Comparison of Adequacy of Endometrial Sampling by Manual Vacuum Aspiration and Conventional Dilatation and Curettage for Histopathology in Abnormal Uterine Bleeding.
Keywords:Abnormal uterine bleeding, endometrial sampling, efficacy, safety, cost effectiveness, MVA, D&C
AbstractBackground: Abnormal uterine bleeding is a common problem experienced by women of reproductive age. Dilatation and curettage (D&C) is one of the most popular method for diagnosing the pathology. But with the advent of method like Manual Vacuum Aspiration (MVA) having multiple advantages, its use should also be promoted in low resource settings like ours. Objective: To compare the adequacy of endometrial sampling with dilatation and curettage for endometrial sampling in women with abnormal uterine bleeding. Methods: This randomized control study was done at Lady Willingdon Hospital Lahore over a period of 6 months from July 2015 to January 2016. A total of 140 patients (70 in each group) were taken using simple random sampling. The sample group was divided in two groups i.e. Group A & Group B. In Group A endometrial tissue was sampled by conventional D&C and in Group B by MVA. For Group A, D&C patients came to operation theatre NPO along with baseline investigations. Anesthesia was administered. In Group B patients, no preoperative preparation was done. Analgesia was given. Data was analyzed by SPSS version 20. Results: The mean age in D & C group was 42.96 4.315 years and 43.01 5.645 years in the MVA group. In D & C group 69 (98.36%) cases needed analgesia while in MVA group only 6(8.6%) required analgesia which was significantly lower than D & C group, p-value < 0.0001. D & C and MVA groups, sample was adequate in 63 (90%) of the females with statistically same value in both group with p-value > 0.05.Post-operative vaginal bleeding occurred in 16(22.9%) and 2(2.9%) cases in D & C and MVA group respectively with significantly lesser rate in MVA group, p-value < .0001. The mean cost in D & C was Rs.1000 17.025 and in MVA group, it was Rs. 397.86 13.285. The mean cost in MVA group was significantly lower than D & C group, p-value < 0.0001. Conclusion: MVA is a procedure which yields same adequacy of endometrial sampling as conventional dilatation and curettage. MVA, at the same time is easy to perform with lesser complications, needs minimum analgesia and is a cost-effective method for low resource settings like ours.
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