Uterine Aspiration Research Articles

Impact of formal family planning training on Ob/Gyn residents' skills in uterine aspiration and contraception provision

The purpose of this study was to assess the impact of formal, opt-out family planning training on clinical competence in uterine evacuation and contraception skills among Ob/Gyn residents at 34 programs.

Conservative management of large uterine arteriovenous malformation: case report

Uterine arteriovenous malformation is a rare condition that may be associated with uterine bleeding. Eventually morphologic aspects of the lesions induce unnecessary aggressive surgery; we report here a case of successful expectant management.

A randomized trial of tramadol versus ibuprofen as an adjunct to pain control during vacuum aspiration abortion

Background The study was conducted to determine whether tramadol is more effective than ibuprofen for reducing pain during uterine aspiration for abortion. Study Design Women presenting to a community-based abortion clinic were invited to participate in this double-blind, randomized trial. Following informed consent, subjects were randomly assigned to receive either 50 mg tramadol or 800 mg ibuprofen orally in addition to the standard clinic analgesic protocol. The primary outcome was pain as verbally rated on a scale from 0 to 10. Measurements were obtained immediately after and 30 min postprocedure. Results One hundred fifty-eight women were enrolled, 80 women were randomized to ibuprofen and 78 women, to tramadol. Immediately after the procedure, the mean pain scores in both treatment groups were 4.9 (95% CI=4.3–5.5). Thirty min postoperatively the mean pain score in the ibuprofen group was 2.8 compared to 3.6 in the tramadol group (p=.04). Conclusion There was no difference in immediate postprocedure pain between women receiving tramadol or ibuprofen. Ibuprofen is somewhat more effective than tramadol at reducing pain 30 min following surgical abortion.

Impact of formal family planning residency training on clinical competence in uterine evacuation techniques

Background The goal of this study was to assess the impact of formal opt-out family planning training on clinical competence in uterine evacuation. Study Design Residents who participated in newly established, routine opt-out family planning training completed surveys before and after their rotations. The surveys asked residents to report clinical experience and competence in family planning. Results One hundred ninety-six pre- and postrotation questionnaires were collected for a total response rate of 63%. After completing the rotation, residents reported higher competence in medical abortion, manual uterine aspiration, electric uterine aspiration and dilation and evacuation (p<.001). Residents also reported increased clinical experience with methods of termination, postabortion contraception, including intrauterine contraception, ultrasound and perioperative pain management. Conclusions Participation in a formal opt-out family planning rotation results in increased clinical exposure to family planning and in reported competence in pregnancy termination.

Can mifepristone medication abortion be successfully integrated into medical practices that do not offer surgical abortion?

Background The introduction of medication abortion with mifepristone has expanded women's abortion options. Medication abortion may be easier than aspiration abortion to incorporate into medical practices. The purpose of this study was to determine the proportion of women who select medication abortion in a clinic setting where surgical abortion is not available. Methods This retrospective cohort study examines patients presenting for pregnancy options counseling to Family Medicine and Obstetrics/Gynecology clinics at the University of New Mexico from 2002 to 2005. All women presenting for options counseling received a dating ultrasound. All patients with an estimated gestational age of 63 days or less who chose to terminate were offered onsite medication abortion or referral to affiliated sites for uterine aspiration. Medical charts were abstracted for surgical and medical abortions, follow-up visits and complications. Results Two hundred twenty women presented for options counseling and 204 (92.7%) were eligible for medication abortion. One hundred seventy-three (85%) of the 204 eligible women chose medication abortion. One hundred thirty-six (88.3%) of 154 women under 7 completed weeks (49 days) chose medication abortion compared to 37 (74%) of 50 eligible women over 7 completed weeks (p<.03). Ninety-six percent of women undergoing medication abortion had at least one follow-up visit where 98% had a documented complete abortion. Conclusions Medication abortion can be successfully integrated into a practice that does not offer surgical abortion. Family medicine and obstetrician/gynecologist physicians may consider incorporating medication abortion into their practices even if they are unable to offer aspiration abortion.

