Chapter I. Summary of Methods (continued)

5.1 Classical D&C. This procedure is meant to remove the inflamed or hypertrophic endometrium from a non-pregnant uterus. If the procedure is tried to terminate a pregnancy there may arise a number of problems. Often much blood loss occurs because the placenta is separated from the uterine wall but not removed rapidly. There is a real danger of perforation of the uterine wall, especially in advanced pregnancies, because the instruments are pressed against the very soft uterine wall. In aspiration the wall is sucked against the canula so that the incidence of perforation is much lower. In many cases cervical damage occurs due to excessive dilating. In aspiration the necessary dilation is limited.

5.2 Finks's method for abortion over 13 weeks. This is a modification of Classical D&C developed by the Australian doctor Arnold A.Finks, (London), who also designed special instruments. His method avoids most of the dangers of classical D&C in advanced pregnancy. The use of a noradrenaline (nor-epinephrin) containing local anaesthetic diminishes blood loss considerably. See Chapter 5 for a discussion of vasoconstrictors in advanced pregnancy. The instruments which he designed specifically for his method need only a limited dilation of 12 to 14 mm to enter the uterus.

5.3 Manual aspiration with a large syringe (IPAS) and a narrow flexible canula (Karman type). This method, originating from so-called Menstrual Regulation is described in Chapter 6. It is a typical third world method. The equipment is cheap and little skill is required and, if reasonable sterility is maintained, complications like perforation and infection practically never occur. But there is a high incidence of retention of placental tissue which may lead to blood loss and secondary infections.

5.4 Manual aspiration with the Lewis Portable Intrauterine Suction Apparatus. This is the same technique as aspiration but instead of an electric pump a hand pump resembling a bicycle pump is used. It is clearly meant for travelling along third world health centres. It has more power than the syringe but less than an electric pump.

5.5 Aspiration This has become the standard treatment for pregnancies up till 13 weeks. In the United States succion is also used for more advanced pregnancies.The soft tissues and the fetus are removed by means of aspiration using a powerful electric pump and a canula with an adequate diameter.

5.6 Aspirotomy is a combination of Finks' method and aspiration. The use of a (nor)adrenaline containing local anaesthetic and the rapid aspiration of the soft tissues prevent blood loss. With the specially designed small Finks forceps, or the Mac Clintock forceps, the fetal parts are removed. By alternatively applying the forceps to shatter the fetal parts and the canula to remove them, the uterus is evacuated.

Of all methods mentioned, Aspiration and Finks' D&E technique have the nearest approach to the ideal method.They evacuate the uterus completely in a short time. With a proper premedication and local anaesthesia the discomfort for the patient is minimal. Provided a thorough examination is done to diagnose the pregnancy and find conditions which may complicate the procedure the method is the safest of all. Indeed it is safer to have an aspiration done than allowing the pregnancy to continue.

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last reviewed spring 2010