e-ISSN: 0976-822X, p-ISSN:2961-6042
A ailable online on h p://www.ijcp .com/
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Bhowmick e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
407
O iginal Resea ch A icle
A Compa a i e S udy o Manual Vacuum Aspi a ion (MVA) and Elec ic
Vacuum Aspi a ion (EVA) o he Su gical Managemen in P egnancy
Te mina ion o Up o 10 Weeks Ges a ion
Madhu ima Bhowmick1, Oisha ya Bane jee2, Sangee a Roy3
1Fellow – Gynaecologic Oncology, M.B.B.S, M.S., F.M.A.S, Depa men o Obs e ics and Gynecology,
Na ayana Hospi al – R.N. Tago e Hospi al, Mukundapu , Kolka a, Wes Bengal – 700099
2Fellow – A h oplas y and A h oscopy, M.B.B.S, M.S. (O hopaedics), Depa men o A h oplas y and
A h oscopy, JBCH (Join & Bone Ca e Hospi al), Bidhannaga , Kolka a, Wes Bengal – 700064
3Specialis Medical O ice , M.B.B.S, M.S., D.N.B., Depa men o Obs e ics and Gynecology, Islampu
Supe Speciali y Hospi al, Islampu , U a Dinajpu , Wes Bengal – 733202
Recei ed: 01-07-2025 / Re ised: 16-08-2025 / Accep ed: 04-09-2025
Co esponding Au ho : D . Madhu ima Bhowmick
Con lic o in e es : Nil
Abs ac
In oduc ion: Te mina ion o p egnancy in he i s imes e is one o he mos commonly pe o med
gynecological p ocedu es wo ldwide. Bo h Manual Vacuum Aspi a ion (MVA) and Elec ic Vacuum Aspi a ion
(EVA) a e es ablished me hods o su gical managemen o ea ly p egnancy e mina ion. While bo h echniques
a e conside ed sa e and e ec i e, di e ences may exis in e ms o e icacy, sa e y p o ile, complica ions,
p ocedu e ime, and pa ien accep abili y.
Objec i es: To compa e he ou comes o Manual Vacuum Aspi a ion (MVA) and Elec ic Vacuum Aspi a ion
(EVA) o p egnancy e mina ion up o 10 weeks o ges a ion.
Me hods: This hospi al-based p ospec i e andomized compa a i e s udy was conduc ed o e one yea in he
Depa men o Obs e ics & Gynecology a Chi a anjan Se a Sadan College. I included 200 women wi h i s -
imes e abo ion (≤10 weeks) who me he Go e nmen o India MTP c i e ia. Pa ien s we e andomized o
unde go ei he Manual Vacuum Aspi a ion (MVA) o Elec ic Vacuum Aspi a ion (EVA), and da a we e
collec ed on age, g a ida, ges a ional age, locali y, and socioeconomic s a us, cause o abo ion, bleeding,
complica ions, pain, and pos -abo al con acep i e p ac ices o compa e ou comes be ween he wo g oups.
Resul s: In his s udy o 200 pa ien s, he MVA and EVA g oups we e compa able in age dis ibu ion, wi h he
majo i y in he 21–30 yea s ange (MVA: 71%, EVA: 64%; p=0.466) and simila g a ida s a us (p=0.74), while
ges a ional age showed a signi ican di e ence (p=0.02), wi h mo e pa ien s a 5 weeks in he MVA g oup (5%)
and mo e a 10 weeks in he EVA g oup (28%). Socioeconomic s a us also di e ed signi ican ly (p=0.044), wi h
a highe p opo ion o lowe socioeconomic pa ien s in he MVA g oup (77% s 64%). Blood loss inc eased
wi h ges a ional age, wi h MVA consis en ly lowe han EVA (6 weeks: 23.5 ml s 27.5 ml, p<0.001; 8 weeks:
28.46 ml s 35.03 ml, p<0.001; 9 weeks: 33.4 ml s 38.86 ml, p=0.01; 10 weeks: 36.29 ml s 43.49 ml, p<0.001;
7 weeks di e ence no signi ican , 28.5 ml s 32.3 ml, p=0.076). Hospi al s ay was sho e wi h MVA ac oss all
ges a ional ages (6–6.67 days) compa ed o EVA (13.2–15 days), wi h signi ican di e ences a 6, 8, 9, and 10
weeks. G ade I bleeding was mo e equen in MVA (69% s 13%), while highe g ades occu ed mo e in EVA
(p<0.001). Pain was also lowe wi h MVA (G ade I: 37% s 0%; G ade IV: 7% s 54%; p<0.001). O e all
complica ions (p=0.215) and pos -abo al con acep i e p ac ices (p=0.345).
