12.3 Aspiration


Vacuum aspiration (either manual or electric) is the alternative to medication abortion. 

12.3.1 Precautions

– Purulent cervicitis or pelvic infection:
• delay aspiration if possible, until antibiotic treatment (Chapter 9, Section 9.6.6) has been completed.
• if aspiration cannot be delayed, start antibiotic treatment before starting the procedure.
– Coagulation disorders: risk of haemorrhage. Aspiration must be performed in a facility where emergency surgery and blood transfusion are available.

12.3.2 Equipment

Chapter 9, Section 9.5.3.

12.3.3 Technique

– Follow precautions common to all intrauterine procedures (Chapter 9, Section 9.1.1).
– Start antibiotic treatment in case of infection if the abortion cannot be delayed. For antibiotherapy, see Chapter 9, Section 9.6.6.
– For antibiotic prophylaxis, cervix preparation (if necessary), premedication, preparation of equipment, paracervical block and the procedure, see Chapter 9, Section 9.5.4.

Note: if the patient desires an IUD as her method of contraception, it can be inserted after aspiration, as long as no pelvic infection is present.

12.3.4 Patient follow-up

Immediate

– Settle the patient comfortably during the monitoring period (at least 2 hours).
– Monitor vital signs and blood loss.
– Pain management: paracetamol and/or ibuprofen (Appendix 7).
– The patient can go home if the vital signs are stable, if she can walk and she has been given the following information:
• Cramps continue for a few days.
• Bleeding lasts for 8 to 10 days.
• Menstrual periods will resume within 4 to 8 weeks.
• Fertility returns rapidly; ovulation can occur as early as 10 days post-abortion. Begin contraception that same day (Chapter 11, Section 11.5).
• Personal hygiene: cleansing with soap and clean water once daily; no vaginal douches.
• Seek immediate medical attention in case of severe pain or heavy bleeding, foul smelling discharge or fever.

Post-abortion consultation

– No routine post-abortion consultation is required.
– The woman is encouraged to come back at any moment in case of concerns, complications or questions.
– The woman is invited to return for contraception if she did not start a method immediately at the time of the abortion.

12.3.5 Complications

Chapter 9, Section 9.6.6.