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We work with partners around the world to advance reproductive justice by expanding access to abortion and contraception.

Ipas Sustainable Abortion Care

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The global movement for legal, accessible abortion is growing. Our staff and partners in countries as diverse as Bolivia, Malawi and India are working to ensure all people can access high-quality abortion care.


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Clinical Updates in Reproductive Health

Uterine evacuation: Replace sharp curettage with aspiration or medications

Last reviewed: September 15, 2022


  • Vacuum aspiration or medical abortion should replace sharp curettage (also known as dilatation and curettage [D&C]) for the treatment of abortion and postabortion care.

Strength of recommendation: Strong

Quality of evidence: Moderate

Last reviewed: September 15, 2022

The World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) recommend against the use of sharp curettage-including sharp curette ‘checks’ to complete the abortion-and state that vacuum aspiration or medication regimens should replace sharp curettagefor uterine evacuation (FIGO, 2011; WHO, 2022). In places where no uterine evacuation services exist, vacuum aspiration and medical abortion should be introduced.

Multiple systematic reviews have shown that vacuum aspiration is as effective as sharp curettage in treating early incomplete and missed abortions while reducing procedure time, blood loss and pain (Ghosh et al., 2021; Tuncalp, Gulmezoglu, & Souza, 2010) and it is feasibile to introduce in settings using D&C (Kakinuma, et al 2020). In a retrospective case series of 80,437 women seeking induced abortion, vacuum aspiration was associated with less than half the rate of major and minor complications compared to sharp curettage (Grimes, Schulz, Cates Jr, & Tyler Jr., 1976). A more recent series, including more than 100,000 abortion procedures, found that sharp curettage performed alone or in combination with vacuum aspiration was significantly more likely to be associated with complications, particularly incomplete abortion, than vacuum aspiration without curettage (Sekiguchi et al., 2015).

Multiple studies on induced abortion and postabortion care have shown that because vacuum aspiration can be performed in an outpatient setting by many different kinds of health care workers without general anaesthesia, the costs to both the health system and individuals are significantly less than sharp curettage (Benson, Okoh, KrennHrubec, Lazzarino, & Johnston, 2012; Choobun, Khanuengkitkong, & Pinjaroen, 2012; Farooq, Javed, Mumtaz, & Naveed, 2011; Johnston, Akhter, & Oliveras, 2012).

A 2021 network meta-analysis compared surgical uterine evacuation methods, including D&C, to medical management of early pregnancy loss, finding similar effectiveness for vacuum aspiration, D&C, and medical management (Ghosh et al., 2021). The safety and tolerability of medical regimens for uterine evacuation are well documented (Kulier et al., 2011; Neilson, Gyte, Hickey, Vazquez, & Dou, 2013).

The use of sharp curettage to manage incomplete or missed abortion may be associated with Asherman’s syndrome (intrauterine adhesions). A retrospective review from one tertiary care center reported on 884 women who underwent sharp curettage, manual vacuum aspiration or misoprostol for early pregnancy failure (Gilman Barber, Rhone, & Fluker, 2014). In follow-up, 1.2% of women managed with sharp curettage were found to have Asherman’s syndrome (6 out of 483 women), while no cases were found in the 401 women managed by manual vacuum aspiration or misoprostol.


Benson, J., Okoh, M., KrennHrubec, K., Lazzarino, M. A., & Johnston, H. B. (2012). Public hospital costs of treatment of abortion complications in Nigeria. International Journal of Gynecology & Obstetrics, 118(2), 60012-60015.

Choobun, T., Khanuengkitkong, S., & Pinjaroen, S. (2012). A comparative study of cost of care and duration of management for first-trimester abortion with manual vacuum aspiration (MVA) and sharp curettage. Archives of Gynecology and Obstetrics, 286(5), 1161-1164.

Farooq, F., Javed, L., Mumtaz, A., & Naveed, N. (2011). Comparison of manual vacuum aspiration, and dilatation and curettage in the treatment of early pregnancy failure. Journal of Ayub Medical College Abbottabad, 23(3), 28-31.

FIGO. (2011). Consensus statement on uterine evacuation. Retrieved from https://www.figo.org/news/new-download-uterine-evacuation-figo-consensus-statement-0014150

Ghosh, J., Papadopoulou, A., Devall, A.J., Jeffery, H.C., Beeson, L.E., … & Gallos, I.D. (2021). Methods for managing miscarriage: A network meta-analysis. Cochrane Database of Systematic Reviews, 6(6):CD012602

Gilman Barber, A. R., Rhone, S. A., & Fluker, M. R. (2014). Curettage and Asherman’s syndrome-lessons to (re-) learn? Journal of Obstetrics and Gynaecology Canada, 36(11), 997-1001.

Grimes, D. A., Schulz, K. F., Cates Jr, W., & Tyler, C. W., Jr. (1976). The Joint Program for the Study of Abortion/CDC: A Preliminary Report. Paper presented at the Abortion in the Seventies: Proceeding of the Western Regional Conference on Abortion, Denver, Colorado.

Johnston, H. B., Akhter, S., & Oliveras, E. (2012). Quality and efficiency of care for complications of unsafe abortion: A case study from Bangladesh. International Journal of Gynecology & Obstetrics, 118(2), 60013-60017.

Kakinuma, T., Kakinuma, K., Sakamoto, Y., Kawarai, Y., Saito, K., Ihara, M., Matsuda, Y., Sato, I., Ohwada, M., Yanagida, K., & Tanaka, H. (2020). Safety and efficacy of manual vacuum suction compared with conventional dilatation and sharp curettage and electric vacuum aspiration in surgical treatment of miscarriage: a randomized controlled trial. BMC Pregnancy Childbirth, 16;20(1), 695.

Kulier, R., Kapp, N., Gulmezoglu, A. M., Hofmeyr, G. J., Cheng, L., & Campana, A. (2011). Medical methods for first trimester abortion. Cochrane Database of Systematic Reviews, 9(11).

Neilson, J. P., Gyte, G. M., Hickey, M., Vazquez, J. C., & Dou, L. (2013). Medical treatments for incomplete miscarriage. Cochrane Database of  Systematic Reviews, 28(3).

Sekiguchi, A., Ikeda, T., Okamura, K., & Nakai, A. (2015). Safety of induced abortions at less than 12 weeks of pregnancy in Japan. International Journal of Gynecology & Obstetrics, 129(1), 54-57.

Tuncalp, O., Gulmezoglu, A. M., & Souza, J. P. (2010). Surgical procedures for evacuating incomplete miscarriage. Cochrane Database of Systemtatic Reviews, 8(9).

World Health Organization. (2022). Abortion Care Guideline. Geneva: World Health Organization.