Conclusion: Manual Vacuum Aspi a ion and Elec ic Vacuum Aspi a ion a e bo h sa e and e ec i e echniques
o su gical e mina ion o p egnancy up o 10 weeks. MVA is pa icula ly ad an ageous in esou ce-limi ed
se ings, while EVA may be mo e sui able in acili ies wi h adequa e in as uc u e. The choice o me hod
should be indi idualized based on pa ien p e e ence, clinical se ing, and esou ce a ailabili y.
Keywo ds: Manual Vacuum Aspi a ion, Elec ic Vacuum Aspi a ion, Su gical abo ion, Fi s - imes e
p egnancy, P egnancy e mina ion.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access
Ini ia i e (h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium,
p o ided o iginal wo k is p ope ly c edi ed.
In oduc ion
Te mina ion o p egnancy is one o he mos
common gynecological p ocedu es pe o med
globally, pa icula ly in he i s imes e , and i
plays a c ucial ole in sa egua ding women’s
ep oduc i e heal h. Acco ding o he Wo ld Heal h
O ganiza ion (WHO), nea ly hal o all p egnancies
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Mollah e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
408
wo ldwide a e unin ended, and a signi ican
p opo ion o hese end in abo ion, wi h he
majo i y occu ing wi hin he i s 12 weeks o
ges a ion [1]. Sa e abo ion se ices a e he e o e
an essen ial componen o comp ehensi e
ep oduc i e heal h ca e, educing ma e nal
mo bidi y and mo ali y associa ed wi h unsa e
me hods. Su gical abo ion me hods, especially
aspi a ion echniques, ha e gained p ominence due
o hei sa e y, e icacy, and accep abili y compa ed
o olde me hods such as dila ion and cu e age
(D&C) [2].
Vacuum aspi a ion, ei he manual o elec ic, has
eme ged as he s anda d o ca e o ea ly p egnancy
e mina ion up o 12 weeks ges a ion. Manual
Vacuum Aspi a ion (MVA) in ol es he use o a
hand-held, sy inge-like de ice o c ea e suc ion,
whe eas Elec ic Vacuum Aspi a ion (EVA) uses
an elec ically powe ed suc ion machine. Bo h
echniques unc ion on he same p inciple o
nega i e p essu e o e acua e u e ine con en s bu
di e in e ms o equipmen , logis ics, and
applicabili y in di e en heal hca e se ings [3].
Compa ed wi h sha p cu e age, aspi a ion me hods
a e associa ed wi h lowe complica ion a es,
educed blood loss, sho e p ocedu e ime, and
as e eco e y, making hem sa e al e na i es o
i s - imes e abo ion [4].
MVA has been widely p omo ed by in e na ional
agencies, pa icula ly in low- and middle-income
coun ies, because i is cos -e ec i e, does no
equi e elec ici y, is po able, and can be
pe o med in pe iphe al cen e s wi h minimal
in as uc u e. This makes i especially sui able in
esou ce-cons ained se ings whe e access o
highe -le el acili ies is limi ed [5]. Addi ionally,
MVA can be sa ely pe o med unde local
anes hesia, educing he need o gene al anes hesia
and associa ed isks. EVA, on he o he hand,
hough equi ing elec ic powe and hospi al-based
in as uc u e, o e s ad an ages such as consis en
suc ion p essu e, educed ope a o a igue, and ease
o handling la ge olumes o u e ine con en s [6].
