Surgical methods for first trimester termination of pregnancy

The finding that dilatation and curettage was not clearly superior to manual vacuum aspiration in tertiary care settings under trial conditions suggests that the use of manual vacuum aspiration could be encouraged at the primary and secondary levels the health care systems in low-income countries. Clinical trials comparing the surgical methods were small and lacked power to identify differences between the groups for rare outcomes.

RHL Commentary by OL Odusoga, OA Olatunji

EVIDENCE SUMMARY

The review compares the safety and efficacy of dilatation and curettage (D&C) with manual vacuum aspiration (MVA) methods in the termination of first trimester pregnancy. It also evaluates the use of flexible versus rigid vacuum aspiration cannula. The outcomes compared in both cases were excessive blood loss, blood transfusion, cervical injury, febrile morbidity, incomplete or repeat uterine evacuation procedure, re-hospitalization, postoperative abdominal pain or therapeutic antibiotic use and duration of operation.

Only adequately randomized controlled trials with good methodological quality were considered to be eligible for the review. Three trials met the criteria. Two of the trials compared (D&C) with vacuum aspiration, while one compared rigid metal cannula with flexible plastic cannula for vacuum aspiration.

The duration of the procedure was found to be statistically significantly shorter (1.0 minute less on average; 95% CI: -1.5 - -0.6 minutes) for manual vacuum aspiration than for (D&C) in the only trial that reported this outcome. All other outcomes compared were similar with both methods. Both procedures were conducted under local anaesthesia (paracervical block) in the two trials.

No significant differences were noted between the use of rigid and flexible cannula in all the outcomes measured in the single trial involving 300 women.

The search strategy used for the review, the selection of the trials for inclusion in the review and the process of data extraction from the trials were adequate. The outcomes compared were well assessed. However, the sample size was small and this may be responsible for the lack of differences noted between the two methods (D&C vs. MVA) and between the use of the two different cannulae (rigid vs. flexible). This point is a limitation of the review as some large observational studies could have provided useful information (1).

The nature of the procedures also makes blinding of the operators impossible and liable to introduction of bias, although assessment of the outcome measures was adequately concealed.

The full RHL commentary also includes sections on:

Relevance
- Magnitude of the problem
- Feasibility of the intervention
- Applicability of the results of the Cochrane Review
- Implementation of the intervention
- Research
References

Subscribe now for access to the full text and PDFs
@ www.rhlibrary.com

This document should be cited as: OL Odusoga, OA Olatunji. Surgical methods for first trimester termination of pregnancy: RHL commentary (last revised: 11 November 2002). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com