B. MANUAL VACUUM ASPIRATION (≤ 10 Weeks)
Evacuation of early gestations, within one week of a missed period,  with a small-bore vacuum cannula can be performed in an office setting by a properly trained physician.

The instruments required are a speculum, a tenaculum, a Karman cannula, and a modified 50 mL syringe (IPAS or Milex). Some women, especially multiparous women, do not require dilatation. All women should have a paracervical block with 10 to 20 mL of 1% lidocaine.

After the procedure the tissue should be examined, by floating it in a clear plastic dish over a light source, to confirm the presence of chorionic villi or gestational sac. In experienced hands and with the use of a cannula of a size in mm equal to the gestational age in weeks,  the failure rate (need for reaspiration) is 0.25%. If a cannula smaller than the gestational age is used, the failure rate increases to 1.5%.

As complication and failure rates are similar for manual vacuum aspiration and early vacuum aspiration up to 10 weeks’ gestation, there is no need to delay the procedure for those women who present early.

Advantages
1. Office procedure
2. Can be performed without delay, with early relief from undesirable symptoms of pregnancy
3. Only local anaesthetic needed in most cases
4. Private
5. Early detection of ectopic pregnancy29
6. Cost effective
7. Safe

Exceptions
1.  Definite known allergic response to local anaesthetic2.  Contraindication to local anaesthetic or drugs used for premedication

3.  Non-compliant or difficult patient

4.  Very young nulliparous women who are difficult to examine

5.  Any patient who is psychologically or physically unable to cope with the procedure under local anaesthesia will require conscious sedation, e.g., fentanyl (50 - 100 ìg) with midazolam (1 - 3mg).

Summary of Recommendations

REFERENCES

Victoria Jane Davis, MD
These guidelines were reviewed by the Clinical
Practice - Gynaecology Committee and the Social and Sexual
Issues Committee and approved by the Executive and Council of
the Society of Obstetricians and Gynaecologists of Canada.