Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010 Sep 8;2010(9):CD001993.
doi: 10.1002/14651858.CD001993.pub2.

Surgical procedures for evacuating incomplete miscarriage

Ozge Tunçalp  1 , A Metin Gülmezoglu, João Paulo Souza
Affiliations
Meta-Analysis

Surgical procedures for evacuating incomplete miscarriage

Ozge Tunçalp et al. Cochrane Database Syst Rev. .

Abstract

Background: Incomplete miscarriage is a major problem that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of incomplete miscarriage usually involves vacuum aspiration or sharp curettage.

Objectives: To compare the safety and effectiveness of surgical uterine evacuation methods for management of incomplete miscarriage.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2010).

Selection criteria: Randomized trials where different surgical methods were used to manage incomplete miscarriage 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 (involving 550 women) were included. Vacuum aspiration was associated with statistically significantly decreased blood loss (mean difference (MD) -17.10 ml, 95% confidence interval (CI) -24.05 to -10.15 ml), less pain during the procedure (risk ratio (RR) 0.74, 95% CI 0.61 to 0.90), and shorter duration of the procedure (MD -1.20 minutes, 95% CI -1.53 to -0.87 minutes), than sharp metal curettage, in the single study that evaluated these outcomes in 357 women. 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: Although the review indicates that vacuum aspiration is safe, quick to perform, and less painful than sharp curettage, and should be recommended for use in the management of incomplete miscarriage, the results are based on data from only one study. Analgesia and sedation should be provided as necessary for the procedure.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Any type of vacuum aspiration versus sharp metal curettage, Outcome 1 Uterine perforation.
1.2
1.2. Analysis
Comparison 1 Any type of vacuum aspiration versus sharp metal curettage, Outcome 2 Need for re‐evacuation of uterus.
1.3
1.3. Analysis
Comparison 1 Any type of vacuum aspiration versus sharp metal curettage, Outcome 3 Sepsis.
1.4
1.4. Analysis
Comparison 1 Any type of vacuum aspiration versus sharp metal curettage, Outcome 4 Moderate to severe pain during procedure.
1.5
1.5. Analysis
Comparison 1 Any type of vacuum aspiration versus sharp metal curettage, Outcome 5 Blood loss >= 100 ml.
1.6
1.6. Analysis
Comparison 1 Any type of vacuum aspiration versus sharp metal curettage, Outcome 6 Blood loss (ml).
1.7
1.7. Analysis
Comparison 1 Any type of vacuum aspiration versus sharp metal curettage, Outcome 7 Post‐op hemoglobin level < 10 g/dl.
1.8
1.8. Analysis
Comparison 1 Any type of vacuum aspiration versus sharp metal curettage, Outcome 8 Duration of procedure (minutes).
1.9
1.9. Analysis
Comparison 1 Any type of vacuum aspiration versus sharp metal curettage, Outcome 9 Duration of bleeding (days).
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Tan 1969 {published data only}
    1. Tan PM, Ratnam SS, Quek SP. Vacuum aspiration in the treatment of incomplete abortion. Journal of Obstetrics and Gynaecology of the British Commonwealth 1969;76:834‐6. - PubMed
Verkuyl 1993 {published data only}
    1. Verkuyl DAA, Crowther CA. Suction versus conventional curettage in incomplete abortion. A randomised controlled trial. South African Medical Journal 1993;83:13‐5. - PubMed