Sublingual lorazepam is an acceptable pre-medication for outpatient uterine aspiration

Studies of abortion pain have found that uterine aspiration is painful. Complex factors affect pain perception; however, anxiety and fearfulness are strongly associated with higher pain scores. We aimed to evaluate the acceptability of sublingual (SL) lorazepam in combination with ibuprofen and cervical block for first-trimester uterine aspiration in a general gynecology outpatient setting.

The effect of the Papaya Workshop on medical students' knowledge about intrauterine contraception and uterine aspiration

The effect of the Papaya Workshop on medical students' knowledge about intrauterine contraception (IUC) and uterine aspiration (UA) was studied.

Simultaneous very low dose mifepristone and vaginal misoprostol for medical abortion

Objective This pilot study was designed to evaluate the outcome of medical abortion following simultaneous mifepristone (100 mg) and misoprostol (800 μg). Methods Enrollees had gestational ages up to 56 days and desired a medical abortion. They received 100 mg of mifepristone orally and 800 μg of misoprostol vaginally. Follow-up examination occurred in 2–7 days. A phone call 3 weeks later assessed symptoms and acceptability. A 95% success rate, as seen in higher dose studies, gives a 95% confidence interval of 88–100% for 40 subjects. Results Forty women were enrolled; 39 women had follow-up visits. Completed medical abortion was confirmed for 35 (90%) of 39 women. Four women had uterine aspiration. Two patients required repeat misoprostol. Median time from medication to abortion was 7 h. Most women (92%) strongly preferred taking all medications in the clinic. Conclusions The simultaneous administration of vaginal misoprostol with 100 mg of oral mifepristone had the outcome of completed abortion within the predicted confidence interval. In addition, simultaneous dosing was highly acceptable.

“You can't do that 'round here”: a case study of the introduction of medical abortion care at a University Medical Center

Mifepristone medical abortion was introduced in 2002 into the University of New Mexico Medical Center clinic system through a joint effort of the departments of Family Medicine and Obstetrics and Gynecology. A stepwise approach to the integration of medical abortion, manual vacuum uterine aspiration, and first trimester obstetric ultrasound was successful in overcoming a series of educational, political, economic and logistical challenges. The integration of medial abortion care into resident training in FM and Ob/Gyn may expand access to reproductive services in primary care settings.

Misoprostol as the primary agent for medical abortion in a low-income urban setting

The purpose of this study was to assess the outcomes of early medical abortion in an inner-city hospital abortion service, using misoprostol as the primary agent. This was a retrospective chart review from July 2001 through December 2002. Women were eligible if they had a viable pregnancy with gestational age 8 weeks or less by transvaginal ultrasound and no medical contraindications. Two doses of 800 μg misoprostol were administered vaginally, 24 h apart. Initial follow-up was scheduled 2–3 days later. Of the 440 women who underwent medical abortion, 373 (90.8%, 95% confidence interval (CI) 88–94%) completed abortion medically, 38 (9.2%) had uterine aspiration and the remainder had incomplete or no follow-up. Of uterine aspirations, 11 were medically indicated, giving a rate of indicated aspiration of 2.7%. Gestational age, age, gravidity, parity, past abortion history, ethnic group and payer did not significantly correlate with overall rate of aspiration or rate of follow-up, but gestational age was correlated with medically indicated aspiration. Among 57 women who reported a time of tissue passage, the mean time from initial misoprostol dose was 8.5 h (95% CI 6.5–13 h).