Bo h me hods, howe e , ha e hei unique
indica ions, bene i s, and limi a ions, necessi a ing
compa a i e e alua ion in clinical p ac ice. Se e al
s udies ha e demons a ed ha he success a e o
comple e u e ine e acua ion wi h bo h MVA and
EVA exceeds 95%, wi h minimal equi emen o
epea p ocedu es [7]. Complica ions such as
hemo hage, u e ine pe o a ion, ce ical
lace a ion, and pel ic in ec ion a e a e bu can
occu wi h ei he me hod. While EVA may p o ide
a mo e com o able expe ience o he ope a o ,
MVA is o en p e e ed by pa ien s in u al o
semi-u ban se ings due o i s accessibili y and
a o dabili y. Fu he mo e, in he con ex o pos -
abo ion ca e, MVA has been in eg a ed in o
aining p og ams o mid-le el p o ide s, he eby
expanding he pool o heal hca e pe sonnel capable
o p o iding sa e abo ion se ices [8].
F om a public heal h pe spec i e, he choice
be ween MVA and EVA has impo an
implica ions. In coun ies like India, whe e
ma e nal mo ali y due o unsa e abo ion emains a
p e en able cause o dea h, imp o ing access o
sa e, simple, and e ec i e me hods is a p io i y [9].
Na ional guidelines and in e na ional bodies
ad oca e he use o aspi a ion echniques o e
sha p cu e age, and he e is a g owing emphasis on
equipping p ima y heal hca e cen e s wi h MVA
ki s o enhance sa e abo ion co e age. A he same
ime, in e ia y ca e cen e s wi h adequa e
in as uc u e, EVA con inues o be widely
p ac iced, especially in cases whe e epea
p ocedu es o managemen o incomple e abo ion
a e equi ed.
Gi en his backg ound, a di ec compa a i e
analysis o MVA and EVA in e ms o sa e y,
e icacy, complica ions, p ocedu e ime, and pa ien
sa is ac ion is wa an ed. Such s udies help guide
e idence-based policy and clinical decisions,
ensu ing ha women ecei e he mos app op ia e
ca e based on hei clinical p o ile and he
heal hca e se ing. This compa a i e s udy he e o e
aims o e alua e he ou comes o MVA e sus
EVA in p egnancy e mina ion up o 10 weeks
ges a ion, con ibu ing o he g owing body o
e idence on sa e abo ion p ac ices and helping
op imize se ice deli e y in di e se heal hca e
con ex s [10].
Ma e ials and Me hods
S udy Design: Hospi al based p ospec i e
andomized compa a i e s udy.
Place o s udy: The S udy was ca ied ou in he
depa men o Obs e ics & Gynecology,
Chi a anjan Se a Sadan College o Obs e ics,
Gynaecology and Child Heal h.
Pe iod o s udy: One Yea .
S udy Popula ion: All pa ien s coming o
gynecology opd o m p and ul illing he c i e ia
o m p gi en by Go e nmen o India we e
selec ed.
S udy Va iables
• Age
• G a ida
• Pog
• Locali y
• Socioeconomic S a us
• Cause
• Bleeding
• Complica ions
• Pain
• Pos Abo al Con acep i e
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Mollah e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
409
Sample Size: Two Hund ed (200) Women
admi ed wi h he diagnosis o i s imes e less
han o equal o en weeks abo ion.
Inclusion C i e ia: Women in he ep oduc i e
age g oup wi h his o y o <=10 weeks ges a ion
i espec i e o any pa i y wi h
• h ea ened abo ion
• missed abo ions
• incomple e abo ions
• ailed medial abo ion
Exclusion C i e ia
Women wi h (a)>10 weeks ges a ional pe iods.
• Ec opic p egnancy
• P egnancy wi h Fib oid u e us o u e ine
anomalies
• Mola p egnancy
• Unwilling pa en
• pel ic in ec ions
• bleeding diso de s
S a is ical Analysis: Con inuous a iables a e
exp essed as Mean, Median and S anda d
De ia ion and compa ed ac oss he g oups using
Mann-Whi ney U es . Ca ego ical a iables a e
exp essed as Numbe o pa ien s and pe cen age o
pa ien s and compa ed ac oss he g oups using
Pea son’s Chi Squa e es o Independence o
A ibu es/ Fishe 's Exac Tes as app op ia e.
