A Novel Modification Of Manual Vacuum Aspiration Technique Guided By Ultrasound For Safe And Effective Abortion Management

Background: Manual vacuum aspiration (MVA) is a widely used technique for first-trimester pregnancy termination. However, conventional MVA involves back-and-forth cannula movements while turning 360°rotational, which may increase procedural complexity and risk of complications. This study introduces a novel MVA modification using continuous only 360° rotational cannula movement under real-time ultrasound (USG) guidance, hypothesized to improve safety and efficacy. Methods: In this retrospective observational pilot study conducted at Stella Maris Women’s and Children’s Hospital (Medan, Indonesia) from January 2024 to January 2025, 60 patients with missed abortion ≤8 weeks gestation were allocated into two groups: conventional ultrasound-guided MVA (USGMVA) and rotational USG-MVA without back-and-forth cannula motion. Procedures were performed by a single experienced gynecologist. Outcomes assessed included pain scores, blood loss, procedure time, laceration, retained of conception, pelvic inflammatory disease (PID) and uterine perforation. Results: The rotational USG-MVA group reported significantly lower pain scores (2.13 ± 0.78 vs. 3.01 ± 1.48, p=0.003), shorter procedure time (8.87 ± 0.68 min vs. 9.67 ± 1.97 min, p=0.040), reduced cervical laceration (0.00 ± 0 vs 0.13 ± 0.31, p = 0.043), lower blood loss (27.27 ± 2.78 mL vs. 30.77 ± 4.77 mL; p = 0.001) and the number of aspirations required was fewer in the rotational USG-MVA group (3.8 ± 0.74 vs. 4.3 ± 0.92; p = 0.035). No cases of uterine perforation, pelvic inflammatory disease, or retained products of conception occurred in either group. Conclusion: The novel rotational MVA technique perfomed under USG guidance is a safe, effective and user-friendly alternative to conventional MVA.