Termination of early pregnancy through a combination of the antiprogestin and prostaglandin analogue

Termination of early pregnancy (less than 49 days of amenorrhea) was induced in 75 patients with the combination of the antigestagen mifepristone and a prostaglandin analogue, meteneprost. After 48 h a single oral dose of 600 mg of mifepristone was followed by a 10 mg meteneprost vaginal pessary. Pregnancy was confirmed by clinical and ultrasound examinations and plasma HCG assessment. Complete abortion occurred in 72 patients (96%) and the three others required a surgical uterine aspiration. Bleeding continued for 4 to 12 days (mean = 8). Uterine pain and side effects occurred during the 3 h following the use of prostaglandin. Only minor analgesic were required in 30 patients. The combination of mifepristone and meteneprost is a safe and effective method to terminate an early pregnancy.

Early termination of pregnancy: medical induction with prostaglandins versus surgical aspiration under local anesthetic

Termination of pregnancy at 4–8 weeks gestation in 1085 patients using either local prostaglandin instillation (n = 820) or uterine aspiration under local anesthetic (n = 265) have been analyzed. Morbidity for both methods was similar although the incidence of side-effects (0.4%) and the transfusion rate (0%) were lower after aspiration than the respective rates of 59% and 1.3% after prostaglandin treatment. However the rates of genital tract trauma (0.75%) and uterine sepsis (1.8%) after aspiration were higher than the respective rates of 0.3% and 0.9% after prostaglandin treatment. The major disadvantage of prostaglandin treatment was the rate of re-admission for evacuation (8.5%) compared with (0.9%) after aspiration, although patient acceptability for both techniques was similar. In view of the advantages, more widespread use of both methods of termination is indicated.

Cervical priming before first trimester aspiration abortion: a single blind study comparing gemeprost 1 mg and prostaglandin E2 10 mg pessaries.

1030 patients were studied in 1 of the largest single center prospective random trials which assessed the effects of 2 prostaglandin (PG) vaginal pessaries on cervical dilatation and compliance during 1st trimester abortion by uterine aspiration under general anesthesia. Gemeprost 1 mg pessaries inserted 1-4 hours prior to surgery produced marginally greater cervical dilatation and less operative blood loss than PGE2 10 mg pessaries with a reduction in distressing preoperative side effects. No reduction in effect on the cervix was ascertained if pessaries were inserted for only 1-2 hours as compared with 3-4 hours. Postoperative side effects and later complications were infrequent and similar with both preparations. Gemeprost 1 mg pessaries are thus preferable to PGE2 10 mg pessaries for this purpose.

Ultrasound-guided transfundal uterine sperm recovery from Macaca fascicularis.

Previous studies from this center have indicated that the cynomolgus macaque (Macaca fascicularis) may serve as a model for human sperm interaction with the cervix and uterus. In some macaque species, transcervical aspiration of the uterine contents carries a significant risk of disturbing the cervical milieu due to the serpentine nature of the cervix. The only alternatives have been surgical procedures such as laparotomy or laparoscopy. In this paper, we report our experience with a new technique for ultrasound-guided sampling of spermatozoa in the macaque uterus. Twenty adult female cynomolgus macaques were monitored for menses (first day of menses = day 1), and one mating per cycle was allowed on day 10, 11, or 12. In one group of ten animals, cervical mucus was sampled at 3 or 18 hr postcoitus (pc) and ultrasound-guided uterine aspiration was performed at 24 hours pc. In a second group of ten monkeys, uterine aspiration was at six hr pc and sperm numbers and motility were counted in the uterine fluid. Uterine fluid was obtained from fourteen of twenty monkeys. Pregnancy occurred in ten of the twenty experimental cycles. Ultrasound-guided uterine aspiration appears to be a reliable method for the evaluation of sperm transport in female macaques. The correlations between uterine sperm recovery and cervical mucus sperm populations are discussed. The high conception rate in treatment cycles indicates that this procedure can be performed without apparent risk to pregnancy.

