Benefits of manual vacuum aspiration for abortion
Notice bibliographique
Résumé
Manual vacuum aspiration (MVA) was designed for use in low-resource settings and is associated with lower costs compared with electric vacuum aspiration (EVA) [1]. A systematic review of 10 trials comparing MVA with EVA found no statistically significant differences in complete abortion rates or participant satisfaction; in addition, less blood loss and less severe pain were reported for the MVA procedures [2]. These findings have led to an increase in MVA use in high-resource settings; a survey of National Abortion Federation clinics in the USA and Canada found that 49% of abortion providers selectively use MVA [3]. Most licensing bodies require that the tubing used for EVA be discarded after each use. This is based on international standards such those set by the Center for Disease Control in the Guideline for Disinfection and Sterilization in Healthcare Facilities [4], in which it is stated that “[a] reused single-use device will have to comply with the same regulatory requirements of the device when it was originally manufactured.” By contrast, MVA involves the use of a plastic reusable syringe (e.g. the Ipas EasyGrip cannula [Ipas, Chapel Hill, NC, USA]). Manual vacuum aspiration has been used since 2008 at the Everywoman's Health Centre, Vancouver, Canada—which is a free-standing urban abortion clinic—for all procedures involving women at less than 10 weeks (69 days) of pregnancy. Each set of tubing for EVA weighs 293 g. In 2009, 2255 MVA procedures were carried out at the center, resulting in 660 kg less plastic tubing being discarded. The Ipas syringes are reprocessed using accelerated hydrogen peroxide, so the by-products are water and oxygen only. Each syringe weighs 108 g. There are currently 15 syringes at the clinic, each of which lasts for approximately 3 years, resulting in around 0.5 kg of plastic syringes being discarded each year. If EVA had been performed, the cost of the tubing discarded for the 2255 procedures undertaken in 2009 would have been Can$14,094 (with each set of tubing costing Can$6.25). The cost of the discarded MVA syringes was approximately Can$250 (5 syringes at Can$50 each) and the cost of the reprocessing solution was Can$510 (Can$10 per week for 51 weeks). The cost of reprocessing the syringes for each procedure—which involved taking the pieces apart, rinsing them, placing them in the reprocessing solution for 5 minutes, and drying and reassembling the unit—was Can$4698 (Can$25 per hour × 5 minutes × 2255 syringes). As a result, the cost saving for using MVA instead of EVA for 1 year was Can$8636. Manual vacuum aspiration is as effective as EVA for induced abortion and for completion of spontaneous abortion in early pregnancy and is associated with less pain and blood loss. It is also less expensive and less damaging to the environment, owing to the reduced amount of material discarded for each procedure. Manual vacuum aspiration should be recommended for use in induced abortion and completion of spontaneous abortion in early pregnancy. The authors have no conflicts of interest.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».