The s a is ical so wa e SPSS e sion 22 has been
used o he analysis. An alpha le el o 5% has
been aken, i.e. i any p alue is less han 0.05 i has
been conside ed as signi ican .
Resul
Table 1: Compa ison o Demog aphic and Clinical Cha ac e is ics be ween MVA and EVA G oups
(n=200)
MVA
EVA
To al
P-
Value
Signi icance
Age (Yea s)
≤20
10(10)
15(15)
25(12.5)
0.466
No
Signi ican
21-25
38(38)
28(28)
66(33)
26-30
33(33)
36(36)
69(34.5)
31-35
13(13)
17(17)
30(15)
>35
6(6)
4(4)
10(5)
To al
100(100)
100(100)
200(100)
G a ida
P imi-g a ida
12(12)
13(13)
25(12.5)
0.74
No
Signi ican
G a idaII
17(17)
12(12)
29(14.5)
G a idaIII
26(26)
30(30)
56(28)
G a idaIV
26(26)
22(22)
48(24)
G a idaV
19(19)
22(22)
41(20.5)
G a idaVI
0(0)
1(1)
1(0.5)
To al
100(100)
100(100)
200(100)
POG(Weeks)
5
5(5)
0(0)
5(2.5)
0.02
Signi ican
6
28(28)
16(16)
44(22)
7
3(3)
2(2)
5(2.5)
8
40(40)
44(44)
84(42)
9
3(3)
10(10)
13(6.5)
10
21(21)
28(28)
49(24.5)
To al
100(100)
100(100)
200(100)
Locali y
Ru al
26(26)
31(31)
57(28.5)
0.434
No
Signi ican
U ban
74(74)
69(69)
143(71.5
)
To al
100(100)
100(100)
200(100)
Socioeconomic
S a us
Lowe
77(77)
64(64)
141(70.5
)
0.044
Signi ican
Middle
23(23)
36(36)
59(29.5)
To al
100(100)
100(100)
200(100)
Cause
Failed Con acep ion
70(70)
66(66)
136(68)
0.457
No
Signi ican
Failed Medical
Me hod
3(3)
4(4)
7(3.5)
Incomple e Abo ion
7(7)
15(15)
22(11)
Missed Abo ion
12(12)
9(9)
21(10.5)
Unma ied
7(7)
6(6)
13(6.5)
O he s
1(1)
0(0)
1(0.5)
To al
100(100)
100(100)
200(100)
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410
Table 2: Compa ison o Blood Loss and Du a ion o Hospi al S ay be ween MVA and EVA ac oss
Ges a ional Weeks
POG
(Weeks)
P ocedu
e
Mean Blood Loss
(ml)
Median
(ml)
S d.
