Recommended Uterine Evacuation Methods

Purpose This module describes aspects of the safety, efficacy and acceptability of different methods of first-trimester uterine evacuation (for treatment of complications or safe induced abortion) and how to transition from the use of sharp curettage (SC) to vacuum aspiration, particularly manual vacuum aspiration (MVA), and/or medical abortion.

Objectives By the end of this module, learners should be able to: Describe methods for evacuating the uterus. Explain the rationale for replacing sharp curettage (SC) with vacuum aspiration and/or medical abortion.

Objectives (continued) Describe factors in deciding which uterine evacuation method to use. Provide information to support the transition from SC to MVA and/or medical abortion.

Uterine Evacuation Methods Uterine evacuation removes contents of the uterus. There are several methods for providing first-trimester uterine evacuation: Vacuum aspiration techniques Medical (or pharmacological) techniques Sharp curettage (SC)

Which Method Is Best? Use of a certain method depends on: Safety, efficacy and cost Staff skills Equipment, supplies, drugs available The woman’s clinical condition Her personal preference

Recommended UE Methods Adapted from WHO, 2003. Safe Abortion: Technical and Policy Guidance for Health Systems

Manual Vacuum Aspiration (MVA) Ipas MVA Plus® with Ipas EasyGrip® Cannula

Electric Vacuum Aspiration (EVA) Machine

Advantages of Vacuum Aspiration Low risk of infection, injury Little or no cervical dilatation required Can be performed as an outpatient procedure Decreased need for anesthetic drugs compared to SC

Medical Abortion Pills

Advantages of medical abortion (MA) MA can help increase access to safe induced abortion and treatment of some abortion complications where other abortion services are not available MA is simple, easy to manage and the drugs do not require refrigeration

Advantages of medical abortion (MA) (continued) In many situations, MA requires less resources including equipment, facilities and staffing than other UE methods Mid-level providers can provide effective services

Advantages of MA (continued) Even if clinicians cannot give the medications directly, they can advise women about how to safely use MA Example: “Harm Reduction” Approach in Uruguay Access to legal abortion is very restricted Public health laws permit physicians to provide women with guidance on using MA safely and effectively Women purchase and take the medications A follow-up study found that no women in this intervention experienced serious complications

Metal Curette (for sharp curettage)

Long-Term Effects Safe induced abortion does not cause future infertility, preterm delivery, breast cancer or severe psychological reactions (RCOG, 2004; ACOG Committee, 2003; Adler, 1990).

According to the World Health Organization (WHO) Vacuum aspiration and medical abortion are preferred methods for first-trimester abortion (safe induced or treatment of complications). WHO recommends replacing SC with vacuum aspiration or medication abortion.

Illustrations by Stephen C. Edgerton.