Proportion and factors associated with intra-procedural pain among women undergoing manual vacuum aspiration for incomplete abortion at Mbarara Regional Referral Hospital, Uganda

Abstract

Introduction: intra-procedural pain (IPP) is common among women undergoing Manual Vacuum Aspiration (MVA) for incomplete abortion. Globally, the proportion varies between 60% to 90% while in sub-Saharan Africa including Uganda, the proportion varies between 80% to 98%. Intra-procedural pain management during MVA include para-cervical block (using 1% lidocaine) or an opioid (using 100 mg of intravenous pethidine). The study aimed to determine the proportion and factors associated with IPP among women undergoing MVA for incomplete abortion at Mbarara Regional Referral Hospital (MRRH).

Methods: we conducted a cross-sectional study among 207 women who underwent MVA for incomplete abortion between December 2020 and May 2021. An interviewer-administered structured questionnaire was used, and pain assessment was done using the Visual Analogue Scale (VAS) considering an IPP as a pain score of 6 or more. The participant characteristics were summarized. The proportion of women with IPP was calculated. We performed multivariable logistic regression to determine the factors associated with IPP.

Results: we consecutively enrolled 207 women with a mean age of 25.8 ± 5.8 years. The proportion of women with IPP undergoing MVA at MRRH was 82.6%, 95% C.I 76.8 – 87.2. The factors significantly associated with IPP were age and cervical dilatation. The odds of IPP increased with decreasing age of the women; compared to older women aged >30 years, teenagers aged <20 years; aOR: 8, 95% CI 1.85-34.61; p=0.005, while women aged 20-24 years; aOR: 3.45, 95% CI 1.47-8.20; p=0.004 and those aged 25-30 years; aOR: 2.84, 95% CI 1.20-6.74; p=0.018. Women with cervical dilatation of 1-2 cm had the odds of IPP increased; aOR: 2.27, 95% CI 1.11-4.62; p=0.024 compared to a cervical dilation of 3-4 cm.

Conclusion: majority of women undergoing MVA at MRRH experienced IPP. Younger women and those with cervical dilatation 1-2 cm are more likely to experience IPP. We recommend optimised and personalised pain management strategies for women undergoing MVA.