FIGO Consensus Statement: Uterine Evacuation

Uterine evacuation: use vacuum aspiration or medications, not sharp curettage

Consensus statement: International Federation of Gynecology and Obstetrics (FIGO)

Recommendation
Evacuate the uterus with vacuum aspiration or medications, not sharp curettage (also known as dilatation and curettage or D&C). Vacuum aspiration and medications for uterine evacuation should be introduced instead of sharp curettage to improve the safety and quality of abortion services for women.

Summary of the evidence
Vacuum aspiration and medical abortion are the recommended techniques to manage incomplete, missed or induced abortion.

Vacuum Aspiration
A recent Cochrane review of surgical therapy for incomplete abortion showed that vacuum aspiration is as effective as sharp curettage and has reduced blood loss, pain and procedure time. Randomised trials of induced abortion have also shown reduced procedure time with vacuum aspiration. A recent Cochrane review of surgical therapy for induced abortion was inconclusive regarding the likelihood of major morbidities associated with vacuum aspiration versus sharp curettage. However, the number of women enrolled in the included trials was insufficient to determine a significant difference between the two techniques.

In a retrospective case series of 80,437 women, vacuum aspiration was associated with less than half the rate of major and minor complications compared to sharp curettage. Extensive programmatic experience has shown that vacuum aspiration improves the access to and quality of safe abortion care while reducing its cost.

Medical Abortion
The safety and tolerability of medical regimens for uterine evacuation are well documented. Misoprostol is as effective as vacuum aspiration in the management of incomplete abortion. The complete abortion rates are generally lower in women who use medication compared to aspiration for the treatment of missed and induced abortion. There are no trials that compare the safety and effectiveness of medical regimens to sharp curettage for incomplete, missed or induced abortion.

Definitions:

• Sharp curettage is a surgical procedure that involves dilatation of the cervix with mechanical dilators or pharmacological agents followed by the use of sharp metal curettes to scrape the walls of the uterus.

• Vacuum aspiration also involves dilation of the cervix, followed by either electric or manual aspiration to evacuate the uterus.

• Medical abortion uses medications to induce uterine evacuation, avoiding insertion of instruments into the uterus. 

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