Use Of Vacuum Aspiration Research Articles

Identifying the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine curettage

AbstractAimTo evaluate the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine evacuation and curettage.MethodsA total of 2546 patients who had surgical abortion (uterine evacuation and curettage) before the 20th gestational week with indications of missed abortion, anembryonic pregnancy, incomplete abortion, and elective curettage in a tertiary antenatal care center were recruited. The patients were called and surveyed for their symptoms; including infertility, oligo‐amenorrhea and recurrent pregnancy loss, preterm birth and intrauterine growth retardation and abnormal placentation as criteria of Asherman Syndrome. Diagnostic (office) hysteroscopy was performed for 177 who had one of those complaints.ResultsThe incidence of Asherman Syndrome was 1.6% (n = 43/2546). History of ≥3 abortions was the main factor that increased the risk of Asherman Syndrome for by 4.6 times. Use of vacuum aspiration or sharp curettage, premedication for cervical priming, and having a pregnancy >10th gestational weeks were not risk factors for Asherman Syndrome.ConclusionWhen the diagnosis was based on presence of symptoms who underwent uterine instrumentation, the incidence of Asherman Syndrome was found to be 1.6%. Repeated abortions were the main risk factor for Asherman Syndrome and avoiding from repeated uterine instrumentations may have a role in prevention.

Health system capacity for post-abortion care in Java, Indonesia: a signal functions analysis

BackgroundThe quality of obstetric care has been identified as a contributing factor in Indonesia’s persistently high level of maternal mortality, and the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC). Due to unique health policies and guidelines, in Indonesia, uterine evacuation for PAC is typically administered only by Ob/Gyns practicing in hospitals.MethodsUsing data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we applied a signal functions analysis to measure the health system’s capacity to offer PAC. We then used this framework to simulate the potential impact of the following hypothetical reforms on PAC capacity: allowing first-trimester uterine evacuation for PAC to take place at the primary care level, and allowing provision by clinicians other than Ob/Gyns. Finally, we calculated the proportion of PAC patients treated using four different uterine evacuation procedures.ResultsForty-six percent of hospitals in Java have the full set of services needed to provide PAC, and PAC capacity is concentrated at the highest-level referral hospitals: 86% of referral hospitals have the full set of services, staffing, and equipment compared to 53% of maternity hospitals and 34% of local hospitals. No health centers are adequately staffed or authorized to offer basic PAC services under Indonesia’s current guidelines. PAC capacity at all levels of the health system increases substantially in hypothetical scenarios under which authorization to perform first-trimester uterine evacuation for PAC is expanded to midwives and general physicians practicing in health centers. In 2018, 88% percent of PAC patients were treated using dilation and curettage (D&C).ConclusionsOffering first-trimester uterine evacuation for PAC in PONEDs and allowing clinicians other than Ob/Gyns to perform this procedure would greatly improve the capacity of Java’s health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol for PAC-related uterine evacuation would lower the burden of treatment for patients and facilitate the task-shifting efforts needed to expand access to this life-saving service.

Comparison between vacuum aspiration and forceps plus blunt curettage for the evacuation of complete hydatidiform moles

ObjectiveSuction curettage is recommended for molar evacuation rather than sharp curettage because of its safety. However, the superiority of suction curettage with respect to the incidence of gestational trophoblastic neoplasia (GTN) has not been reported. This study aimed to compare the efficacy and safety of two evacuation procedures, vacuum aspiration and forceps/blunt curettage, for complete hydatidiform moles (CHMs) to determine the differences between them. Materials and methodsPatients with androgenetic CHM determined by multiplex short tandem repeat polymorphism analysis were included in this observational cohort study. Patients underwent evacuation with forceps and blunt curettage (forceps group) before March 2013 and with vacuum aspiration (vacuum group) thereafter. GTN was diagnosed based on the International Federation of Gynecology and Obstetrics 2000 criteria. The incidence of GTN and other clinical parameters were compared. ResultsNinety-two patients were diagnosed with androgenetic CHM. The number of patients in the forceps and vacuum groups was 41 and 51, respectively. The incidence of GTN was 12.2% (5/41) and 13.7% (7/51) in the forceps and vacuum groups, respectively, which was not significantly different (P = 1, Fisher's exact test). No major adverse events, such as uterine perforation and blood transfusion, were noted in either group. The median surgery time was shorter in the vacuum group (16 min) than in the forceps group (25 min) (P = 0.05, Mann–Whitney U test). ConclusionThere were no differences in the incidence of GTN between the forceps and vacuum groups for androgenetic CHM. However, vacuum aspiration could have the advantage of a shorter surgery period. The use of vacuum aspiration for molar pregnancy seems to be safer. Therefore, we recommend suction curettage for the first evacuation of hydatidiform moles.

