Vacuum aspiration

Vacuum or suction aspiration uses aspiration to remove the contents of the uterus through the cervix. It is a method of induced abortion as well as a therapeutic procedure used after miscarriage. The rate of infection is lower than any other surgical abortion procedure at 0.5%. Some sources may use the terms dilation and evacuation or "suction" dilation and curettage to refer to vacuum aspiration, although those terms are normally used to refer to distinct procedures.

Clinical uses
Vacuum aspiration may be used as a method of induced abortion, as a therapeutic procedure after miscarriage, to aid in menstrual regulation, and to obtain a sample for endometrial biopsy. It is also used to terminate molar pregnancy.

When used as a miscarriage treatment or an abortion method, vacuum aspiration may be used alone or with cervical dilation anytime in the first trimester (up to 12 weeks gestational age). For more advanced pregnancies, vacuum aspiration may be used as one step in a dilation and evacuation procedure. Vacuum aspiration is the procedure used for almost all first-trimester abortions in many countries.

Procedure
Vacuum aspiration is an outpatient procedure that generally involves a clinic visit of several hours. The procedure itself typically takes less than 15 minutes. Suction is created with either an electric pump (electric vacuum aspiration or EVA) or a manual pump (manual vacuum aspiration or MVA). Both methods use the same level of suction, and so can be considered equivalent in terms of effectiveness and safety.

The clinician may first use a local anesthetic to numb the cervix. Then, the clinician may use instruments called "dilators" to open the cervix, or sometimes medically induce dilation with drugs. Finally, a sterile cannula is inserted into the uterus and attached via tubing to the pump. The pump creates a gentle vacuum which empties uterine contents.

After a procedure for abortion or miscarriage treatment, the tissue removed from the uterus is examined for completeness. Expected contents include the embryo or fetus as well as the decidua, chorionic villi, amniotic fluid, amniotic membrane and other tissue.

Post-treatment care includes brief observation in a recovery area and a follow-up appointment approximately two weeks later.

Advantages over dilation and curettage
Dilation and curettage (D&C), also known as sharp curettage, was once the standard of care in situations requiring uterine evacuation. However, vacuum aspiration has a number of advantages over D&C and has largely replaced D&C in many settings.

Vacuum aspiration may be used earlier in pregnancy than dilation and curettage (D&C). Manual vacuum aspiration is the only surgical abortion procedure available earlier than the 6th week of pregnancy. Vacuum aspiration has lower rates of complications when compared to D&C.

Vacuum aspiration - especially manual vacuum aspiration - is significantly cheaper than D&C. The equipment needed for vacuum aspiration costs less than a curette set. Unlike D&C, vacuum aspiration does not require general anesthesia and so can be performed as an outpatient procedure at a clinic rather than in a hospital surgical setting. While D&C is generally provided only by physicians, vacuum aspiration may be performed by mid-level health care providers such as physician's assistants and midwives.

Manual vacuum aspiration does not require electricity and so can be provided in locations that have unreliable electrical service or none at all. Manual vacuum aspiration also has the advantage of being quiet, without the noise of an electric vacuum pump.

Complications
When used for uterine evacuation, vacuum aspiration is 98% effective in removing all uterine contents. Retained products of conception require a second aspiration procedure. This is more common when the procedure is performed very early in pregnancy, before 6 weeks gestational age.

Other complications occur at a rate of less than 1 per 100 procedures and include excessive blood loss, infection, injury to the cervix or uterus, and uterine adhesions.

History
The key to the development of MVA was the invention of the Karman canula, a soft, flexible cannula that reduced the risks of puncturing the uterus.