Manual Vacuum Aspiration versus Sharp Curettage for Incomplete Abortion: Which One is Better?

Abstract

Manual Vacuum Aspiration versus Sharp Curettage for Incomplete Abortion: Which One is Better? Aspirasi Vakum Manual dibandingkan dengan Kuret Tajam untuk Abortus Inkomplit: Mana yang Lebih Baik? JM Seno Adjie, Erik J Triyadi Departement of Obstetric and Gynecology Faculty Medicine Universitas Indonesia Dr. Cipto Mangunkusumo Hospital Jakarta Abstract Abstrak Objective : To acknowledge the effectiveness and safety of manual vacuum aspiration (MVA) compared with Sharp Curettage (SC) in the management of incomplete abortion below 12 weeks of gestation which compare time to perform the procedure, rates of evacuation and infection one week after the procedure, and complication during MVA and SC procedure. Tujuan : Mengetahui efektifi tas dan keamanan dari AVM dibandingkan dengan kuret tajam pada penanganan abortus inkomplit di bawah usia kehamilan 12 minggu dengan melihat dari lama tindakan, proporsi tingkat kebersihan evakuasi sisa konsepsi 1 minggu pascatindakan, proporsi gejala–gejala infeksi 1 minggu pascatindakan dan proporsi komplikasi pada saat tindakan AVM dan kuret tajam. Methods : A prospective study with 62 subjects with incomplete abortion came to the emergency wom of at Dr. Cipto Mangunkusumo hospital, Fatmawati hospital and Karawang hospital, divided into 31 subjects on MVA group and 31 subjects on SC group. The data was documented on the time of MVA procedure compare to SC, clinical fi ndings on complication during the procedure, completed evacuation and infection symptoms one week after the procedure. Metode : Penelitian ini merupakan penelitian kohort prospektif (observasional) dengan jumlah sampel 62 subjek yang berkunjung dengan abortus inkomplit ke UGD RSCM, RS Fatmawati dan RSUD Karawang terbagi dalam 31 subjek pada kelompok prosedur AVM dan 31 subjek pada kelompok prosedur kuret tajam. Data dikumpulkan melalui pencatatan waktu lama prosedur AVM dibandingkan kuret tajam, pemeriksaan klinis komplikasi selama prosedur berlangsung, pemeriksaan klinis kebersihan sisa konspesi 1 minggu pascatindakan dan gejala – gejala infeksi 1 minggu pasca tindakan. Results : Sixty two subjects (31 each group) with average time of procedure was 17,65 ± 4,128 minutes and SC was 22,26 ± 4,611 minutes with p = 0,00 and 95% CI; -4,513(6,837 to -2,389 with signifi cant statistically difference.

The comparison of completed evacuation one week after

procedure was 3,2% (n = 1) on MVA and 6,5% (n = 2) on

SC with clinical fi ndings, and p = 0,554, RR = 1,034 and

95% CI 0,924 – 1,158 with no statistically difference. On the

other comparison, we did not fi nd any infection symptoms

one week after procedure and complication during the

procedure on both procedures. Hasil : Sebanyak 62 subjek (masing – masing 31 subjek), di mana didapatkan rerata dan simpang baku prosedur AVM 17,65 ± 4,128 menit dan kuret tajam 22,26 ± 4,611 menit dengan p = 0,00 dan IK 95% -4,513 (-6,837 -2,389), bermakna secara statistik. Pada perbandingan proporsi tingkat kebersihan evakuasi sisa konsepsi 1 minggu pascatindakan didapatkan pada AVM 3,2% (n = 1) dan pada kuret tajam 6,5% (n = 2) terdapat sisa konsepsi dengan penilaian klinis, p = 0,554, RR = 1,034 dan IK95% 0,924 – 1,158 tidak memiliki perbedaan bermakna secara statistik. Pada perbandingan lainnya, tidak ditemukan gejala – gejala infeksi 1 minggu pascaprosedur dan komplikasi selama prosedur berlangsung pada prosedur AVM dan kuret tajam. Conclusions : MVA has more effective than SC on the time of procedure in incomplete abortion with below 12 weeks of gestation. MVA has superiority from completed evacuation but no statistical difference and has equal safety to SC on clinical infection symptoms and complication during the Kesimpulan : AVM juga memiliki keunggulan dalam procedure. kebersihan sisa konsepsi namun tidak bermakna secara Keywords : incomplete abortion, manual vacuum aspiration (MVA), sharp curettage (SC). statitik dan memiliki keamanan yang setara dengan kuret tajam dari tingkat gejala infeksi dan komplikasi selama prosedur. Kata kunci : abortus inkomplit , aspirasi vakum manual (AVM), kuret tajam