References to studies excluded from this review

Allen 1971 {published data only}
    1. Allen A, Philpott RH. Management of incomplete abortion as an outpatient procedure. Central Afican Journal of Medicine 1971;17:91‐6. - PubMed
Antonovski 1975 {published data only}
    1. Antonovski L, Ljatkova K, Sukarov L, Brenner W, Edelman D, Bernard R. A comparative study of metal and plastic (Karman) cannulae for first trimester abortion by suction curettage. International Journal of Gynecology & Obstetrics 1975;13:33‐8. - PubMed
Balogh 1982 {published data only}
    1. Balogh SA. Vacuum aspiration with the IPAS modified gynecologic syringe. Contraception 1983;27:63‐8. - PubMed
Blumenthal 1994 {published data only}
    1. Blumenthal PD, Remsburg RE. A time and cost analysis of the management of incomplete abortion with manual vacuum aspiration. International Journal of Gynecology & Obstetrics 1994;45:261‐7. - PubMed
Caceres 1979 {published data only}
    1. Caceres EM. Manangement of incomplete abortion: completion by vacuum aspiration and by sharp curettage. Peronal communication 1979.
Caceres 1981 {published data only}
    1. Caceres GH. Hospital management of incomplete abortion: comparative study of dilation and curettage versus vacuum aspiration [Manejo hospitalario del aborto incompleto: Estudio Comparitivo del curetaje uterino versus la aspiracion por vacio]. Monografias de la Corporacion Centro Regional del Poblacion 1981;16:45‐81.
Caceres 1981a {published data only}
    1. Caceres GH, Gamboa GR, Hernandez MA, Escobar GL. Hospital management of incomplete abortion: comparative study of dilation and curettage versus vacuum aspiration [Manejo hospitalario del aborto incompleto: Estudio Comparitivo del curetaje uterino versus la]. Personal communication 1981.
Cheng 1976 {published data only}
    1. Cheng MCE, Ng A, Seng KM, Ratnam SS. The safety of outpatient abortion, a controlled study. Annals of the Academy of Medicine, Singapore 1976;4:245‐8.
de Holanda 2003 {published data only}
    1. Holanda AAR, dos Santos HPFD, Barbosa MF, Barreto CFB, Felinto AS, Araujo IA. Treatment of miscarriage in the first trimester of pergnancy: curettage versus manual vacuum aspiration [Tratamento do abortamento do primeiro trimestre da gestacao: curetagem versus aspiracao manual a vacuo]. Revista Brasileira de Ginecologia e Obstetricia 2003;25(4):271‐6.
Edwards 2007 {published data only}
    1. Edwards S, Tureck R, Fredrick M, Huang X, Zhang J, Barnhart K. Patient acceptability of manual versus electric vacuum aspiration for early pregnancy loss. Journal of Women's Health 2007;16(10):1429‐36. - PubMed
El Kabarity 1985 {unpublished data only}
    1. Kabarity H, Louz SA, El‐Etribi A, Yeyha M, Ellian A. Suction abortion versus traditional evacuation in the management of incomplete inevitable abortions. International College of Surgeons, Fifth American Federation Congress; 1995 Nov 25‐28; Cairo. 1985.
Farell 1982 {published data only}
    1. Farell RG, Stonington DT, Ridgeway RA. Incomplete and inevitable abortion: treatment by suction in the emergency department. Annals of Emergency Medicine 1982;11:652‐8. - PubMed
Filshie 1973 {published data only}
    1. Filshie GM, Ahluwalia J, Beard RW. Portable Karman curette equipment in management of incomplete abortions. Lancet 1973;2:1114‐6. - PubMed
Fonseca 1997 {published data only}
    1. Fonseca W, Misago C, Fernandes L, Correia L, Silveira D. Adoption of manual vacuum aspiration for treatment of incomplete abortion reduces costs and duration of patient's hospital stay in an urban area of Northeastern Brazil. Revista de Saúde Pública 1997;31:472‐8. - PubMed
Gruenberger 1979 {published data only}
    1. Grunberger W, Mutz N, Reinold E, Ulm R. Experiences using the suction curettage system of Hamann and Pockrandt [Erfahrungen mit dem Saugkurettensystem nach Hamann und Pockrandt]. Zentralblatt fur Gynakologie 1979;101:320‐7. - PubMed
Henderson Lewis 1979 {unpublished data only}
    1. Henderson Lewis JA. Management of incomplete abortion: completion by vacuum aspiration and by sharp curettage ‐ inpatient and outpatient procedures. Prepared for the Instituto Salvadoreno del Seguro Social 1979.
Hill 1971 {published data only}
    1. Hill DL. Management of incomplete abortion with vacuum curettage. Minnesota Medicine 1971;54(3):225‐8. - PubMed
Johnson 1993 {published data only}
    1. Johnson BR, Benson J, Bradley J, Ordonez AR. Costs and resource utilization for the treatment of incomplete abortion in Kenya and Mexico. Social Science and Medicine 1993;36:1443‐53. - PubMed
Kizza 1990 {published data only}
    1. Kizza APM, Rogo KO. Assessment of the manual vacuum aspiration (MVA) equipment in the management of incomplete abortion. East African Medical Journal 1990;67:812‐22. - PubMed
Lean 1976 {published data only}
    1. Lean TH, Vengadasalam D, Pachauri S, Miller ER. A comparison of D & C and vacuum aspiration for performing first trimester abortion. International Journal of Gynecology & Obstetrics 1976;14(6):481‐6. - PubMed
Lukman 1996 {published data only}
    1. Lukman HY, Pogharian D. Management of incomplete abortion with manual vacuum aspiration in comparison to sharp metallic curette in an Ethiopian setting. East African Medical Journal 1996;73:598‐603. - PubMed
Magnelli 1992 {published data only}
    1. Magnelli A, Tellez A, Jiminez R, Azuaga A, Calderon F. Uterine aspiration with karman cannula [Aspiracion uterina con canula de Karman]. Revista de Obstetricia y Ginecologia de Venezuela 1992;52(1):43‐8.
Magotti 1995 {published data only}
    1. Magotti RF, Munjinja PGM, Lema RSM, Ngwalle EKW. Cost effectiveness of managing abortions: manual vacuum aspiration (MVA) compared to evacuation by curettage in Tanzania. East African Medical Journal 1995;72:248‐51. - PubMed
Mahomed 1994 {published data only}
    1. Mahomed K, Healy J, Tandon S. A comparison of manual vacuum aspiration (MVA) and sharp curettage in the management of incomplete abortion. International Journal of Gynecology & Obstetrics 1994;46:27‐32. - PubMed
Rashid 1970 {published data only}
    1. Rashid S, Smith P. Suction evacuation of uterus for incomplete abortion. Journal of Obstetrics and Gynaecology of the British Commonwealth 1970;77:1047‐8. - PubMed
Ricalde 1997 {published data only}
    1. Ricalde RL, Ramirez AT, Barsse GC, Castro P. Manual intrauterine aspiration in the treatment of incomplete abortion [Aspiracion manual endouterina para el tratamiento del aborto incompleto]. Ginecologia y Obstetricia de Mexico 1997;65:101‐6. - PubMed
Suter 1970 {published data only}
    1. Suter PEN, Chatfield WR, Kotonya AO. The use of suction curettage in incomplete abortion. Journal of Obstetrics and Gynaecology of the British Commonwealth 1970;77:464‐6. - PubMed

