Minor differences with electric and manual aspiration of molar pregnancy

Manual vacuum aspiration of molar pregnancy achieves similar outcomes to electric vacuum aspiration, although it may lead to a lower incidence of uterine synechia, according to a paper published in the April edition of Obstetrics & Gynecology.

While electric vacuum aspiration of molar pregnancy is the dominant technique in North America, in other parts of the world, such as Brazil, manual vacuum aspiration is far more commonly used.

In a retrospective cohort study, researchers looked at outcomes for 1,727 patients with molar pregnancy; 1,206 of these patients underwent electric vacuum aspiration, and 521 underwent manual vacuum aspiration.

Patients who underwent electric vacuum aspiration had significantly shorter operative times (25.3 minutes vs. 34.2 minutes; P less than .001) and showed a greater drop in hemoglobin levels after evacuation (–0.3 g/dL vs. –0.19 g/dL; P less than .001), compared with those who underwent manual vacuum aspiration.

The electric procedure was also associated with a significantly higher risk of intrauterine adhesions after the procedure, compared with the manual vacuum aspiration (5.2% vs. 1.2%; P less than .001).

Lilian Padrón, MD, of the Trophoblastic Disease Center at the Rio de Janeiro Federal University and coauthors commented that the vacuum pressure is about 100 mm Hg higher in the electric technique than it is in the manual technique, which may be responsible for the greater risk of synechia.

However, there were no significant differences seen between the two groups in the risk of developing postmolar gestational trophoblastic neoplasia (14.2% with electric vs. 17.3% with manual; P = .074) nor in the presence of metastatic disease (19.9% vs. 17.8%; P = .082) or the need for multiagent chemotherapy.

Around 13% of patients had incomplete uterine evacuation, but the risk was similar between electric and manual vacuum aspiration.

“In our sample, formed exclusively by patients with molar pregnancy, the rate of complete uterine emptying did not reach 90% with either technique,” the authors wrote. “This may reflect not only the greater amount of molar trophoblastic tissue, compared with an abortion, but also the invasiveness of molar trophoblastic cells into the maternal decidua.”

There were nine cases of uterine perforation in the electric vacuum aspiration group (0.7%), and none in the manual group, although the difference was not statistically significant.

“Although differences in rates of uterine perforation as well as prolonged length of stay were not statistically different between the groups,” the authors wrote, “both of these were rare events, and we lacked sufficient power to detect differences in rare outcomes.”

No conflicts of interest were declared.

SOURCE: Padrón L et al. Obstet Gynecol. 2018;131:652-9.

Manual vacuum aspiration of molar pregnancy achieves similar outcomes to electric vacuum aspiration, although it may lead to a lower incidence of uterine synechia, according to a paper published in the April edition of Obstetrics & Gynecology.

While electric vacuum aspiration of molar pregnancy is the dominant technique in North America, in other parts of the world, such as Brazil, manual vacuum aspiration is far more commonly used.

In a retrospective cohort study, researchers looked at outcomes for 1,727 patients with molar pregnancy; 1,206 of these patients underwent electric vacuum aspiration, and 521 underwent manual vacuum aspiration.

Patients who underwent electric vacuum aspiration had significantly shorter operative times (25.3 minutes vs. 34.2 minutes; P less than .001) and showed a greater drop in hemoglobin levels after evacuation (–0.3 g/dL vs. –0.19 g/dL; P less than .001), compared with those who underwent manual vacuum aspiration.

The electric procedure was also associated with a significantly higher risk of intrauterine adhesions after the procedure, compared with the manual vacuum aspiration (5.2% vs. 1.2%; P less than .001).

Lilian Padrón, MD, of the Trophoblastic Disease Center at the Rio de Janeiro Federal University and coauthors commented that the vacuum pressure is about 100 mm Hg higher in the electric technique than it is in the manual technique, which may be responsible for the greater risk of synechia.

However, there were no significant differences seen between the two groups in the risk of developing postmolar gestational trophoblastic neoplasia (14.2% with electric vs. 17.3% with manual; P = .074) nor in the presence of metastatic disease (19.9% vs. 17.8%; P = .082) or the need for multiagent chemotherapy.

Around 13% of patients had incomplete uterine evacuation, but the risk was similar between electric and manual vacuum aspiration.

“In our sample, formed exclusively by patients with molar pregnancy, the rate of complete uterine emptying did not reach 90% with either technique,” the authors wrote. “This may reflect not only the greater amount of molar trophoblastic tissue, compared with an abortion, but also the invasiveness of molar trophoblastic cells into the maternal decidua.”

There were nine cases of uterine perforation in the electric vacuum aspiration group (0.7%), and none in the manual group, although the difference was not statistically significant.

“Although differences in rates of uterine perforation as well as prolonged length of stay were not statistically different between the groups,” the authors wrote, “both of these were rare events, and we lacked sufficient power to detect differences in rare outcomes.”

No conflicts of interest were declared.

SOURCE: Padrón L et al. Obstet Gynecol. 2018;131:652-9.

Manual vacuum aspiration of molar pregnancy achieves similar outcomes to electric vacuum aspiration, although it may lead to a lower incidence of uterine synechia, according to a paper published in the April edition of Obstetrics & Gynecology.

While electric vacuum aspiration of molar pregnancy is the dominant technique in North America, in other parts of the world, such as Brazil, manual vacuum aspiration is far more commonly used.

In a retrospective cohort study, researchers looked at outcomes for 1,727 patients with molar pregnancy; 1,206 of these patients underwent electric vacuum aspiration, and 521 underwent manual vacuum aspiration.

Patients who underwent electric vacuum aspiration had significantly shorter operative times (25.3 minutes vs. 34.2 minutes; P less than .001) and showed a greater drop in hemoglobin levels after evacuation (–0.3 g/dL vs. –0.19 g/dL; P less than .001), compared with those who underwent manual vacuum aspiration.

The electric procedure was also associated with a significantly higher risk of intrauterine adhesions after the procedure, compared with the manual vacuum aspiration (5.2% vs. 1.2%; P less than .001).

Lilian Padrón, MD, of the Trophoblastic Disease Center at the Rio de Janeiro Federal University and coauthors commented that the vacuum pressure is about 100 mm Hg higher in the electric technique than it is in the manual technique, which may be responsible for the greater risk of synechia.

However, there were no significant differences seen between the two groups in the risk of developing postmolar gestational trophoblastic neoplasia (14.2% with electric vs. 17.3% with manual; P = .074) nor in the presence of metastatic disease (19.9% vs. 17.8%; P = .082) or the need for multiagent chemotherapy.

Around 13% of patients had incomplete uterine evacuation, but the risk was similar between electric and manual vacuum aspiration.

“In our sample, formed exclusively by patients with molar pregnancy, the rate of complete uterine emptying did not reach 90% with either technique,” the authors wrote. “This may reflect not only the greater amount of molar trophoblastic tissue, compared with an abortion, but also the invasiveness of molar trophoblastic cells into the maternal decidua.”

There were nine cases of uterine perforation in the electric vacuum aspiration group (0.7%), and none in the manual group, although the difference was not statistically significant.

“Although differences in rates of uterine perforation as well as prolonged length of stay were not statistically different between the groups,” the authors wrote, “both of these were rare events, and we lacked sufficient power to detect differences in rare outcomes.”

No conflicts of interest were declared.

SOURCE: Padrón L et al. Obstet Gynecol. 2018;131:652-9.