Evacuation of the gravid uterus by negative pressure (suction evacuation)

500 patients treated by suction evacuation of the gravid uterus are described. There were 80 therapeutic abortions, 375 early incomplete abortions, 21 late incomplete abortions, 18 missed abortions, and 6 cases of hydatidiform mole. The suction method was attempted to avoid the trauma of the curette. The 80 therapeutic abortions were done in Weeks 5-10 of pregnancy. To check results, an immediate curettage was made in 56 cases: this verified that no tissue remained in the uterus. In the 18 cases of missed abortion an adherent and fibrotic placenta was encountered in 9. A curettage was then needed to complete the procedure. The suction method was not used for subsequent cases of missed abortion. In the 375 cases of early incomplete abortion suction evacuation was 100% successful; in these cases the cervix was usually already adequately dilated. In the 21 cases of late incomplete abortion, 17 had the fetus already expelled. However, the remaining placenta tended to block the suction tube. Parts of the placenta were then left to be removed by curettage. In the 4 cases in which the fetus had not been expelled it could not be evacuated through the suction tube. Therefore suction evacuation was no longer done for late incomplete abortion. In all 6 cases of hydatidiform mole suction evacuation was quickly performed with minimal bleeding. Damage to the basal layer of the endometrium and the myocardium is avoided in the separation of the placenta by suction evacuation. The method is recommended as better than curettage for early therapeutic abortion, early incomplete abortion, and hydatidiform mole but not for late incomplete abortion or missed abortion.