Additional references

Blum 2007
    1. Blum J, Winikoff B, Gemzell‐Danielsson K, Ho PC, Schiavon R, Weeks A. Treatment of incomplete abortion and miscarriage with misoprostol. International Journal of Gynecology & Obstetrics 2007;99:S186‐S189. - PubMed
Clarke 2000
    1. Clarke M, Oxman AD, editors. Cochrane Reviewers' Handbook 4.1 [updated June 2000]. In: Review Manager (RevMan) [Computer program]. Version 4.1. Oxford, England: The Cochrane Collaboration, 2000.
Greenslade 1993
    1. Greenslade FC, Leonard AL, Benson J, Wunkler J, Henderson VL. Manual vacuum aspiration: a summary of clinical and programmatic experience worldwide. IPAS, 1993.
Higgins 2009
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009. Available from www.cochrane‐handbook.org.
Milingos 2009
    1. Milingos DS, Mathur M, Smith NC, Ashok PW. Manual vacuum aspiration: a safe alternative for the surgical management of early pregnancy loss. British Journal of Obstetrics and Gynaecology 2009;116:1268‐71. - PubMed
Neilson 2010
    1. Neilson JP, Gyte GML, Hickey M, Vazquez JC, Dou L. Medical treatments for incomplete miscarriage (less than 24 weeks). Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD007223.pub2] - DOI - PMC - PubMed
RevMan 2008 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.
WHO 1991
    1. World Health Organization. Essential elements of obstetric care at first referral level. Geneva: WHO, 1991.
WHO 1995
    1. World Health Organization. Complications of abortion: technical and managerial guidelines for prevention and treatment. Geneva: WHO, 1995.
Zhang 2005
    1. Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick CM. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. New England Journal of Medicine 2005;353:761‐9. - PubMed

References to other published versions of this review

Forna 2001
    1. Forna F, Gülmezoglu AM. Surgical procedures to evacuate incomplete miscarriage. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD001993] - DOI - PubMed

LinkOut - more resources