Manual and Vacuum Aspiration for Abortion

Surgery Overview

There are two methods of vacuum aspiration (also called suction aspiration):

  • Manual vacuum. This procedure can be used around 5 to 12 weeks after the last menstrual period (early first trimester). It involves the use of a specially designed syringe to apply suction. This method is not available everywhere. But it may be more available than machine aspiration in some geographic areas.
  • Machine vacuum. This procedure is a common method used in the first 5 to 12 weeks (first trimester) of pregnancy. Machine vacuum aspiration involves the use of a hollow tube (cannula) that is attached by tubing to a bottle and a pump, which provides a gentle vacuum. The cannula is passed into the uterus, the pump is turned on, and the tissue is gently removed from the uterus.

Manual vacuum aspiration procedure

Manual vacuum aspiration usually takes between 5 and 15 minutes. It can be done safely in a clinic or medical office using local anesthetic and a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. For this procedure, the health professional will:

  • Position you on the exam table in the same position used for a pelvic exam, with your feet on stirrups while you are lying on your back.
  • Insert a speculum into the vagina.
  • Clean the vagina and cervix with an antiseptic solution.
  • Inject a numbing medicine (local anesthetic) in the cervix.
  • Insert a small instrument into the cervix to slightly open (dilate) it, if needed. In most cases, though, dilation isn't needed.
  • Pass a thin tube through the cervix and into the uterus. A handheld syringe is attached and used to suction the tissue out of the uterus. As the uterine tissue is removed, the uterus will contract. Most women feel cramping during the procedure. The cramps will decrease after the tube is removed. Some women also have nausea or sweating, or they feel faint. But typically symptoms are less severe than with machine vacuum aspiration.

Machine vacuum aspiration procedure

Hours before or the day before a machine vacuum aspiration procedure, a cervical (osmotic) dilator may be placed in the cervix to slowly open (dilate) it. Just before, antibiotics are given to prevent infection. A medicine called misoprostol may be given to soften the cervix before the procedure.

Machine vacuum aspiration usually takes between 10 and 15 minutes. It can be done safely in a clinic or medical office under local anesthetic. For this procedure, the health professional will:

  • Position you on the exam table in the same position used for a pelvic exam, with your feet on stirrups while lying on your back.
  • Insert a speculum into the vagina.
  • Clean the vagina and cervix with an antiseptic solution.
  • Inject a numbing medicine (local anesthetic) in the cervix. Medicine for pain or sedation, in addition to the local anesthetic, may be given by mouth or through a vein (intravenously). Vasopressin, or a similar medicine that slows uterine bleeding, may be mixed with the local anesthetic to reduce blood loss.
  • Grasp the cervix with an instrument to hold the uterus in place.
  • Open (dilate) the cervical canal with a small instrument. Dilation reduces the risk of any injury to the cervix during the procedure.
  • Pass a thin, hollow tube (cannula) into the cervical canal and attaching a gentle vacuum that will draw the tissue out of the uterus. As the uterine tissue is removed, the uterus will contract. Most women feel cramping during the procedure. The cramps will decrease after the tube is removed. Some women also may have nausea or sweating or feel faint.

The tissue removed from the uterus during a vacuum aspiration procedure is examined to make sure that all of the tissue has been removed and the abortion is complete.

Sometimes a dilation and curettage (D&C) procedure is needed after a vacuum aspiration if all of the tissue has not been removed. D&C uses a sharp surgical instrument to clear tissue from the uterus.

What To Expect After Surgery

Vacuum aspiration is a minor surgical procedure. A normal recovery includes:

  • Irregular bleeding or spotting for the first 2 weeks. During the first week, avoid tampons and use only pads.
  • Cramps similar to menstrual cramps. These may be present for several hours and possibly for a few days, as the uterus shrinks back to its nonpregnant size.
  • Emotional reactions for 2 to 3 weeks. After an abortion, it is normal to feel relief, sadness, grief, or guilt. Hormonal changes during pregnancy can make emotions stronger than usual.

After the procedure:

  • Take your full course of prescribed antibiotics to prevent infection.
  • Rest quietly for the day. You can do normal activities the following day, based on how you feel.
  • Acetaminophen (such as Tylenol) or ibuprofen (such as Advil) can help relieve cramping pain.
  • Do not have sexual intercourse for at least 1 week. Use birth control following the abortion. And use condoms to prevent infection. You can start certain birth control methods right after the procedure.

