Manual, low-tech method for 2nd trimester abortions found safe and effective

Useful in developing countries

A hand-held vacuum aspiration device works as well as a more expensive electrical one for ending second-trimester pregnancies, according to results of a study by Johns Hopkins obstetricians published in the October issue of the International Journal of Gynecology & Obstetrics.

“Now that we know the low-tech device is safe and effective, it can be taught to doctors in developing nations to help reduce the prevalence of unsafe abortions and complications,” says Paul D. Blumenthal, M.D., M.P.H., senior author of the paper and an associate professor of gynecology and obstetrics at Johns Hopkins.

The more costly electrical devices and the electricity needed to power them often are not available in less developed parts of the world, but there had been questions about comparative quality of the two methods. The manual technique had been commonly used for first-trimester abortions, but never for second-trimester abortions.

The Hopkins investigators compared both techniques while performing second-trimester abortions on 110 women who came to the Johns Hopkins Bayview Medical Center for this service between January 1998 and September 2000. The patients’ average age was 23.4 years, with an average gestation of 16 weeks.

Doctors performed manual vacuum aspiration on 73 women and electric vacuum aspiration on 37 women. There were no significant differences in procedure time between the two groups, and no complications reported.

In vacuum aspiration, doctors use either a hand-held specially designed syringe or a hollow tube hooked up to an electrical pump to apply suction inside the cervix, removing the uterine contents. The manual instrument is approved by the U.S. Food and Drug Administration for first-trimester abortions but had not been tested for second-trimester abortions, which are usually performed using the electric-powered aspirator.

In the United States, only 12 percent of abortions are performed in the second trimester of pregnancy, Blumenthal says.

“Generally, women who request a second-trimester abortion are those who need it most — either teenagers, who may deny the pregnancy at first or don’t know where to turn, or older women who have an unexpected pregnancy and other children to care for,” he says.

Study coauthors were C.S. Todd, M.E. Soler, L. Castleman, and M.K. Rogers.

Todd, C.S. et al, “Manual Vacuum Aspiration for Second-Trimester Pregnancy Termination,” International Journal of Gynecology & Obstetrics, October 2003, Vol. 83, Issue 1, pages 5-9.