Manual and vacuum aspiration for abortion

Surgery Overview

There are two methods of vacuum aspiration (also called suction aspiration):

• Manual vacuum. This procedure can be used up to 10 weeks after the last menstrual period (early first trimester). It is the only surgical abortion procedure available before 6 to 7 weeks of pregnancy. It involves the use of a specially designed syringe to apply suction. This method is not available everywhere, but it may be more available than machine aspiration in some geographic areas.
• Machine vacuum. This procedure is the most common method used in the first 6 to 12 weeks (first trimester) of pregnancy. Machine vacuum aspiration involves the use of a hollow tube (cannula) that is attached by tubing to a bottle and a pump, which provides a gentle vacuum. The cannula is passed into the uterus, the pump is turned on, and the tissue is gently removed from the uterus.

Manual vacuum aspiration procedure

Manual vacuum aspiration usually takes between 5 and 15 minutes. It can be done safely in a clinic or medical office using local anesthetic and a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. The procedure includes:

• Positioning you on the exam table in the same position used for a pelvic exam, with your feet on stirrups while lying on your back.
• Inserting a speculum into the vagina.
• Cleaning the vagina and cervix with an antiseptic solution.
• Injecting a numbing medicine (local anesthetic) in the cervix.
• Inserting a small instrument into the cervix to slightly open (dilate) it, if necessary. In most cases, however, dilation isn't needed.
• Passing a thin tube through the cervix and into the uterus. A handheld syringe is attached and used to suction the tissue out of the uterus. As the uterine tissue is removed, the uterus will contract; most women feel cramping during the procedure. The cramps will lessen after the tube is removed. Some women also have nausea, sweating, or feel faint, but generally symptoms are less severe than with mechanical vacuum aspiration.

Machine vacuum aspiration procedure

Hours before or the day before a machine vacuum aspiration procedure, a cervical (osmotic) dilator is usually placed in the cervix to slowly open (dilate) it. Just beforehand, antibiotics are also given to prevent infection. A medicine called misoprostol is given before the procedure to soften the cervix.

Machine vacuum aspiration usually takes between 10 and 15 minutes. It can be done safely in a clinic or medical office under local anesthetic. The procedure includes:

• Positioning you on the exam table in the same position used for a pelvic exam, with your feet on stirrups while lying on your back.
• Inserting a speculum into the vagina.
• Cleaning the vagina and cervix with an antiseptic solution.
• Injecting a numbing medicine (local anesthetic) in the cervix. Medicine for pain or sedation, in addition to the local anesthetic, may be given by mouth or through a vein (intravenously). Vasopressin, or a similar medicine that slows uterine bleeding, may be mixed with the local anesthetic to reduce blood loss.
• Grasping the cervix with an instrument to hold the uterus in place.
• Opening (dilating) the cervical canal with a small instrument. Dilation reduces the risk of any injury to the cervix during the procedure.
• Passing a thin, hollow tube (cannula) into the cervical canal and attaching a gentle vacuum that will draw the tissue out of the uterus. As the uterine tissue is removed, the uterus will contract; most women feel cramping during the procedure. The cramps will lessen after the tube is removed. Some women also may have nausea or sweating or feel faint.

The tissue removed from the uterus during a vacuum aspiration procedure is examined to make sure that all of the tissue has been removed and the abortion is complete.

Occasionally a dilation and curettage (D&C) procedure is necessary after a vacuum aspiration if all of the tissue has not been removed. D&C uses a sharp surgical instrument to clear tissue from the uterus.

What To Expect After Surgery

Vacuum aspiration is a minor surgical procedure. A normal recovery includes:

• Irregular bleeding or spotting for the first 2 weeks. During the first week, avoid tampons and use only sanitary pads.
• Cramps similar to menstrual cramps, which may be present for several hours and possibly for a few days, as the uterus shrinks back to its nonpregnant size.
• Emotional reactions for 2 to 3 weeks.

After the procedure:

• Take your full course of prescribed antibiotics to prevent infection.
• Rest quietly for the day. You can do normal activities the following day, based on how you feel.
• Acetaminophen (such as Tylenol) or ibuprofen (such as Advil) can help relieve cramping pain.
• Do not have sexual intercourse for at least 1 week. Use birth control following the abortion, as well as condoms to prevent infection. You can start birth control pills right after the procedure. Barrier methods of birth control (such as a male condom) or an intrauterine device (IUD) can be used as soon as you resume sexual relations.

Signs of complications

Less than 1% of all women who have an abortion have serious problems afterward.¹

Call your health professional immediately if you have any of these symptoms after an abortion:

• Severe bleeding. Both medical and surgical abortions usually cause bleeding that is different from a normal menstrual period. Severe bleeding can mean:
  • Passing clots that are bigger than a golf ball, lasting 2 or more hours.
  • Soaking more than 2 large sanitary pads in an hour, for 2 hours in a row.
  • Bleeding heavily for 12 hours in a row.
• Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
• Severe pain in the abdomen that is not relieved by pain medicine, rest, or heat
• Hot flushes or a fever of 100.4°F (38°C) or higher that lasts longer than 4 hours
• Vomiting lasting more than 4 to 6 hours
• Sudden abdominal swelling or rapid heart rate
• Vaginal discharge that has increased in amount or smells bad
• Pain, swelling, or redness in the genital area

Call your health professional for an appointment if you have had any of these symptoms after a recent abortion:

• Bleeding (not spotting) for longer than 2 weeks
• New, unexplained symptoms that may be caused by medicines used in your treatment
• No menstrual period within 6 weeks after the procedure
• Signs and symptoms of depression. Hormonal changes after a pregnancy can cause postpartum depression that requires treatment.

