title: Morbidity of first trimester aspiration termination and the seniority of the surgeon.
abstract: Vacuum aspiration is a safe, acceptable, and efficacious method of first trimester pregnancy termination. The success and complication rates are thought to be partially dependent on operator experience and gestation. We examined this further by studying the outcome of 828 consecutive surgical abortions up to 13 weeks gestation in our hospital. The following outcomes were measured: surgical curettage for presumed retained products of conception; continuing pregnancy; uterine perforation; pelvic sepsis requiring intravenous antibiotics; and blood transfusion required. The complete abortion rate was 94.6% and the rate of continuing pregnancy 0.24%. There was a significant relationship between efficacy and seniority of the surgeon; consultants, senior registrars, registrars, and senior house officers had complete abortion rates of 97.8, 92.8, 94.7, and 88.4% respectively (P = 0.039). Parity did not affect efficacy. Terminations at 12-13 weeks gestation were associated with a significantly lower complete abortion rate. The rates of uterine perforation, blood transfusion, pelvic sepsis requiring intravenous antibiotics, and overnight hospital admission were 0.24, 0, 0.97, and 1.69% respectively. Thus, the only significant factors affecting outcome of surgical abortion are grade of operating surgeon or terminations performed at later gestations of 12-13 weeks. It is vital that physicians performing surgical terminations are adequately trained.
authors.affiliation: Department of Obstetrics and Gynaecology, Women's Centre, Oxford Radcliffe Hospitals NHS Trust, Headington, Oxford OX3 9DU, UK. tim.child@muhc.mcgill.ca
authors.forename: T J
authors.initials: TJ
authors.lastname: Child
authors.forename: J
authors.initials: J
authors.lastname: Thomas
authors.forename: M
authors.initials: M
authors.lastname: Rees
authors.forename: I Z
authors.initials: IZ
authors.lastname: MacKenzie
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003475:Curettage; D005260:Female; D005865:Gestational Age; D006801:Humans; D008875:Middle Aged; D009774:Obstetrics; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy / Q000453:epidemiology; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011361:Professional Competence; D014595:Uterine Perforation / Q000453:epidemiology / Q000209:etiology; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents