The preferred method of evacuation of the uterus is by manual vacuum aspiration.
Dilatation and curettage should be used only if manual vacuum aspiration is not
Review for indications.
Review general care principles.
Provide emotional support and encouragement and give pethidine IM or IV before the procedure. If necessary,
use a paracervical block.
Administer oxytocin 10 units IM or ergometrine 0.2 mg IM before the procedure to make the myometrium firmer and reduce the risk of perforation.
Perform a bimanual pelvic examination to assess the size and position of the uterus and the condition of the
Apply antiseptic solution to the vagina and cervix (especially the
Check the cervix for tears or protruding products of conception. If
products of conception are present in the vagina or cervix, remove them using ring (or sponge) forceps.
Gently grasp the anterior lip of the cervix with a vulsellum or single-toothed tenaculum
Note: With incomplete abortion, a ring (sponge) forceps is preferable as it is less likely than the tenaculum to tear the cervix with traction and does not require the use of
lignocaine for placement.
using a tenaculum to grasp the cervix, first inject 1 mL of 0.5% lignocaine solution into the anterior or posterior lip of the cervix which has been exposed by the speculum (the 10
o’clock or 12 o’clock position is usually used).
Dilatation is needed only in cases of missed abortion or when some retained products of conception have remained in the uterus for several days:
- Gently introduce the widest gauge cannula or curette;
- Use graduated dilators only if the cannula or curette will not pass. Begin with the smallest dilator and end with the largest dilator that ensures adequate dilatation (usually
10–12 mm) (Fig P-33);
- Take care not to tear the cervix or to create a false opening.
Inserting a retractor and holding the anterior lip of the cervix
Dilating the cervix
The uterus is very soft in pregnancy and can be easily injured during this procedure.
Curetting the uterus
Perform a bimanual pelvic examination to check the size and firmness of the uterus.
Examine the evacuated material. Send material for histopathological examination, if required.
- prolonged cramping (more than a few days);
- prolonged bleeding (more than 2 weeks);
- bleeding more than normal menstrual bleeding;
- severe or increased pain;
- fever, chills or malaise;
Top of page