Why It Is Done

Vacuum aspiration is done in the first trimester of pregnancy.

Vacuum aspiration can be done for:

• An induced therapeutic abortion.
• A failed medical abortion.
• Death of the fetus (missed spontaneous abortion).
• An incomplete miscarriage (incomplete spontaneous abortion).

How Well It Works

First-trimester surgical abortions are safe and effective and have few complications.

Infection is less likely to develop after an aspiration procedure than any other type of surgical abortion, with an overall rate of 0.5%, or 1 in 200 women.²

In rare cases, an aspiration procedure doesn't successfully end a pregnancy. This is more likely to happen during the earliest weeks of a pregnancy—among manual aspirations performed before 6 weeks, about 3% fail, requiring a repeat procedure.³

Risks

First-trimester surgical abortions are considered one of the safest surgical procedures. The risk of complications is low. Some minor complications include:

• Injury to the uterine lining or cervix.
• Infection. Bacteria can enter the uterus during the procedure and cause an infection. This is more likely if an untreated disease, such as a sexually transmitted disease (STD), is present before the procedure. Symptoms of fever, pain, and abdominal tenderness will usually start within 2 to 3 days of the procedure. Antibiotics given during or after the procedure reduce the risk of infection.

Rare complications include:

• A hole in the wall of the uterus (uterine perforation, rare), which most commonly happens during cervical dilation. (Often, however, dilation with an instrument isn't even necessary before an aspiration procedure.) Bleeding is usually minimal, and no repair is necessary. If bleeding is a concern, a laparoscopy (a procedure that uses a lighted viewing instrument) can be used to see whether it has stopped.
• Tissue remaining in the uterus (retained products of conception), usually causing recurring cramping abdominal pain and bleeding within a week of the procedure. However, prolonged bleeding sometimes does not develop until several weeks later.
• Blood clots. If the uterus doesn't contract to pass all of the tissue, the cervical opening can become blocked, preventing blood from leaving the uterus. The uterus becomes enlarged and tender, often causing abdominal pain, cramping, and nausea.

A repeat vacuum aspiration and medicine to stop bleeding are used to treat retained products of conception or blood clots.

Undiagnosed ectopic pregnancy after manual or machine vacuum aspiration

It is possible to have an undiagnosed ectopic (tubal) pregnancy that isn't discovered until after a D&C procedure. Although the pregnancy test before the procedure is positive, the pregnancy is not in the uterus. Therefore, the abortion method does not end the pregnancy. Symptoms of an ectopic pregnancy that occur after an abortion procedure can include:

• Abdominal or pelvic pain that gets worse.
• Pain with intercourse.
• Vaginal bleeding.
• Lightheadedness or fainting caused by blood loss.

Ectopic pregnancy requires urgent medical care. Call your health professional immediately if you have symptoms of a possible ectopic pregnancy. For more information, see the topic Ectopic Pregnancy.

What To Think About

Choosing a medical or surgical procedure for an abortion will depend on your medical history, how many weeks pregnant you are, what options are available where you live, and your personal preferences.

In the United States, vacuum aspiration is the most common method of abortion used within the first 12 weeks (first trimester) of pregnancy. Manual aspiration is the only surgical procedure done in the first 6 weeks of pregnancy. Early in pregnancy through most of the first trimester, a woman can also consider use of medicine (medical abortion).

Nearly 90% of all abortions are done in the first trimester of pregnancy.¹

A first-trimester abortion poses less overall risk than carrying a pregnancy to term.¹

An abortion rarely affects your ability to become pregnant in the future, so it is possible to become pregnant in the weeks right after the procedure. Avoid sexual intercourse until your body has fully recovered, usually for at least 1 week. Use birth control in the first weeks following the abortion, as well as condoms to prevent infection.

Postpartum depression can be triggered by changing pregnancy hormones after an abortion. If you have more than 2 weeks of symptoms of postpartum depression, such as fatigue, sleep or appetite change, or feelings of sadness, emptiness, anxiety, or irritability, see your health professional about treatment. Keep track of your symptoms with a postpartum depression checklist(What is a PDF document?).

The hospital or surgery center may send you instructions on how to get ready for your surgery or a nurse may call you with instructions before your surgery.

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You most likely will stay in the recovery area for 1 to 4 hours, and then you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will go home with a page of care instructions including who to contact if a problem arises.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Author:	Healthwise Medical Writer	Last Updated: October 6, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Lori A. Boardman, MD, ScM - Obstetrics and Gynecology
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