Over 1 million induced abortions are performed each year in the US. The majority of first trimester abortions are performed using vacuum aspiration. There are two methods of vacuum aspiration available; manual vacuum aspiration (MVA) and electric vacuum aspiration (EVA). In studies performed prior to 11 weeks’ gestation, no differences between the methods have been found in regards to completed abortion rate, complication rate, or patient satisfaction. Currently, there are no US studies specifically comparing the two methods between 11 and 14 weeks gestation.
Statement of Purpose
The purpose of our trial was to compare procedure time, from start of cervical dilation until complete uterine evacuation, for manual and electric vacuum aspiration between 10 0/7 and 13 6/7 weeks gestation to determine if one method was faster than the other.
This study was a randomized, controlled, single-site superiority trial with two parallel groups. We enrolled between October 2015 and April 2016. To be eligible to participate, women had to be at least 18 years old, speak English, be presenting for a surgical-induced abortion, and have an intrauterine pregnancy between 10 0/7 and 13 6/7 weeks gestation confirmed by ultrasound. After enrolling, the participant completed a survey assessing demographics, reproductive history, and procedure expectations. She then underwent her procedure. During the procedure, the research assistant collected data about procedure time, anesthesia used, complications, and procedure difficulty as determined by the abortion provider. Immediately prior to discharge the participant completed a post-procedure survey assessing pain and anxiety during, as well as satisfaction with, the procedure. A follow-up phone survey occurred 2 weeks after the procedure to assess for the patient’s post-procedure symptoms, any delayed complications that were not reported to our study site, and satisfaction with her procedure.
A total of 146 women enrolled in the study. 72 were randomized to receive EVA and 74 to MVA. Median procedure time was similar in the EVA and MVA groups (2.4 vs. 2.6 min). When we looked at procedure time by gestational age, there was no difference in median procedure time between 10 0/7 and 11 6/7 for EVA vs. MVA (2.1 vs 2.1 min). However, between 12 0/7 and 13 6/7, median operative time was significantly shorter when EVA was used as compared to MVA (2.5 vs 3.5 minutes).
In conclusion, between 10 0/7 and 13 6/7 weeks gestation, EVA and MVA have similar procedure times. When stratified into two gestational age groups, EVA between 12 0/7 – 13 6/7 weeks gestation was significantly faster than MVA.