De ia ion
P-
Value
Signi icance
5
MVA
20.68
20.8
0.18
NA
NA
6
MVA
23.5
23.55
0.19
<0.001
Signi ican
EVA
27.5
27.9
0.64
7
MVA
28.5
28.5
0.1
0.076
No
Signi ican
EVA
32.3
32.3
0
8
MVA
28.46
28.5
0.14
<0.001
Signi ican
EVA
35.03
35
0.94
9
MVA
33.4
33.4
0
0.01
Signi ican
EVA
38.86
38.9
0.23
10
MVA
36.29
36.2
0.59
<0.001
Signi ican
EVA
43.49
43.5
0.22
5
MVA
6
6
0
NA
NA
6
MVA
6.5
6
0.79
<0.001
Signi ican
EVA
14.13
15
1.63
7
MVA
6.67
6
1.15
0.068
No
Signi ican
EVA
15
15
0
8
MVA
6.48
6
0.78
<0.001
Signi ican
EVA
14.02
15
1.49
9
MVA
6.67
6
1.15
0.005
Signi ican
EVA
13.2
12
1.93
10
MVA
6.33
6
0.58
<0.001
Signi ican
EVA
13.96
15
1.43
Table 3: Compa ison o Bleeding, Complica ions, Pain, and Pos -Abo al Con acep i e Use Be ween
MVA and EVA G oups
MVA
EVA
To al
P-
Value
Signi icance
Bleeding
G ade I
69(69)
13(13)
82(41)
<0.001
Signi ican
G ade II
26(26)
50(50)
76(38)
G ade III
5(5)
37(37)
42(21)
To al
100(100)
100(100)
200(100)
Complica ions
No Complica ion
93(93)
81(81)
174(87)
0.215
No
Signi ican
Ce ical Lace a ion
0(0)
3(3)
3(1.5)
D ug Sensi i i y
0(0)
1(1)
1(0.5)
Headache
3(3)
5(5)
8(4)
Incomple e (diagnosed
by USG)
1(1)
4(4)
5(2.5)
Nausea
1(1)
3(3)
4(2)
Vomi ing
2(2)
3(3)
5(2.5)
To al
100(100)
100(100)
200(100)
Pain
G ade I
37(37)
0(0)
37(18.5)
<0.001
Signi ican
G ade II
27(27)
13(13)
40(20)
G ade III
29(29)
33(33)
62(31)
G ade IV
7(7)
54(54)
61(30.5)
To al
100(100)
100(100)
200(100)
Pos Abo al
Con acep i e
None
16(16)
17(17)
33(16.5)
0.345
No
Signi ican
Ba ie Me hod
1(1)
0(0)
1(0.5)
IUCD
21(21)
12(12)
33(16.5)
OCP
15(15)
14(14)
29(14.5)
Tubec omy
47(47)
57(57)
104(52)
To al
100(100)
100(100)
200(100)
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Mollah e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
411
Figu e 1: Compa ison o Bleeding, Complica ions, Pain, and Pos -Abo al Con acep i e Use Be ween
MVA and EVA G oups
In his s udy o 200 pa ien s, he age dis ibu ion
was compa able be ween MVA and EVA g oups,
wi h he majo i y in he 21–30 yea s age ange, and
he di e ence was no s a is ically signi ican
(p=0.466). G a ida s a us was also simila ac oss
g oups, wi h no signi ican di e ence (p=0.74).
The dis ibu ion o ges a ional age (POG) showed a
signi ican di e ence (p=0.02), wi h mo e pa ien s
a 5 weeks in he MVA g oup and mo e a 10
weeks in he EVA g oup. Locali y ( u al s u ban)
did no di e signi ican ly be ween g oups
(p=0.434). Socioeconomic s a us showed a
signi ican di e ence (p=0.044), wi h a highe
p opo ion o lowe socioeconomic pa ien s in he
MVA g oup. The cause o abo ion, including
ailed con acep ion, ailed medical me hod,
incomple e abo ion, missed abo ion, and
unma ied s a us, was simila be ween g oups, wi h
no signi ican di e ence (p=0.457).
The s udy e alua ed blood loss and hospi al s ay in
pa ien s unde going MVA and EVA om 5 o 10
weeks o ges a ion. Blood loss inc eased wi h
ad ancing ges a ional age in bo h p ocedu es, wi h
EVA consis en ly showing highe mean blood loss
han MVA. The di e ence in blood loss was
s a is ically signi ican a 6, 8, 9, and 10 weeks,
while a 7 weeks i was no signi ican (p=0.076).
Simila ly, he du a ion o hospi al s ay was sho e
o MVA ac oss all ges a ional ages, anging om
6 o 6.67 days, compa ed o EVA, which anged
om 13.2 o 15 days. The di e ence in hospi al
s ay was s a is ically signi ican a 6, 8, 9, and 10
weeks, and no signi ican a 7 weeks (p=0.068).
