Surgical termination of pregnancy: First trimester
- Frank W Ling, MD
Frank W Ling, MD
- Clinical Professor, Department of Obstetrics and Gynecology
- Vanderbilt University School of Medicine
Suction curettage is the most commonly used method of pregnancy termination in the United States [1,2]. The procedure, also referred to as dilation and evacuation, is usually performed between the 7th and 13th menstrual weeks. According to the Centers for Disease Control, over 96 percent of abortions in the United States in 2001 were performed by suction curettage . The procedure does not require hospitalization except in women with medical or surgical disorders that place them at higher surgical risk.
Suction curettage of the uterus in the first trimester will be reviewed here. General issues regarding preoperative evaluation and patient preparation, anesthesia, complications, and follow-up, and second trimester pregnancy termination are discussed separately. (See "Overview of pregnancy termination" and "Second trimester pregnancy termination: Overview and surgical termination".)
Dilation of the cervix is usually necessary to allow insertion of instruments and removal of bulky uterine contents. However, very early pregnancies (eg, less than seven weeks of gestation) may not require cervical dilation. In pregnancies 7 to 13 weeks, the endocervical canal can either be dilated manually or osmotic dilators or prostaglandins can be used to gradually dilate the cervix. The latter two methods require a few hours to work and may involve additional patient visits; therefore, many practitioners and clinics due not use them in the first trimester. (See "Overview of pregnancy termination", section on 'Cervical preparation'.)
Manual vacuum aspiration — Vacuum aspiration is generally performed with an electric suction device, however, it may also be performed with a manual aspirator. At less than 10 weeks of gestation, it appears that manual vacuum aspiration (MVA) is as safe and effective as electric vacuum aspiration (EVA), and may result in less pain and blood loss [4,5]. A systematic review that compared MVA to EVA for termination of pregnancy at less than 10 weeks reported no significant differences between the two methods for complete abortion rate or patient satisfaction .
Both EVA and MVA produce about 60 mmHg of suction, but manual aspiration has the advantage of being quieter. Patients are often disturbed by the noise of the electric device . In contrast to an electric suction device, the manual vacuum aspirator is more portable, inexpensive, and does not require electricity, thereby making it a favorable choice for low-resource settings.
- Castadot RG. Pregnancy termination: techniques, risks, and complications and their management. Fertil Steril 1986; 45:5.
- American College of Obstetricians and Gynecologists. Methods of midtrimester abortion. ACOG technical bulletin #109. American College of Obstetricians and Gynecologists, Washington, DC 1987.
- www.cdc.gov/mmwr/preview/mmwrhtml/ss5309a1.htm (Accessed on March 08, 2005).
- Wen J, Cai QY, Deng F, Li YP. Manual versus electric vacuum aspiration for first-trimester abortion: a systematic review. BJOG 2008; 115:5.
- Goldberg AB, Dean G, Kang MS, et al. Manual versus electric vacuum aspiration for early first-trimester abortion: a controlled study of complication rates. Obstet Gynecol 2004; 103:101.
- Dean G, Cardenas L, Darney P, Goldberg A. Acceptability of manual versus electric aspiration for first trimester abortion: a randomized trial. Contraception 2003; 67:201.
- Verkuyl DA, Crowther CA. Suction v. conventional curettage in incomplete abortion. A randomised controlled trial. S Afr Med J 1993; 83:13.
- Shulman LP, Elias S, Simpson JL. Induced abortion for genetic indications: techniques and complications. In: Genetic Disorders and the Fetus: Diagnosis, Prevention and Treatment, Milunsky A (Ed), Johns Hopkins University Press, 1992. p.721.
- Munsick RA. Clinical test for placenta in 300 consecutive menstrual aspirations. Obstet Gynecol 1982; 60:738.
- Paul M, Lackie E, Mitchell C, et al. Is pathology examination useful after early surgical abortion? Obstet Gynecol 2002; 99:567.
- Heath V, Chadwick V, Cooke I, et al. Should tissue from pregnancy termination and uterine evacuation routinely be examined histologically? BJOG 2000; 107:727.
- Seckl MJ, Gillmore R, Foskett M, et al. Routine terminations of pregnancy--should we screen for gestational trophoblastic neoplasia? Lancet 2004; 364:705.
- Hodgson JE. Major complications of 20,248 consecutive first trimester abortions: problems of fragmented care. Adv Plan Parent 1975; 9:52.
- Nathanson BN. Ambulatory abortion: experience with 26,000 cases (July 1, 1970, to August 1, 1971). N Engl J Med 1972; 286:403.
- Hodgson JE, Portmann KC. Complications of 10,453 consecutive first-trimester abortions: a prospective study. Am J Obstet Gynecol 1974; 120:802.