What is a curettage/vacuum aspiration and is it necessary after medical abortion?
Vacuum aspiration or curettage or dilation and curettage (D&C) is a surgical intervention to remove the contents of the uterus. Sometimes this treatment is necessary if there are complications after medical abortion or spontaneous miscarriage.
However in some countries doctors are accustomed to performing a curettage even though it might not be needed for medical reasons.
You do NOT need a vacuum aspiration if the ultrasound shows that there are still some small remains in the uterus (incomplete abortion) or experience some bleeding after 3 weeks AND you do not have any complaints like pain, fever or heavy bleeding. Small remains in the uterus can be treated with an extra doses of Misoprostol (2 tablets) or you can just wait until your next menstruation. The uterus will most likely empty itself. Regular menstruation comes back 4 to 6 weeks after a medical abortion. After a normal menstruation you should not have any remaining tissue left over in the uterus.
However, in case you do have complaints like fever, persistent pain and heavy bleeding, a surgical intervention called vacuum aspiration is needed. Some doctors still only do a procedure called D&C or sharp curettage. This should not be done!! So ask the doctor what kind of procedure she/he uses because they should perform a vacuum aspiration and not a sharp curettage or D&C (vacuum aspiration is less painful and has less risks).
All procedures should be done under local or general anaesthesia!
More scientific information:
According to the World Health Organization “If the woman is well, neither prolonged bleeding nor the presence of tissue in the uterus (as detected by ultrasound) is an indication for surgical intervention. Remaining products of conception will be expelled during subsequent vaginal bleeding. Surgical evacuation of the uterus may be carried out on the woman’s request or if the bleeding is heavy or prolonged, or causes anaemia, or if there is evidence of infection”. 63 68
If there are remains in the uterus showed by ultrasound but you feel well, the best is to wait still some weeks. If you start to observe signs of complications, you should go back to the doctor immediately. Read in this article "How do you know if you have a complication and what should you do?"
Dilatation and curettage should be used only in case of diagnosed complications and only if vacuum aspiration is not available. Vacuum aspiration is a newer and much safer surgical method and you should always ask for it if you are given a choice between vacuum aspiration and curettage. 77 78 84 85 93 94 95 101 103