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Dilatation and Curettage

Suction Curettage
for Abortion

Management of Major
Uterine Perforations
From Suction Curet or
Radium Tandem

Cesarean Section


Jones Operation
for Correction of
Double Uterus

Hysteroscopic Septal
Resection by Loop
Electrical Excision
Procedure (LEEP) for
Correction of a Double

Manchester Operation

Richardson Composite Operation

Total Vaginal Hysterectomy

Total Abdominal
Hysterectomy With
and Without Bilateral

Laparoscopy-Assisted Vaginal Hysterectomy

Suction Curettage for Abortion

Suction curettage has proven to be the most efficacious technique for evacuation of the uterus in the first trimester of pregnancy. It has advantages over sharp curettage in that it has a lower incidence of uterine perforation and less blood.

The purpose of the operation is to evacuate the gravid uterus in the first trimester.

Physiologic Changes. The use of a strong vacuum through a suction catheter placed through the dilated cervix into the uterine cavity rapidly shears away the first-trimester placenta from the uterine wall.

When a vacuum pump producing 70 mm Hg and 100 mL of airflow per minute is used, the products of conception are rapidly separated from the uterine wall, allowing their removal from the endometrial cavity and inducing uterine contraction, thereby reducing blood loss.

Points of Caution. Care must be taken to determine the length of gestation of the pregnancy. This should be done by history and by physical examination of the pelvis. In addition, the uterine cavity should be accurately measured with a sound prior to initiating the procedure. In this way, pregnancies exceeding 13 weeks should be diagnosed, and suction abortion performed, in those circumstances where the potential benefits outweigh the risks of performing a second-trimester abortion with the suction technique.

The surgeon should be sure that adequate airflow through the suction pump is maintained at all times. An airflow in the system of approximately 100 mL/minute is preferred. For most standard suction curettage machines, this means turning the pump to the maximum setting. Reduced or low airflow through the system allows retained products of conception and therefore increases the risk of hemorrhage and postpartum infection.

If perforation of the uterus is suspected, the vacuum should be turned off, and the curet should be removed with caution to prevent injury to the intestine.


The patient is placed in the dorsal lithotomy position after appropriate anesthesia (general, regional, or local) has been administered.

A careful pelvic examination is performed to accurately ascertain the gestational size of the uterus.

A Sims posterior retractor is used to obtain adequate exposure to the upper vagina and cervix. Lateral retractors or self-retaining retractors are rarely needed for this procedure.

The anterior lip of the cervix is grasped with a wide-mouthed Jacobs tenaculum. Single-toothed tenacula should be avoided, as they tend to tear the pregnant cervix. A uterine sound is passed through the undilated cervix until the fundus is reached. The length of the uterine cavity is recorded.

Tapered cervical dilators, such as Pratt dilators, are used to progressively dilate the cervix, usually to 10 mm in diameter. Nontapered dilators, such as Hegar dilators, should be avoided because they are difficult to pass through the cervix, particularly in nulliparous patients, and produce a greater amount of cervical trauma.

After appropriate dilatation, a suction cannula is introduced through the cervix. We prefer large-diameter straight suction cannulae, such as 10-mm straight cannulae, rather then the curved or angulated variety. This is because 360° arcs of the cannulae must be made to adequately remove all gestational tissue. When 360° arcs are made with angulated cannulae, the diameter of the arc created in the intrauterine cavity by the angulated suction cannulae is excessive.

The suction curet should be introduced all the way to the fundus.

The suction is applied to the curet. The curet is rotated in a 360° arc and is slowly withdrawn in 1-cm increments.

The suction curet should be introduced 2-3 times to ensure that all products of conception have been adequately removed.

It is efficacious at this point to administer 50 international units of Pitocin in an intravenous drip and 0.2 mg of Methergine given intravenously. This has significantly reduced blood loss by inducing uterine contraction.

An ovum or sponge forceps is introduced into the endometrial cavity and are opened, closed, and withdrawn several times to ensure that all gestation tissue has been removed.

The patient is observed for 2 hours for hemorrhage prior to discharge.


Copyright - all rights reserved / Clifford R. Wheeless, Jr., M.D. and Marcella L. Roenneburg, M.D.
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