The analysis o pos -p ocedu al ou comes e ealed
signi ican di e ences in bleeding and pain
be ween MVA and EVA g oups. G ade I bleeding
was signi ican ly mo e common in he MVA g oup
(69%) compa ed o EVA (13%), while highe
g ades (II and III) we e mo e equen in EVA
(p<0.001). Pain se e i y also di e ed signi ican ly;
G ade I pain was obse ed in 37% o MVA cases
and none in EVA, whe eas G ade IV pain was
ma kedly highe in EVA (54%) compa ed o MVA
(7%) (p<0.001). Howe e , he o e all incidence o
complica ions such as ce ical lace a ion, d ug
sensi i i y, headache, incomple e abo ion, nausea,
and omi ing did no di e signi ican ly be ween
he g oups (p=0.215). Pos -abo al con acep i e
p ac ices, including IUCD, OCP, ubec omy, and
ba ie me hods, we e compa able be ween g oups
wi h no s a is ically signi ican di e ence
(p=0.345).
Discussion
In his s udy o 200 pa ien s unde going i s -
imes e p egnancy e mina ion, MVA
demons a ed a o able ou comes in e ms o blood
loss, pain, hospi al s ay, and pos -p ocedu al
complica ions, consis en wi h p e iously published
li e a u e. The mean age o pa ien s was
compa able be ween MVA and EVA g oups (21–
30 yea s being mos common), simila o indings
by Ke u e e al. [11] and Singh e al. [12], who
epo ed ha i s - imes e e mina ions
p edominan ly occu in women aged 20–30 yea s.
Ou demog aphic analysis showed no signi ican
di e ence in g a ida s a us and locali y be ween
g oups, aligning wi h obse a ions by Pa il e al.
[13], sugges ing ha pa i y and esiden ial
backg ound do no signi ican ly in luence
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Mollah e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
412
p ocedu e selec ion. Rega ding ges a ional age, a
highe p opo ion o pa ien s a 5 weeks unde wen
MVA, whe eas mo e pa ien s a 10 weeks
unde wen EVA, consis en wi h Tasnim e al. [14],
who no ed ha ea ly ges a ional age o en a o s
MVA due o echnical ease and lowe complica ion
a es. Blood loss was consis en ly lowe in he
MVA g oup ac oss ges a ional ages, wi h
s a is ically signi ican di e ences a 6, 8, 9, and 10
weeks, who also obse ed educed in aope a i e
bleeding wi h MVA. Simila ly, he du a ion o
hospi al s ay was sho e o MVA pa ien s (6–6.67
days) compa ed o EVA (13–15 days),
co obo a ing by Singh e al. [15] and Du a e al.
[16], who emphasized he e iciency o MVA in
educing hospi aliza ion and associa ed cos s. Pain
assessmen showed ha G ade I pain was mo e
common in MVA (37%), whe eas G ade IV pain
was mo e equen in EVA (54%), Maheshwa i&
Bha i [17], highligh ing be e pa ien com o wi h
MVA. Pos -p ocedu al complica ions we e
minimal and compa able be ween g oups, wi h no
s a is ically signi ican di e ence, in ag eemen
wi h Kakinuma e al. [18]. Pos -abo al
con acep i e p ac ices did no di e signi ican ly
be ween he g oups, simila o he indings epo ed
by Singh e al. [19]. O e all, unc ional and clinical
ou comes demons a e ha MVA is a sa e,
e ec i e, and pa ien - iendly al e na i e o EVA
o i s - imes e p egnancy e mina ion, p o iding
less blood loss, sho e hospi aliza ion, lowe pain
sco es, and compa able complica ion a es,
suppo ing i s p e e en ial use in app op ia ely
selec ed pa ien s, and Singh e al. [20].
Conclusion
In his s udy, Manual Vacuum Aspi a ion (MVA)
demons a ed clea ad an ages o e Elec ic
Vacuum Aspi a ion (EVA) o i s - imes e
p egnancy e mina ion, including signi ican ly
lowe blood loss, sho e hospi al s ays, and
educed pain, while main aining compa able a es
o pos -p ocedu al complica ions and con acep i e
up ake. These indings, consis en wi h p io
s udies, sugges ha MVA is a sa e, e ec i e, and
pa ien - iendly p ocedu e, pa icula ly sui able o
ea ly ges a ional ages and esou ce-limi ed se ings,
and should be conside ed he p e e ed op ion o
app op ia ely selec ed pa ien s.
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