Is ward evacuation for uncomplicated incomplete abortion under systemic analgesia safe and effective? A randomised clinical trial

Abstract

Objective: To compare evacuation under systemic analgesia (fentanyl and midazolam) in a treatment room (ward group) with evacuation under general anaesthesia in theatre.

Design: A prospective randomised clinical trial.

Setting: A tertiary medical centre serving a black urban population.

Subjects: One hundred and forty-two patients with uncomplicated incomplete abortions.

Intervention: Randomisation into two groups, those for evacuation under systemic analgesia and those for evacuation under general anaesthesia.

Main outcome measures: Both groups were compared in terms of safety, efficacy, acceptability, blood consumption and time delay between admission and evacuation.

Results: Significantly less blood was used in the ward group (37 units for 13 patients) than in the theatre group (65 units for 24 patients) (P < 0.03). Significantly less time was taken between admission and evacuation in the ward group (median 7 hours 15 minutes) than in the theatre group (median 12 hours 38 minutes) (P < 0.0003). Evacuation under fentanyl and midazolam was safe, effective and acceptable for the majority of patients compared with evacuation under general anaesthesia.

Conclusion: Patients with uncomplicated incomplete abortions (uterine size equivalent to a pregnancy of 14 weeks' duration or less) can undergo evacuation safely and effectively under fentanyl and midazolam and have a significantly smaller chance of requiring a blood transfusion.