Procedure

Manual Uterine Aspiration in First Trimester Pregnancy Loss

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Manual Uterine Aspiration in First Trimester Pregnancy Loss

  • See Also
  1. Early Pregnancy Loss
  • Indications
  1. Early Pregnancy Loss <13 weeks
    1. See Early Pregnancy Loss for diagnosis and Ultrasound confirmation
    2. Uncontrolled uterine Hemorrhage in a hemodynamically Unstable Patient when obstetrics is not available
  • Contraindications
  1. No absolute contraindications in life-threatening Hemorrhage
  2. Septic Abortion (risk of uterine perforation, Massive Hemorrhage)
  3. Suspected Molar Pregnancy (Massive Hemorrhage risk)
  4. Uterine anatomical abnormalities
  • Preparation
  • Equipment
  1. Antiseptic solution (e.g. Povidone-Iodine, Chlorhexidine)
  2. Large cotton swabs (procto swabs)
  3. Anesthetic for Paracervical Block
    1. Spinal needles 20 to 22-gauge, 3.5 to 5 cm length
    2. Two 10 cc Syringes
    3. Lidocaine 1% 20 ml
  4. Suction cannulas
    1. Cannulas are sized for Gestational age (e.g. size 7 cannula is used for 7 week gestation)
  5. Large syringe (e.g. 20 to 50 ml) or aspirator (e.g. ipas manual aspirator)
  6. Tenaculum
  7. Speculum
  8. Cervical Dilator
  9. Aspirator
  • Technique
  1. Obtain Informed Consent
  2. Place speculum
  3. Prepare the Cervix
    1. Apply antiseptic (Povidone-Iodine or Chlorhexidine) to surface of Cervix
      1. Apply in circular motion with large cotton swabs (procto swabs)
      2. Include entire Cervix and cervicovaginal junction
    2. Perform Paracervical Block (includes Tenaculum application)
  4. Cervical Dilation
    1. Use sterile technique
    2. Hold the tenaculum (applied at 12:00 position) for counter traction
    3. Insert the cervical dilator into Uterus via the cervical os, gently rotating dilator between fingers
  5. Uterine Aspiration
    1. Attach suction cannula to aspirator or large syringe
    2. Activate the vacuum if using an aspirator (e.g. pressing 2 buttons on the aspirator)
    3. Aspiration cycle
      1. Insert the suction catheter into the Uterus and gently advance until reaching the fundus
      2. Withdraw the suction catheter back 2 cm before applying vacuum (prevent uterine wall injury or perforation)
      3. Pull back the plunger on syringe or aspirator to suction material into syringe
      4. Slowly withdraw the suction cannula while rotating 360 degrees
      5. Empty syringe or aspirator after each pass of the suction cannula
    4. Repeat the aspiration cycle until no further contents is aspirated
  6. Confirmation
    1. Send aspirated contents to pathology
    2. Consider Ultrasound to confirm empty Uterus after procedure
  7. Disposition
    1. Close interval follow-up with obstetrics
    2. Antibiotics
      1. Some organizations recommend post-procedure prophylaxis with Doxycycline
      2. If signs of Septic Abortion, hospitalize and initiate broad spectrum IV Antibiotics with anaerobic coverage
  • Complications
  1. Uterine Hemorrhage in Early Pregnancy Loss may be life threatening without intervention
  2. Major events requiring intervention occurred in <0.1% of procedures in stable office-based gynecology procedures
    1. Uterine Hemorrhage requiring transfusion
    2. Uterine perforation
    3. White (2015) Contraception 92(5):422-38 +PMID: 26238336 [PubMed]
  • References
  1. Wegman (2024) MedEdPORTAL 20:11469 +PMID: 39530104 [PubMed]