J Pak Med Assoc. 2017 Jun;67(6):948-950.

Manual vacuum aspiration (MVA) – A safe option for evacuation of first trimester miscarriage in cardiac patients

Ansari A and Abbas S

Abstract This case series was done at Armed Forces Institute of Cardiology, National Institute of Heart Disease, Rawalpindi, to observe safety and efficacy of manual vacuum aspiration and frequency of complications in cardiac patients with missed abortion. All cardiac patients presenting in first trimester with diagnosed early foetal demise (missed miscarriage) or incomplete miscarriage were included. Manual vacuum aspiration was done as an outpatient procedure. Cardiac and procedure related complications including arrhythmias, thromboembolism, heart failure and ischaemia were noted. A total of 34 patients were enrolled. Mean age and parity was 25.9 ± 2.25 years and 1.18 ± 1.02. Mitral valve was the dominant valve involved in 20 (58.8%) followed by double valve replacement in 5 (14.7%), dilated cardiomyopathy 4 (11.76%), aortic valve involvement in 3 (8.8%) and supra ventricular tachycardia in 2 (5.9%) patients. Complete evacuation was achieved in 100% patients and there were no major cardiac or gynaecological complications except arrhythmia in 1 (2.9%) patient. MVA seems to be a safe and cost effective intervention compared to other modalities of miscarriage management even in high risk cardiac patients.

Comment: In women with a (history of) cardiac disease we are often reluctant to prescribe prostaglandins. This study from a cardiac center shows how manual vacuum aspiration is a simple and safe alternative for medical abortion in these women.