Preparation and dilation of the cervical canal
Before surgery, the cervix is positioned: in anteflexio it is pulled downward and backward, and in retroflexio — forward. Using a uterine sound, the position of the organ is determined and the length of the cavity is measured, establishing the direction for further manipulations.
Cervical dilation is performed using Hegar dilators, which are inserted in strict sequence. Each instrument is held with three fingers to carefully pass the internal os and immediately stop movement upon encountering resistance. If a size does not pass, return to the previous one, holding it in the cervix with backward pressure.
Vacuum aspiration of the ovum
The method allows the removal of the ovum using metal or disposable polyethylene cannulae (sizes No. 6, 7, 8). A feature of the method is that the cannulae can be inserted through the cervical canal without preliminary dilation.
- Technique: the cannula is advanced to the uterine fundus and toward the operator, destroying the ovum and aspirating the contents using the negative pressure of the aspirator.
- Completion criterion: pink foam without tissue admixtures begins to flow from the tube, and the uterus contracts.
Instrumental uterine curettage
Surgical termination of pregnancy requires a strict order of instrument placement on the instrument table: vaginal specula, tenaculum forceps, uterine sound, Hegar dilators, loop curettes (No. 6, 4, 2), and abortion forceps.
Curettage of the uterine walls is performed in several stages:
- Cervical dilation.
- Destruction and removal of the ovum with a curette and abortion forceps.
- Wall curettage: start with the blunt No. 6 curette, and as the uterus contracts and decreases in size, switch to sharper, smaller curettes.
Briefly: answers to topical questions
What are the contraindications to surgical termination of pregnancy?
Contraindications to artificial termination of pregnancy include acute and subacute inflammatory diseases of the genital organs, as well as extragenital inflammatory processes.
- Genital inflammation — adnexitis, purulent colpitis, endocervicitis.
- Extragenital inflammatory processes — furunculosis, periodontal disease, acute appendicitis, tuberculous meningitis, miliary tuberculosis.
The decision to terminate pregnancy in the presence of contraindications is made by the physician individually, taking into account the results of treatment of these pathologies and the gestational age.
What early complications can occur after instrumental uterine curettage?
Intraoperative and early postoperative complications may develop after instrumental removal of the ovum.
- Uterine perforation — accompanied by the risk of intraabdominal bleeding and injury to adjacent organs: intestines, greater omentum, urinary bladder.
- Uterine bleeding.
- Retained products of conception in the uterine cavity.
- Cervical injury — forced dilation of the cervical canal may cause cervical tears.
Up to what gestational age is vacuum aspiration permitted?
Vacuum aspiration of the ovum is performed at a gestational age of up to 12 weeks. The procedure is performed with mandatory anesthesia, in an inpatient setting. The minimum medical observation time after the procedure is at least 3–4 hours.
The three-finger rule for Hegars: three fingers hold the dilator to think three times before every millimeter of advancement to avoid perforation.
Class and exam questions
What complications can occur during cervical dilation?
Forced insertion of Hegar dilators can lead to tears or perforation of the cervix and uterine body.
What is the main criterion for the completion of vacuum aspiration?
The procedure is considered complete when pink foam without tissue admixtures begins to flow from the cannula and the uterus itself contracts.
How do instruments change during curettage of the uterine walls?
The initial stage is performed with a blunt No. 6 curette. As the uterus contracts and decreases in size, instruments are changed to sharper, smaller curettes.
What else to study on this topic
- Physician tactics in case of difficulty passing a Hegar dilator
- Exact dimensions and numbering of loop curettes
- Design and operating principle of the vacuum aspirator device
- Features of using abortion forceps in surgical abortion
- Strict sequence of instrument layout on the operating table
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