Basic equipment for aspiration include:

1. An operating table with leg supports. A simple table is adequate. The possibility to change the height is preferred but not strictly necessary.

2. An autoclave to sterilize the instruments is preferred over other types of steriliser.

3. A powerful suction pump, preferably one specially designed for termination of pregnancy.

4. An ultrasound scanner prevents most of the complications which may arise. An abdominal transducer is used for advanced pregnancies, a vaginal transducer makes precise diagnosis of early pregnancy and such conditions as ectopic pregnancy possible.

5. Beds are preferred over chairs or reclining seats for recovery after the procedure.

To enable a smooth and rapid patient flow the instruments should be packed in standard packs. Each pack contains all instruments necessary for the aspiration, wrapped up in sterilizing paper and sterilized in an autoclave. Some disposable items which can stand autoclaving may be added to the pack: gauze, a hygienic pad and a window towel. Instruments which are used relatively seldom may be packed in a smaller number of additional packs. Such a pack can be opened if the need arises. A checklist of the contents of these standard packs is given in Appendix 7.

A rigid routine must be maintained in the instrument handling room. The used instruments are washed and thoroughly checked for cleanliness. Then the instruments for one of the standard packs are laid together with the business ends pointing in the same direction to facilitate the no-touch technique. The instruments are wrapped in sterilizing paper. Gauze, hygienic pad and a (easily self made) window towel are added. The pack is closed with autoclaving tape and the date and the initials of the packer written on the pack. Four packs fit in a small autoclave. During packing the checklist should be consulted. This reduces the occurrence of a missing instrument during a procedure.

Work in the instrument room is greatly reduced if the doctor adopts the neat habit to consequently lay the used instruments apart from the clean ones. This appears to be difficult. Some doctors seem to have pleasure in making a bloody mass of the sterile field if not the whole theater. I always use the sterile paper in which the gloves are packed as a sterile field for the used instruments. The instruments which have not been used can be packed without cleaning.

Instruments for the preparation of the patient, vaginal toilet and shaving, need not be sterilized. Cleaning and disinfection is enough. A common speculum and two swab forcepses is enough. Further some gauze, a disposable shaver and a kidney dish and a bottle with a 1% cetrimide solution. The vaginal toilet is described in Chapter 9.

For termination of a pregnancy a single blade speculum (Kristeller) and a tenaculum forceps are used to gain access to the uterus. The single blade speculum gives much more freedom for the instruments.A disadvantage is that it may drop out of the vagina and that an assistant is necessary to hold the tenaculum forceps. One of the most practical specula is the Collin or the slightly more complicated Trélat.

Dilation is done with a number of dilators. The tapering type (recommended is the Hawkin Ambler dilator) is preferred over the Hegar type.

Dilation with a tapering dilator is much less traumatising. But if the pregnancy is very young there is a danger of perforating the fundus if the dilator is brought in too deep.

After dilation the uterus is evacuated with a disposable plastic suction curette. These plastic curettes can not be autoclaved, but they may be sterilised a number of times in Cidex®. A slender forceps is necessary to remove tissue which is fixed in the canula or trapped in the cervical canal.

The Karman canula is made from hard nylon. We use this type to perform a gentle curettage after evacuation of the uterus to remove small placental rests. This diminishes the incidence of bleeding after a termination. A small blunt curette may be added for those who want to do a check curettage. However, too rigorous curetting may damage the basal layer of the mucosa which may lead to placenta accreta or Asherman's syndrome in later pregnancies.

For advanced pregnancies a few extra instruments can be packed. Some bigger Hawkin Ambler dilators, a bigger curette and one or two ovum forceps. Since they are seldom needed a few packs suffice. A few instruments which are very seldom needed may be packed individually. They consist of a narrow speculum if access to the vagina is difficult and a few very thin dilators for the infantile or rigid cervix and for those cases in which the ostium externum is unaccessable for bigger dilators.


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