Surgical procedures to evacuate incomplete miscarriage
Abstract
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 methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2002), the Cochrane Controlled Trials Register (The Cochrane Library 2002, Issue 4), MEDLINE (1966 to December 2002), Popline (1970 to December 2002) and reference lists of reviews.
We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 23 September 2009 and added the results to the awaiting classification section of the review.
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.
Authors' 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.
[Note: The four citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
PICOs
Plain language summary
Surgical procedures to evacuate incomplete miscarriage
Vacuum aspiration is a safe and quick treatment for incomplete abortions.
Bleeding and infection generally result if the uterus is not emptied after incomplete abortion (where parts of the products of conception are left in the uterus). The review of trials found that vacuum aspiration (a procedure that empties the uterus by using a vacuum source with or without electricity) was safe, quick and easy to perform. It was also less painful than dilatation and curettage, which is often done under general anesthesia in an operating room.
