What is Vacuum Aspiration for Artificial Termination of Pregnancy?

Vacuum aspiration was first invented by Wu Yuantai, Wang Jiaguang, Cai Guangzong and others in my country in 1958. It is a method of using negative pressure to suck out the embryonic sac of early pregnancy. The negative pressure is controlled at 53.0-66.0 kPa (400-500 mmHg), and it has become a commonly used method at home and abroad.

1. The electric suction device combines an electric suction device with a large-capacity negative pressure reserve device. To prevent accidents, a safety valve is installed between the suction device and the negative pressure bottle to prevent the machine from failing and switching from negative pressure suction to positive pressure blowing. The machine is equipped with an automatic control device that can control the pressure at will. It is easy to operate and is currently the most widely used in China.

2. Indications

(1) Anyone who wishes to terminate pregnancy without contraindications and is within 6 to 10 weeks of pregnancy.

(2) Those who suffer from heart disease, history of heart failure, chronic nephritis and other diseases should not continue pregnancy.

(3) Having a family genetic disease or pelvic exposure to radiation within 12 weeks of pregnancy, or accidentally taking large amounts of drugs that may affect embryonic development and the fetus.

3. Contraindications

(1) Inflammation of reproductive organs, vaginitis, severe cervical erosion, and pelvic inflammatory disease.

(2) Various acute diseases or acute infectious diseases, heart failure, hypertension with subjective symptoms, acute stage of tuberculosis, high fever, and severe anemia.

(3) Those whose body temperature is above 37.5℃ twice on the day of surgery.

4. Preoperative Preparation

(1) Inquire in detail about the history of amenorrhea, menstrual history, early pregnancy reaction, relevant medical history, number of pregnancies, number of parities, etc.; whether the pregnancy is during lactation, whether there is a recent history of artificial abortion, cesarean section or hysterectomy and other high-risk factors; whether there are any systemic diseases and the effectiveness of treatment.

(2) Measure body temperature, pulse, blood pressure, and conduct routine medical examinations.

(3) Gynecological bimanual examination to understand the pelvic condition and confirm the diagnosis of early pregnancy.

(4) Auxiliary examination

1) Routine blood test, blood type, and coagulation-related examinations.

2) Routine examination of leucorrhea to understand the cleanliness of the vagina and whether there is trichomonas, fungus and Gram-negative diplococcus infection.

3) Urine B-HCG examination and B-ultrasound examination.

5. Preparation of surgical supplies

(1) Surgical instruments, dressings and their disinfection

1) Equipment of the surgical kit: 1 short duckbill speculum and 1 ordinary vaginal speculum, 1 gynecological forceps, 1 cervical forceps, 1 uterine probe, 1 cervical dilator (No. 4-10), 1 suction tube (No. 6-8), 1 toothed tissue forceps, 1 small scraper, 1 curved plate, 1 connecting hose, 1 medium-sized perforated towel, 1 medicine cup, 2 cotton swabs, and appropriate amount of cotton balls or gauze.

2) Instruments and dressings should be sterilized by high pressure, and hoses can be sterilized by boiling.

(2) Spare medicines and equipment

1) Spare medicines: uterine contraction drugs, such as ergonovine, oxytocin, etc.; emergency medicines, such as atropine, epinephrine, hypertonic glucose solution, etc.

2) Instruments: large and small syringes and needles, electric abortion aspirator.

(3) Preparation for termination of pregnancy

1) The patient should be informed of the surgical process and possible situations in order to relieve the patient's mental concerns and strengthen contraception and health education. Artificial abortion is a remedial measure for contraceptive failure. After all, it is an intrauterine surgery under non-direct vision, which has a certain degree of blindness and should not be performed frequently.

2) The bladder should be emptied before surgery and sexual intercourse should be prohibited before and after surgery to prevent infection.

3) If the vaginal discharge is inflammatory, the vagina should be flushed for 3 days before surgery.

6. Steps of surgical abortion

(1) The surgeon should wear clean work clothes or surgical gowns, a hat and a mask; wash hands and wear sterilized gloves.

(2) The patient takes the lithotomy position.

(3) Use 1% Sanisol or iodine solution to disinfect the vulva and vagina in order, and lay a disinfectant towel.

(4) The operator rechecks the position, size, and appendages of the uterus.

(5) Use a speculum to dilate the vagina and expose the cervix. Use 2.5% iodine and 75% alcohol to disinfect the cervix, cervical canal and vagina. Then use a cervical clamp to clamp the middle part of the anterior lip of the cervix. Do not clamp it into the cervical canal.

(6) Use a uterine probe to detect the depth of the uterine cavity along the direction of the uterus. At 6 to 8 weeks of pregnancy, the uterine cavity is 8 to 10 cm deep; at 9 to 10 weeks of pregnancy, the uterine cavity is 10 to 12 cm deep.

(7) Use a cervical dilator to dilate the cervical opening along the direction of the uterus. When dilating, the force should be even and not too strong to prevent damage to the cervical opening or uterine perforation.

(8) Have an assistant connect the end of the suction tube to the sterilized rubber tube and then to the connector at the front end of the suction tube.

(9) Slowly insert the tip of the straw into the bottom of the uterus in the direction of the position of the uterus. When encountering resistance, withdraw it slightly. The depth of the straw should not exceed the depth of the uterine cavity measured by the uterine probe. The opening of the straw should be aimed at the site of embryo implantation as much as possible. Clinically, it is believed that the embryonic sac of an anteverted uterus is attached to the anterior wall of the uterus; the embryonic sac of a retroflexed uterus is attached to the posterior wall of the uterus.

(10) Use a small scraper to gently scrape the uterine fundus and uterine horns on both sides to check whether the uterine cavity is completely sucked out. If necessary, reinsert the suction tube and start negative pressure suction again.