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.
last reviewed spring 2010