| Excerpt from The WHO Reproductive Health Library | Published by Update Software Ltd. |
This review compares the safety and efficacy of available surgical methods for the management of incomplete abortion. There are two procedures most widely used for this purpose: The instrumental curettage and vacuum aspiration. The first one is performed with a rigid metal curette, in the operation room and usually under general anesthesia. The second uses suction from electrical or manual syringe sources, plastic or metal cannula for evacuating the uterus and can be performed on an outpatient basis, under local anesthesia or analgesia.
Twenty-five studies were identified, but only two met the eligibility requirements established by the reviewers. Most trials did not qualify because they were not randomized. The reviewers concluded that vacuum aspiration of the uterus is preferable to curettage. This preference is based mainly on the results of one trial from Zimbabwe showing similar efficacy, shorter procedure duration, less blood loss and less need for anaesthesia and pain relief with suction curettage.
The methodology followed was adequate. The analysis of the studies was correct. The authors adequately determined the outcomes to be assessed, but unfortunately only two variables are evaluated in the studies (uterine perforation and the need of uterine re-evacuation) and only one study has complete information for the evaluation of the other variables. Another limitation is that both studies had relatively small sample sizes, one study did not describe the screening methodology and the other had a considerable number of losses on the follow-up. Although the review was conducted appropriately the scarcity of data limits the strength of the conclusions.
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