Proportion And Factors Associated With Intra-Procedural Pain Among Women Undergoing Manual Vacuum Aspiration For Incomplete Abortion At Mbarara Regional Referral Hospital, Uganda

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Abstract Background: 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%. IPP management during MVA include Para-cervical block (using 1% lidocaine) or an opioid (using 100mg of intravenous pethidine). Objectives: This study determined the proportion and factors associated with IPP among women undergoing MVA for incomplete abortion at MRRH.Methods: We conducted a cross sectional study among 207 women who underwent MVA for incomplete abortion from 17th December 2020 to 28th May 2021. An interviewer-administered structured questionnaire was used, and pain assessment was done using 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 (age<20 years); OR=8 (95% CI=1.85-34.61) (p=0.005), while women aged 20-24 years; OR=3.45 (95% CI=1.47-8.20) (p=0.004), and those aged 25-30 years; OR=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; OR=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 1-2cm are more likely to experience IPP. We recommend improvement of pain control among women undergoing MVA.

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