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Electric vacuum aspiration involves use of an electric pump or suction machine connected via flexible tubing to a plastic or metal cannula.

This method — which is used to perform abortion, treat incomplete abortion and manage irregular bleeding — has been found acceptable to women (Bird, et al, 2001).

The Process
After the woman has made an informed decision and undergone a medical examination demonstrating that EVA is a clinically appropriate option, a clinician places a speculum in the vagina. Next, a cannula of the appropriate size (determined according to uterine size) is inserted through the cervix into the uterus. The cannula is attached to a machine that provides suction or vacuum. The products of conception are aspirated through the cannula into a receptacle on the suction machine.

Conditions for Use
According to the World Health Organization, vacuum aspiration is typically used through the preferred surgical method for abortion up to 12 weeks since the woman’s last menstrual period. With appropriate training and skills, vacuum aspiration can also be used for second-trimester uterine evacuation through 15 weeks since the woman’s last menstrual period.

Because the initial purchasing cost of an EVA machine is relatively high, EVA is typically used in centralized settings with high caseloads. This method is less appropriate for settings with intermittent electrical supply.

Safety and Effectiveness
Electric vacuum aspiration is extremely effective and very safe (WHO, 2003). Most studies show that vacuum aspiration is successful in approximately 99 percent of cases (Greenslade et al., 1993).

The method results in few complications, especially when performed before or at 12 weeks since the woman’s last menstrual period. Compared with the sharp-curettage method, use of EVA requires less cervical dilatation and is associated with less blood loss, shorter hospital stays and a reduced need for anesthetic drugs (Hyman and Castleman, 2005; Forna and Gülmezoglu, 2002).

Pain Management
Women undergoing uterine evacuation with EVA generally experience three sources of discomfort: anxiety, cervical dilatation and uterine cramping. These sources require different pain-management strategies. The health-care provider should create a pain-management plan, together with the woman, to reduce any physical pain and anxiety and to minimize medication-induced risks and side effects. Pain during a uterine evacuation with EVA can be reduced with a combination of verbal support, oral medications, local anesthetic to the cervix (paracervical block) and a gentle clinical technique.

Other Options
When EVA is unavailable, women may have other method options, depending on the availability of equipment and a trained health-care provider, and the woman’s clinical circumstances. Alternatives to EVA include manual vacuum aspiration, medication abortion, sharp curettage and carrying the pregnancy to term with prenatal care.

Resources

 


+ Bibliography
  • Bird, Sheryl Thorburn, S. Marie Harvey, Linda J. Beckman, Mark D. Nichols, Kathy Rogers, and Paul D. Blumenthal. 2003. Similarities in women’s perceptions and acceptability of manual vacuum aspiration and electric vacuum aspiration for first trimester abortion. Contraception, 67:207-12.
  • Forna, Fatu, and A. Metin Gülmezoglu. 2002. Surgical procedures to evacuate incomplete abortion (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford, Update Software.
  • Greenslade, Forrest C., Ann H. Leonard, Janie Benson, Judith Winkler and Victoria L. Henderson. 1993. Manual vacuum aspiration: A summary of clinical and programmatic experience worldwide. Carrboro, NC. Ipas.
  • Hyman, Alyson G., and Laura Castleman. 2005. Woman-centered abortion care: Reference manual. Chapel Hill, NC, Ipas.
  • World Health Organization (WHO). 2003. Safe abortion: Technical and policy guidance for health systems. Geneva, WHO.