What contraception do women use after abortion? An analysis of 319,385 cases from eight countries

ABSTRACTContraception is an essential element of high-quality abortion care. However, women seeking abortion often leave health facilities without receiving contraceptive counselling or methods, increasing their risk of unintended pregnancy. This paper describes contraceptive uptake in 319,385 women seeking abortion in 2326 public-sector health facilities in eight African and Asian countries from 2011 to 2013. Ministries of Health integrated contraceptive and abortion services, with technical assistance from Ipas, an international non-governmental organisation. Interventions included updating national guidelines, upgrading facilities, supplying contraceptive methods, and training providers. We conducted unadjusted and adjusted associations between facility level, client age, and gestational age and receipt of contraception at the time of abortion. Overall, postabortion contraceptive uptake was 73%. Factors contributing to uptake included care at a primary-level facility, having an induced abortion, first-trimester gestation, age ≥25, and use of vacuum aspiration for uterine evacuation. Uptake of long-acting, reversible contraception was low in most countries. These findings demonstrate high contraceptive uptake when it is delivered at the time of the abortion, a wide range of contraceptive commodities is available, and ongoing monitoring of services occurs. Improving availability of long-acting contraception, strengthening services in hospitals, and increasing access for young women are areas for improvement.

The Abortion Assessment Project–India: Key Findings and Recommendations

Abstract The Abortion Assessment Project–India, begun in August 2000, is one of the largest studies on abortion ever undertaken in India. This article synthesises the findings of the six facility surveys, two community-based surveys, eight qualitative studies, policy review and commissioned working papers that were produced as part of the project by researchers from across India. Public investment in abortion services nationally was found to be grossly inadequate. 75% of facilities were found in the private sector in the six states and were overwhelmingly perceived to give better services. Although some important changes were made in the 1971 Medical Termination of Pregnancy Act related to clinic certification and medical abortion, further changes during the second phase of the government's Reproductive and Child Health Programme are recommended, based on this research and state and national-level consultations organised by the project. These include integrating abortion services into primary and community health centres, increased investment in public facilities, promoting use of vacuum aspiration and medical abortion, convincing providers to stop using curettage, broadening the base of abortion providers by training paramedics to do first trimester abortions, and reskilling traditional providers to play alternative roles that support women's access to safe abortion services.

Early and late complications following surgical abortion

PIP: A review of the literature concerning early and late complications associated with induced abortion is presented. In the U.S. and some other countries, the mortality rate due to abortion has decreased over the past 5-10 years. This decrease is due in large part to the increased experience of those who perform abortions and the increased incidence of the use of vacuum aspiration to perform first trimester abortion, which requires no general anesthesia and is associated with fewer complications. In the U.S., anesthesia complications are responsible for about 15% of the abortion mortality rate. The frequency of complications is directly related to the type of abortion procedure used and the age of the pregnancy at the time of abortion. Menstrual regulation has the lowest complication rate, while any operation involving laparotomy or vaginal intervention has a high mortality and morbidity rate. Early complications of vacuum aspiration or curettage include anesthesia complication, bleeding, cervical laceration or injury, infection, uterine perforation, and failure to remove fetal matter completely. Late complications of abortion which are definitely related to the operation are erythroblastosis and laceration of the cervix. Ectopic pregnancy, a complication of later pregnancies, cannot be related directly to a previously performed abortion. The Hegar method is no longer preferred for dilatation. Rh-negative women should receive a 200 mcg dosage of anti-D serum after an abortion. Although the simultaneous performance of abortion and sterilization can have positive aspects, e.g. less patient stress, less cost, the need for only 1 anesthesia, this can lead to a multiplication of complications or the situation in which a woman feels herself pressured into undergoing sterilization.