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Maternal mortality in Malawi
•Maternalmortality ratio439per100000livebirths•About 6-30%isduetounsafe abortion
1.WHOhttp://apps.who.int/gho/data/view.main.1390?lang=en2.NationalStatisticsOffice.MalawiDemographicandHealthSurvey2015-2016.2016.https://dhsprogram.com/pubs/pdf/FR319/FR319.pdf (accessed13February2018)3.JacksonE,JohnsonBR,Gebreselassie H,Kangaude GD,Mhango C(2011)AstrategicassessmentofunsafeabortioninMalawi.Reprod HealthMatters19:133-143.
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Abortion in Malawi
• Only legal to save a pregnant woman´s life
• Estimated 140 000 induced abortions every year
PolisCB,Mhango C,Philbin J,Chimwaza W,Chipeta E,Msusa A.IncidenceofinducedabortioninMalawi,2015.PLoS One.2017;12(4):e0173639.
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Complications after abortion
• Complications that may occur after abortion include;– incomplete abortion – uterine perforation– haemorrhage– sepsis– infertility– death
à More likely after an unsafe abortion
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Management● Evacuation of the uterus!
● Medical (Misoprostol/Cytotec)● Surgical
● Metal Curettage● Electrical or Manual Vacuum Aspiration (MVA)
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Why MVA?• Less risk of complications
– Uterine perforation– Intrauterine adhesions– Asherman´s syndrome
• Low cost• Easy to use (can be performed
by nurses and midwives)• Less painful• Portable
• No need for electricity, generalanesthetics or theater
• Can be performed in outpatientclinics
• Appropriate for many different clinical settings
• High patient and provider satisfaction
WorldHealthOrganization(2012)Safeabortion:technicalandpolicyguidanceforhealthsystems.
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Treatment of incomplete abortions in Malawi
OdlandML,Rasmussen H,JacobsenGW,Kafulafula UK,Chamanga P,etal.(2014)Decreaseinuseofmanualvacuumaspirationinpostabortion careinMalawi:across-sectionalstudyfromthreepublichospitals,2008-2012. PLoS One9:e100728.
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Qualitative Follow-Up Study
• Reasons for not using MVA• Lack of training• Shortage of equipment and human resources• Attitudes towards PAC* and prioritization of PAC*
*postabortion care
CookS,deKok B,OdlandML.'It'saverycomplicatedissuehere':understandingthelimitedanddeclininguseofmanualvacuumaspirationfor postabortion careinMalawi:aqualitativestudy.HealthPolicyPlan.2017;32(3):305-13.
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Objectives
Primary objective• To improve the post abortion care in southern Malawi by increasing
the use of MVA in the treatment of incomplete abortions
Secondary objectives • Assess the use of MVA• Increase the use of MVA by 15% by training health personnel in
MVA • Evaluation of the training intervention by investigating the health
personnel's perception of using MVA
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Intervention study• Intervention Hospitals
– Queen Elizabeth Central Hospital– Chiradzulu District Hospital– Chikwawa District Hospital
• Control Hospitals– Kamuzu Central Hospital– Thyolo District Hospital
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Training intervention
• All health personnel treating patients with incomplete
abortions at the intervention hospitals were invited– Clinical Officers and Nurses District Hospitals
– Medical Interns Central Hospital
• Participation voluntary
• 2 hours
• Local consultant in gyneacology
• Theory and practice using pelvic models
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Methods
• Retrospectively reviewing hospital files and collecting– Demographic data– Obstetric data– Type of treatment
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Data collection
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Results Intervention Hospitals21.3%increaseintheuseofMVA
0102030405060708090
100
Jan-March2016 Jan-March2017
Tre
atm
ent
in p
erce
nt o
f all
uter
ine
evac
uatio
ns
(n =
134
9)
Year
Fig 1. Surgical treatment of incomplete abortions before and after the intervention
MVA
D&C
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Results Control Hospitals
0
10
20
30
40
50
60
70
80
90
100
Intervention Hospitals Control Hospitals
Use
of M
VA
ain
per
cent
of a
ll ut
erin
e ev
acua
tions
(n =
185
7)
Fig 2. Use of manual vacuum aspiration (MVA) at intervention hospitals and control hospitals before and after the intervention
Jan-March2016
Jan-March2017
Only3%increaseintheuseofMVAduring thesametimeperiod
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Conclusion
• A simple training intervention is an efficient
way of increasing a safer and cheaper
method of treating incomplete abortions
• There are still obstacles to doing MVA
such as lack of equipment and a support
from management
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Thank you!