Vacuum Aspiration

C. VACUUM ASPIRATION (≤ 13 Weeks)

Vacuum aspiration can be performed easily and safely with little discomfort in the first trimester under local anaesthetic and premedication with narcotics or sedation if necessary.

Advantages
1. Decreased risk from complications of general anaesthesia
2. Decreased incidence of blood loss, perforation, cervical laceration31
3. Quicker recovery from anaesthesia with less disorientation
4. Faster turnover in the recovery room
5. Quicker discharge and resumption of normal activity30
6. Patient acceptance
7. Greater economy

Exceptions
The same as for manual vaccum aspiration.

Preprocedural Cervical Dilatation

The advantage of preprocedural cervical dilatation is the gradual, safe dilatation of the cervix compared with the forcible and instrumental dilatation during the procedure.

Thus preprocedural cervical dilatation facilitates vacuum aspiration and significantly decreases the incidence of cervical lacerations and uterine perforation by up to 80%.

a) Chemical Dilators
The administration of 400 ìg of misoprostol, orally or vaginally, 4 to 12 hours prior to first trimester surgical abortion will effectively provide cervical dilatation and softening similar to osmotic dilators.

Advantages
1. Convenience: the patient can insert the tablets at home
2. Minimal pain on application
3. Highly cost effective

Potential Disadvantages
1. Cramping
2. Bleeding
3. Incomplete abortion before the surgical procedure If these occur, the patient must be encouraged to continue with the surgical procedure.

b) Osmotic Dilators
There are two types of osmotic dilators available in Canada: laminaria osmotic dilators and a synthetic polyacrylonitrile osmotic dilator (Dilapan). A potential disadvantage to osmotic dilators is that if they are wrongly placed, a false passage may be dilated and make access to the endocervical canal difficult. Osmotic dilators can be challenging to place in women who have difficulty with vaginal examinations or who are primigravid. There is also pain associated with the placement of the tenaculum and the insertion into the cervical canal. Laminaria osmotic dilators require six to eight hours to achieve dilatation; the polyacrylonitrile osmotic dilators take only four hours and also soften the cervix.