Signs of complications

Call your doctor immediately if you have any of these symptoms after an abortion:

  • Severe bleeding. Both medical and surgical abortions usually cause bleeding that is different from a normal menstrual period. Severe bleeding can mean:
    • Passing clots that are bigger than a golf ball, lasting 2 or more hours.
    • Soaking more than 2 large pads in an hour, for 2 hours in a row.
    • Bleeding heavily for 12 hours in a row.
  • Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
  • Severe pain in the abdomen that is not relieved by pain medicine, rest, or heat
  • Hot flushes or a fever of 100.4°F (38°C) or higher that lasts longer than 4 hours
  • Vomiting lasting more than 4 to 6 hours
  • Sudden abdominal swelling or rapid heart rate
  • Vaginal discharge that has increased in amount or smells bad
  • Pain, swelling, or redness in the genital area

Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:

  • Bleeding (not spotting) for longer than 2 weeks
  • New, unexplained symptoms that may be caused by medicines used in your treatment
  • No menstrual period within 6 weeks after the procedure
  • Signs and symptoms of depression. Hormonal changes after a pregnancy can cause depression that requires treatment.

Why It Is Done

Vacuum aspiration is done in the first trimester of pregnancy.

Vacuum aspiration can be done for:

  • An induced therapeutic abortion.
  • A failed medical abortion.
  • Death of the fetus (missed spontaneous abortion).
  • An incomplete miscarriage (incomplete spontaneous abortion).

How Well It Works

First-trimester surgical abortions are safe and effective and have few complications.

In rare cases, an aspiration procedure doesn't successfully end a pregnancy. This is more likely to happen during the earliest weeks of a pregnancy.

Risks

The risk of complications is low. Some minor complications include:

  • Injury to the uterine lining or cervix.
  • Infection. Bacteria can enter the uterus during the procedure and cause an infection. This is more likely if an untreated infection, such as a sexually transmitted infection (STI), is present before the procedure. Symptoms of fever, pain, and abdominal (belly) tenderness will usually start within 3 days of the procedure. Antibiotics given during or after the procedure reduce the risk of infection.

Rare complications include:

  • A hole in the wall of the uterus (uterine perforation). This is rare. This most commonly happens during cervical dilation. Bleeding is usually minimal, and no repair is needed. If bleeding is a concern, a laparoscopy (a procedure that uses a lighted viewing instrument) can be used to see whether it has stopped.
  • Tissue remaining in the uterus (retained products of conception). This usually causes recurring cramping belly pain and bleeding within a week of the procedure. Sometimes prolonged bleeding does not develop until several weeks later.
  • Blood clots. If the uterus doesn't contract to pass all of the tissue, the cervical opening can become blocked, preventing blood from leaving the uterus. The uterus becomes enlarged and tender, often causing belly pain, cramping, and nausea.

A repeat vacuum aspiration and medicine to stop bleeding are used to treat retained products of conception or blood clots.

Undiagnosed ectopic pregnancy after manual or machine vacuum aspiration

It is possible to have an undiagnosed ectopic (tubal) pregnancy that isn't discovered until after an abortion procedure. Although the pregnancy test before the procedure is positive, the pregnancy is not in the uterus. So the abortion method does not end the pregnancy. Symptoms of an ectopic pregnancy that occur after an abortion procedure can include:

  • Belly or pelvic pain that gets worse.
  • Pain with intercourse.
  • Vaginal bleeding.
  • Lightheadedness or fainting caused by blood loss.

Ectopic pregnancy requires urgent medical care. Call your doctor immediately if you have symptoms of a possible ectopic pregnancy. To learn more, see the topic Ectopic Pregnancy.

What To Think About

Choosing a medical or a surgical procedure for an abortion will depend on your medical history, how many weeks pregnant you are, what options are available where you live, and your personal preferences.

In the United States, vacuum aspiration is the most common method of abortion used within the first 12 weeks (first trimester) of pregnancy. Early in pregnancy through most of the first trimester, a woman can also consider using medicine (medical abortion).

Nearly 90 out of 100 abortions are done in the first trimester of pregnancy.1

Before your procedure

The hospital or surgery center may send you instructions on how to get ready for your surgery. Or a nurse may call you with instructions before your surgery.

After your procedure

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You most likely will stay in the recovery area for a period of time and then you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will go home with a page of care instructions including who to contact if a problem arises.

An abortion rarely affects your ability to become pregnant in the future. So it is possible to become pregnant in the weeks right after the procedure. Avoid sexual intercourse until your body has fully recovered, usually for at least 1 week. Use birth control in the first weeks following the abortion. And use condoms to prevent infection.

Depression can be triggered when pregnancy hormones change after an abortion. If you have more than 2 weeks of symptoms of depression, such as fatigue, sleep or appetite change, or feelings of sadness, emptiness, anxiety, or irritability, see your doctor about treatment.

Complete the surgery information form (PDF)surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Guttmacher Institute (2011). In Brief: Facts on Induced Abortion in the United States. Available online: http://www.guttmacher.org/pubs/fb_induced_abortion.html.

Credits

By Healthwise Staff
Sarah Marshall, MD - Family Medicine
Rebecca H. Allen, MD, MPH - Obstetrics and Gynecology
Last Revised August 31, 2012

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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