Menstrual Regulation (MR): Procedure, Indication, Time, Complication
What is Menstrual Regulation (MR)?
A relatively simple method of birth control is “MR” which consists of aspiration of the uterine contents 6-14 days of a missed period, but before most pregnancy tests can accurately determine whether or not a woman is pregnant.
Menstrual Regulation Operation Time:
It is done within 8 weeks of pregnancy or 60 days from the 1 day of last menstruation.
Pre-Operative Preparation for Menstrual Regulation (MR):
A. History:
Menstrual, obstetrical, gynaecological and medical history.
B. Examination for Menstrual Regulation (MR):
- G/E: pulse, BP, temperature, anaemia etc.
- Abdominal exam, to exclude any pathology.
- PA/ exam to know about the size & position of the uterus, condition of the cervix and to exclude any pathology.
C. Investigations of Menstrual Regulation (MR):
- Blood for TC, DC, Hb%,
- Blood grouping and cross matching,
- Urine for albumin, sugar,
- Pregnancy test,
- Patient is explained the procedure, counseled about future contraceptive advice, proper consent taken.
- After her bladder she is taken to taken to the OT.
D. Instruments Required for Menstrual Regulation (MR):
- Swab holding forceps,
- Sims vaginal speculum (to expose the cervix),
- Volsellum forceps (to hold the anterior lip of the cervix),
- Karmanscannule (to employ suction),
- Karmans 50cc syringe (to employ suction).
Procedure of Menstrual Regulation (MR):
- The pt. is placed in lithotomy position.
The lower abdomen, thighs, vulva, vagina & perineum are painted with antiseptic solution. (e,g. betadin solution).
The parts are draped with sterile sheets.
Vaginal examination is performed to determine the size & direction of the uterus.
Sim’s posterior vaginal speculum is introduced (to retract posterior vaginal wall) and an assistant is asked to hold.
The anterior lip of the cervix is held and steadied with a volsellum (or Allis) forceps.
The appropriate Karman’s plastic cannula 4-5 mm (corresponding) to the weeks of gestation) is inserted up to the fundus of the ‘uterus.
Negative pressure of 50-70 mm Hg (vacuum) is created in the Karman’s syringe (outside the uterus) and withheld with the thumb block.
The syringe (pre-evacuated) is connected to the Karman’s cannula and then the thumb block is released.
The Karman’s cannula is rotated at the fundus and gradually withdrawn downwards, until it reaches the isthmus; thereafter it may be moved vertically up & down to confirm the grating sensation all around.
The syringe is disconnected from the cannula and the cannula is withdrawn. The volsellum and Sim’s speculum is withdrawn.
Signs of completion of evacuation:
- No further tissue is evacuated.
- Blood stained bubbles are seen in the cannula & syringe.
- The internal os grips the cannula.
- Grating sensation is felt all over.
Post-operative Preparation for Menstrual Regulation (MR):
- Patient is sent to the bed and should be rested for 1 hour for observation. After that she can go to home.
- Vital signs (such as pulse, BP) and vaginal bleeding should be noted she leaves the hospital.
- Antibiotic: Cephalosporins/ Ampicillin/ Amoxycillin + Metronidazole for 7 days.
- Analgesic: may be.
- Contraceptives: immediately (1=t day’ of MR)-ovacon.
Complication of Menstrual Regulation (MR):
A. Immediate:
- Uterine perforation,
- Trauma,
- Incomplete menstrual regulation (MR),
- Continuation of pregnancy,
- Missed abortion,
- Cervical injury.
B. Late:
- Tendency to abortion or premature labour,
- Infertility,
- Menstrual disorder,
- Increase in ectopic pregnancies,
- Rh immunization,
- Secondary amenorrhoea,
- Feeling of guilty,
- Cervical incompetence.
Advice:
- Avoidance of coitus for 15 days.
- Maintenance of personal hygiene.
- Heavy wt. lifting is avoided.
- Come after 2 weeks for follow up. If there is fever, vaginal bleeding, severe lower abdominal pain come earlier.
