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The sensitivity of manual versus electric vacuum aspiration to detect completed abortion at less than 6 weeks of pregnancy

Gillian Dean, Planned Parenthood of New York City, 2009
See also executive summary.

Project abstract

With sensitive urine pregnancy tests, women are now able to confirm very early pregnancies. However, approximately one third of abortion facilities do not offer abortions at less than 6 weeks of pregnancy.

Providers may be concerned that they will be unable to identify products of conception (POCs) in uterine aspirates after early abortion and about the time, cost and risk associated with following serum hCG levels when completed abortion cannot be confirmed by gross inspection. Two published case series demonstrate that abortion at less than 6 weeks is safe. The studies differ greatly in the proportion of patients with undetected POCs, however. The first study has a 6% rate of undetected POCs; the rate of inadequate and no POCs in the other is 22%. Both manual vacuum aspirators (MVA) and electric vacuum aspirators (EVA) were used in the second study; only MVA was used in the first.

Many providers believe that MVA causes less destruction of pregnancy tissue and therefore may increase the likelihood of identifying POCs on gross inspection. One large study found more reaspirations for failure to identify POCs after EVA, however these pregnancies were greater than 6 weeks. No published reports specifically compare MVA to EVA for the detection of complete products of conception and none compare MVA and EVA at less than 6 weeks of pregnancy.

We propose to conduct a randomized controlled trial comparing the sensitivity of MVA to EVA for the detection of completed abortion in 492 women with pregnancies of less than 6 weeks gestation at a large inner city family planning center. We will measure positive identification of POCs on gross inspection in patients subsequently shown to have completed abortions. Because there is no single “gold standard” test of completed abortion, we have defined completed abortion related to follow-up tests and evaluations.

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