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Manual Versus Electric Vacuum Aspiration for Early First-Trimester Abortion: A Controlled Study of Complication Rates

From the Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, and Planned Parenthood League of Massachusetts, Inc., Boston, Massachusetts; and the Department of Obstetrics, Gynecology and Reproductive Sciences and The Center for Reproductive Health Research and Policy, San Francisco General Hospital, University of California, San Francisco, California.

Address reprint requests to: Alisa B. Goldberg, MD, MPH, Planned Parenthood League of Massachusetts, Inc., 1055 Commonwealth Avenue, Boston, MA 02215; e-mail: Alisa_Goldberg{at}pplm.org.

OBJECTIVE: Manual vacuum aspiration is an alternative to electric suction curettage for first-trimester elective abortion. Although many studies have demonstrated that manual vacuum aspiration is safer than sharp curettage for abortion, only a few studies have directly compared it with electric suction curettage. These studies proved the methods to be equally effective and acceptable but were too small to adequately compare safety. We compared immediate complication rates for abortions performed by manual and electric vacuum aspiration.

METHODS: We conducted a retrospective cohort analysis of all women undergoing elective abortion at up to 10 weeks’ gestation at San Francisco General Hospital over a 3.5-year period. A total of 1726 procedures were included: 1002 manual and 724 electric vacuum aspirations. Clinical data were collected from medical records. Rates of uterine reaspiration and other immediate complications occurring at our institution were compared.

RESULTS: We found no difference in the rate of uterine reaspiration after abortions performed with the manual or electric suction device (2.2% versus 1.7%, respectively, P = .43). We had 80% statistical power to detect a 2% difference in uterine reaspiration rates with an µa error of .05. Overall major complication rates were 2.5% with manual and 2.1% with electric suction curettage, P = .56. Multivariable regression analyses controlling for potential confounders showed no difference in uterine reaspiration rates (electric odds ratio [OR] = 0.71, 95% confidence interval [CI] 0.32, 1.6) or overall complications (electric OR = 0.81, 95% CI 0.40, 1.7).

CONCLUSION: Manual vacuum aspiration is as safe as electric suction curettage for abortions at up to 10 weeks’ gestation. Expanded use in an office setting might increase abortion access.

LEVEL OF EVIDENCE: II-2

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