Role of uterine cavity vacuum aspiration in the prevention and treatment of postpartum endometritis

Being supporters of early intervention, we have performed vacuum aspiration of the uterine cavity contents in 62 laboring women over the past two years to prevent the spread of infection beyond the endometrium. During this operation, unlike uterine curettage, the basal layer of the endometrium, the venous lacunas of the internal layer of the myometrium and the myometrium itself are not traumatized. The negative pressure created by the vacuum aspirator prevents the uterine contents from penetrating the venous network.

Maternal deaths in the less developed world: preventable tragedies

A half million women die yearly around the world as a result of pregnancy. Many of these deaths are inaccurately classified and many others are not reported at all, but new demographic techniques have clarified causes of maternal mortality and improved estimates of rates. New data from several less developed countries suggest that many maternal deaths could be prevented by measures already demonstrated to be effective elsewhere. These include better antenatal and intrapartum care, contraception for women who want no more pregnancies, legal abortion to terminate unwanted pregnancies, and uterine aspiration and antibiotics for treatment of septic abortion.

Vacuum aspiration with the IPAS Modified Gynecologic Syringe

The IPAS Modified Gynecologic Syringe was compared with the electric pump and standard hand pump in a clinical trial of 1227 women undergoing vacuum aspiration. This modified double-valve syringe was designed to fit larger 8 mm, 10 mm and 12 mm cannulae, which are more suitable for late first trimester procedures. The study was conducted at four centers in which the double-valve syringe was used alternately with the vacuum source normally used at each clinic. Although there were notable inter-center differences with respect to certain outcome variables, results were similar for procedures performed at the same center. The only significant finding was the lower proportion of women requiring D & C to complete uterine evacuation among double-valve syringe patients than among hand pump cases at one center. The data indicate that the doublevalve syringe is safe and effective for uterine aspiration in women up to 14 weeks' gestation and may be preferable for use in clinics with limited facilities.

Foreign Aid for Abortion

One of the most sensitive subjects in the field of non military foreign assistance is aid for abortion. Consequently, it is very difficult to gather data. Information from interviews was combined with scattered fragments of existing data in the effort to construct a composite picture of the international abortion scene. Apart from any outside intervention, induced abortion is a common practice in developing countries. Abortion is frequent and is a prominent cause of death and illness among women of childbearing age. Foreign aid is a small proportion of the total aid for population activities, and, with the exception of the United Nations agencies, most organizations supplying funds for abortion operate on a clandestine and usually illegal basis. The most common type of foreign aid involves the technique known as uterine aspiration, which goes under various code phases. Abortion can be a profit-making proposition in developing countries. In the United States the politics of abortion have had an overwhelming impact on foreign aid for abortion. As of 1979 only a handful of international donors were involved in direct support of abortion activities in the developing countries; others provided indirect assistance for research, meetings, and information activities. The Agency for International Development (AID) was an ardent supporter of abortion until it was brought to a standstill by the Helms Amendment of 1973. AID was forced to withdraw from most abortion activities. The only agencies operating openly in this field are the World Bank and the United Nations Fund for Population Activities. The International Planned Parenthood Federation has been the most outspoken advocate of legal abortion services in developing countries.

Uterine Aspiration Techniques in Family Planning.

Uterine Aspiration Techniques in Family Planning.

A new approach to patients with suspected anaerobic postpartum pelvic infections. Transabdominal uterine aspiration for culture and metronidazole for treatment

Oral metronidazole was given as therapy in 25 women with the clinical diagnosis of a postpartum anaerobic soft tissue pelvic infection following a vaginal delivery. There was a good clinical response in 80 per cent of these women. No anaerobic organisms resistant to metronidazole were recovered in the treatment failures. Different specimen collection techniques were evaluated, with anaerobes recovered in 4 per cent of the blood cultures, 26.3 per cent of the transabdominal endometrial aspirations, and 88 per cent of the transcervical endometrial samples. The aerobic recovery of organisms was 4 per cent from blood cultures, 15.8 per cent from transabdominal endometrial aspirations, and 96 per cent from the transcervical approach. The significance of these findings is discussed.