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The Cochrane Database of Systematic... 2001Different surgical methods for termination of pregnancy have evolved over the years: Dilatation and curettage, power operated vacuum aspiration, manual vacuum aspiration... (Review)
Review
BACKGROUND
Different surgical methods for termination of pregnancy have evolved over the years: Dilatation and curettage, power operated vacuum aspiration, manual vacuum aspiration (MVA) or hysterotomy. Local or general anaesthesia is used for all methods. Preabortion medical or mechanical cervical preparation may reduce the incidence of cervical or uterine injuries.
OBJECTIVES
To compare the safety and efficacy of different surgical methods for first trimester abortion.
SEARCH STRATEGY
The Cochrane Controlled Trials Register has been searched. A search of the reference lists of identified trials was performed. An additional MEDLINE search was done using the Internet search service Pub Med.
SELECTION CRITERIA
Randomised controlled trials comparing different surgical methods for first trimester abortion were eligible.
DATA COLLECTION AND ANALYSIS
Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Three trials were included, resulting in 2 comparisons: vacuum aspiration versus dilatation and curettage and flexible versus rigid vacuum aspiration cannula. Results are reported as odds ratio for dichotomous data and weighted mean differences for continuous data.
MAIN RESULTS
There were no reports of maternal deaths and cases of uterine perforation in the trials identified. Vacuum aspiration versus dilatation and curettage: There were no statistically significant differences for excessive blood loss, blood transfusion, febrile morbidity, incomplete or repeat uterine evacuation procedure, re-hospitalisation, post operative abdominal pain or therapeutic antibiotic use. Duration of operation was statistically significantly shorter with vacuum aspiration compared to D&C in both gestational age subgroups : < 9 weeks: weighted mean difference (WMD) -1.84 minutes, 95% confidence interval (CI) [-2.542,-1.138]; =/> 9 weeks: WMD -0.600 minutes, 95% CI [-1.166,-0.034]). Flexible versus rigid vacuum aspiration cannula: There were no statistically significant differences with regard to cervical injuries, febrile morbidity, blood transfusion, therapeutic antibiotic use, or incomplete or repeat uterine evacuation procedure.
REVIEWER'S CONCLUSIONS
The included studies do not indicate a preference of providers for one or the other method. The trials included are small and lack power to to present meaningful differences for rare outcomes between the groups. outcomes such as women's satisfaction, the need for pain relief or surgeons preference for the instrument have been inadequately addressed. No data outcomes, such as fertility after surgical abortion, are available.
Topics: Abortion, Induced; Dilatation and Curettage; Female; Humans; Pregnancy; Pregnancy Trimester, First; Vacuum Curettage
PubMed: 11687167
DOI: 10.1002/14651858.CD002900 -
The Cochrane Database of Systematic... 2001Incomplete abortion is a major problem that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of... (Review)
Review
BACKGROUND
Incomplete abortion is a major problem that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of incomplete abortion usually involves vacuum aspiration or sharp curettage.
OBJECTIVES
To compare the safety and effectiveness of surgical uterine evacuation methods for management of incomplete abortion.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register, Medline from 1966, Popline from 1970, and the Cochrane Controlled Trials Register. Trials were also identified from reference lists of reviews. Date of last search: October 2000.
SELECTION CRITERIA
Randomized trials where different surgical methods were used to manage incomplete abortion were eligible for inclusion.
DATA COLLECTION AND ANALYSIS
We extracted population characteristics, settings, and exclusion criteria, in addition to outcomes such as complications of the procedure, duration, need for re-evacuation, blood transfusion, and analgesia/anesthesia.
MAIN RESULTS
Two trials were included. Vacuum aspiration was associated with statistically significantly decreased blood loss (-17 mls weighted mean difference, 95% confidence interval (CI) -24 to -10 mls), less pain (relative risk (RR): 0.74, 95% CI 0.61, 0.90), and shorter duration of procedure (-1.2 minutes weighted mean difference, 95% CI -1.5 to -0.87 minutes), than sharp curettage, in the single study that evaluated these outcomes. Serious complications such as uterine perforation and other morbidity were rare and the sample sizes of the trials were not large enough to evaluate small or moderate differences.
REVIEWER'S CONCLUSIONS
Vacuum aspiration is safe, quick to perform, and less painful than sharp curettage, and should be recommended for use in the management of incomplete abortion. Analgesia and sedation should be provided as necessary for the procedure.
Topics: Abortion, Incomplete; Dilatation and Curettage; Female; Humans; Pregnancy; Treatment Outcome; Vacuum Curettage
PubMed: 11279744
DOI: 10.1002/14651858.CD001993