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Abstract
Objective: To compare Manual Vacuum Aspiration and Pipelle for endometrial sampling based on procedural time, post-procedure pain, infection rate, bleeding, sample adequacy, and cost-effectiveness.
Methods: A quasi-experimental study was conducted at the Department of Obstetrics and Gynaecology, Akhter Saeed Medical College/ Farooq Hospital, Rawalpindi. After obtaining informed consent, 290 patients were included in the study. They were divided into two groups with 145 patients in each group. Endometrial sampling was performed using a manual vacuum aspirator in one group, while a Pipelle sampler was used in the other group. Data on procedural time, pain scores, sample weight, infection, bleeding, sample adequacy, and total procedural cost were recorded. Statistical analysis was performed using independent sample t-tests and chi-square tests.
Results: Manual vacuum aspiration was significantly more efficient in terms of procedural time (5.71 + 0.49 min vs. 8.67 + 0.68 min; p < 0.001) and higher diagnostic tissue yield (100.09 + 3.52 mg vs. 71.87+ 2.67 mg; p < 0.001). However, the Pipelle group reported significantly lower pain scores (4.05 + 0.27 vs. 6.23 + 0.47; p < 0.001). Economically, MVA was more cost-effective per procedure (500 vs. 1000 Rs.; p < 0.001).
Conclusion: Manual Vacuum Aspiration is better than Pipelle in terms of tissue yield, procedural speed, and cost-effectiveness, whereas Pipelle is better tolerated in terms of pain scores. MVA remains a highly effective and economical diagnostic tool for endometrial assessment, making it ideal for routine outpatient evaluations.
Key words: Abnormal Uterine Bleeding, Endometrial Sampling, Manual Vacuum Aspiration, Pipelle Biopsy
References
Ghani S, Masood Z, Tahir H, Ali F, Hassan S, Saeed S. Pattern of abnormal uterine bleeding and spectrum of endometrial pathology among perimenopausal women. Med Forum. 2022;33(8):98-101.
Ansari A, Urooj U. Study of causes behind abnormal uterine bleeding according to PALM-COEIN classification at a tertiary care hospital. J Pak Med Assoc. 2020;70(1):154-7. https://doi.org/10.5455/JPMA.2749
Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13. https://doi.org/10.1016/j.ijgo.2010.11.011
Mutakha GS, Mwaliko E, Kirwa P. Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya. PLoS One. 2020;15(12):e0243166. https://doi.org/10.1371/journal.pone.0243166
Yıldız Ş, Alay İ. Risk factors and hysteroscopic results for insufficient tissue from endometrial biopsy. NKMJ. 2020;8(2):204-11. https://doi.org/10.37696/nkmj.667710
Kashif S, Iftikhar G, Jabbar S, Khawar N, Qureshi MN, Choudhry SS. Comparison between Pipelle sampling and hysteroscopy guided biopsy in histologic evaluation of endometrium in tertiary care hospital in Pakistan. Pak J Med Health Sci. 2022;16(12):378-80. https://doi.org/10.53350/pjmhs20221612378
Asano K, Unno H, Kubota S, et al. Enhancing preoperative diagnostic accuracy in endometrial hyperplasia: a comparison of biopsy methods. Cureus. 2025;17(4):e81880. https://doi.org/10.7759/cureus.81880
World Health Organization. Safe abortion: technical and policy guidance for health systems. 2nd ed. Geneva: WHO; 2012.
Latif F, Waseem Z, Yasmin N, Arif RM, Tahir S, Latief N. Comparison of adequate endometrial tissue sample received by histopathologist by manual vacuum aspiration versus dilation and curettage in women presenting with abnormal uterine bleeding. Pak Postgrad Med J. 2023;34(1):38-42. https://doi.org/10.51642/ppmj.v34i01.504
Sarosh M, Ghafoor F, Shakoor S. Pipelle endometrial sampling versus conventional dilatation and curettage in patients with abnormal uterine bleeding. Pak J Med Health Sci. 2022;16(2):17-19. https://doi.org/10.53350/pjmhs2216217
Wanijasombutti P, Imruetaicharoenchok A, Tangjitgamol S, et al. Comparison of tissue adequacy for histologic examination from Ipas MVA plus and Wallach Endocell in women with abnormal uterine bleeding. J Obstet Gynaecol Res. 2015;41(8):1246-54. https://doi.org/10.1111/jog.12693
Sirimai K, Lertbunnaphong T, Suwanthananon C, Warnnissorn M, Panichyawat N. Correlation between manual vacuum aspiration and endometrial cell sampler in abnormal uterine bleeding. Siriraj Med J. 2023;75(8):560-6. https://doi.org/10.33192/smj.v75i8.262259
Saito E, Matsumoto Y, Nitta S, et al. Manual vacuum aspiration for endometrial biopsy in suspected malignancy: a comparative study. J Obstet Gynaecol Res. 2022;48(9):2896-902. https://doi.org/10.1111/jog.15403
Gupta M, Gupta P, Yadav P. A randomized comparative study to compare Karman's cannula and Pipelle biopsy for evaluation of abnormal uterine bleeding. J Midlife Health. 2022;13(1):67-73. https://doi.org/10.4103/jmh.jmh_168_21
Baqai S, Nawaz Q, Tufail S, Tabassum H, Nasreen S, Nayyer S. A comparative study of improvised manual vacuum aspiration versus Pipelle sampling for endometrial sampling. Pak Armed Forces Med J. 2023;73(3):778-82. https://doi.org/10.51253/pafmj.v73i3.9249
Rauf R, Shaheen A, Sadia S, Waqar F, Zafar S, Sultana S, et al. Outpatient endometrial biopsy with Pipelle vs diagnostic dilatation and curettage. J Ayub Med Coll Abbottabad. 2014;26(2):145-8.
Garg A, Mukherjee S. Pipelle versus MVA cannula for endometrial biopsy: a comparative study. Int J Reprod Contracept Obstet Gynecol. 2022;11(4):1241-4. https://doi.org/10.18203/2320-1770.ijrcog20220912
Nama A, Kochar S, Suthar N, Kumar A, Solanki K. Accuracy of Karman endometrial aspiration in comparison to conventional D and C in women with AUB at tertiary care hospital in North West Rajasthan. J Family Med Prim Care. 2020;9(7):3496-501. https://doi.org/10.4103/jfmpc.jfmpc_291_20
Gaziosmanpasa Research and Education Hospital. Pipelle versus Karman endometrial biopsy under standardized paracervical block (PB-EMB). ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US); 2026.
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