Home / Site Map / Vulva and Introitus / Vagina and Urethra / Bladder and Ureter / Cervix / Uterus

Fallopian Tubes and Ovaries / Colon / Small Bowel / Abdominal Wall / Malignant Disease: Special Procedures

Uterus

Dilatation and Suction Curettage for Abortion

Curettage

Suction Curettage
for Abortion
Suction curettage has proven to be the most efficacious technique for
Management of Major
Uterine Perforations evacuation of the uterus in the first trimester of pregnancy. It has
From Suction Curet or
Radium Tandem advantages over sharp curettage in that it has a lower incidence of
Cesarean Section uterine perforation and less blood.
Myomectomy

Jones Operation
The purpose of the operation is to evacuate the gravid uterus in the
for Correction of
Double Uterus
first trimester.
Hysteroscopic Septal
Resection by Loop
Physiologic Changes. The use of a strong vacuum through a
Electrical Excision
Procedure (LEEP) for
suction catheter placed through the dilated cervix into the uterine
Correction of a Double
Uterus
cavity rapidly shears away the first-trimester placenta from the uterine
Manchester Operation wall.
Richardson Composite
Operation When a vacuum pump producing 70 mm Hg and 100 mL of airflow
Total Vaginal per minute is used, the products of conception are rapidly separated
Hysterectomy

Total Abdominal
from the uterine wall, allowing their removal from the endometrial
Hysterectomy With
and Without Bilateral
cavity and inducing uterine contraction, thereby reducing blood loss.
Salpingo-oophorectomy

Laparoscopy-Assisted
Points of Caution. Care must be taken to determine the length of
Vaginal Hysterectomy gestation of the pregnancy. This should be done by history and by
physical examination of the pelvis. In addition, the uterine cavity
should be accurately measured with a sound prior to initiating the
procedure. In this way, pregnancies exceeding 13 weeks should be
diagnosed, and suction abortion performed, in those circumstances
where the potential benefits outweigh the risks of performing a
second-trimester abortion with the suction technique.
The surgeon should be sure that adequate airflow through the suction
pump is maintained at all times. An airflow in the system of
approximately 100 mL/minute is preferred. For most standard suction
curettage machines, this means turning the pump to the maximum
setting. Reduced or low airflow through the system allows retained
products of conception and therefore increases the risk of
hemorrhage and postpartum infection.
If perforation of the uterus is suspected, the vacuum should be turned
off, and the curet should be removed with caution to prevent injury to
the intestine.
Technique

The patient is placed in the dorsal lithotomy

position after appropriate anesthesia (general,
regional, or local) has been administered.
A careful pelvic examination is performed to accurately
ascertain the gestational size of the uterus.

A Sims posterior retractor is used to obtain Tapered cervical dilators, such as Pratt dilators, are used
adequate exposure to the upper vagina and to progressively dilate the cervix, usually to 10 mm in
cervix. Lateral retractors or self-retaining diameter. Nontapered dilators, such as Hegar dilators,
retractors are rarely needed for this procedure. should be avoided because they are difficult to pass
through the cervix, particularly in nulliparous patients,
The anterior lip of the cervix is grasped with a and produce a greater amount of cervical trauma.
wide-mouthed Jacobs tenaculum. Single-
toothed tenacula should be avoided, as they
tend to tear the pregnant cervix. A uterine
sound is passed through the undilated cervix
until the fundus is reached. The length of the
uterine cavity is recorded.

The suction is applied to the curet. The curet is rotated in

a 360° arc and is slowly withdrawn in 1-cm increments.

The suction curet should be introduced 2-3 times to

ensure that all products of conception have been
adequately removed.
After appropriate dilatation, a suction cannula
is introduced through the cervix. We prefer It is efficacious at this point to administer 50 international
large-diameter straight suction cannulae, such units of Pitocin in an intravenous drip and 0.2 mg of
as 10-mm straight cannulae, rather then the Methergine given intravenously. This has significantly
curved or angulated variety. This is because reduced blood loss by inducing uterine contraction.
360° arcs of the cannulae must be made to
adequately remove all gestational tissue.
When 360° arcs are made with angulated
cannulae, the diameter of the arc created in
the intrauterine cavity by the angulated suction
cannulae is excessive.

The suction curet should be introduced all the

way to the fundus.

An ovum or sponge forceps is introduced into

the endometrial cavity and are opened, closed,
and withdrawn several times to ensure that all
gestation tissue has been removed.

The patient is observed for 2 hours for

hemorrhage prior to discharge.

Copyright - all rights reserved / Clifford R. Wheeless, Jr., M.D. and Marcella L. Roenneburg, M.D.
All contents of this web site are copywrite protected.