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Manual Vacuum Aspiration
Vacuum or suction aspiration is a procedure that uses a vacuum source to remove an embryo or fetus through the cervix. The procedure is performed to induce abortion, as a treatment for incomplete spontaneous abortion (otherwise commonly known as miscarriage) or retained fetal and placental tissue, or to obtain a sample of uterine lining (endometrial biopsy). It is generally safe, and serious complications rarely occur. Some sources may use the terms ''dilation and evacuation'' or "suction" ''dilation and curettage'' to refer to vacuum aspiration, although those terms are normally used to refer to distinctly different procedures. History Vacuuming as a means of removing the uterine contents, rather than the previous use of a hard metal curette, was pioneered in 1958 by Drs Wu Yuantai and Wu Xianzhen in China, but their paper was only translated into English on the fiftieth anniversary of the study which would ultimately pave the way for this procedure becoming exceedingly common. ...
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Abortion
Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word ''abortion'' generally refers to an induced abortion. The reasons why women have abortions are diverse and vary across the world. Reasons include maternal health, an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest. When properly done, induced abortion is one of the safest procedures in medicine. In the United States, the risk of maternal mortality is 14 times lower after induced abortion than after chi ...
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Suction
Suction is the colloquial term to describe the air pressure differential between areas. Removing air from a space results in a pressure differential. Suction pressure is therefore limited by external air pressure. Even a perfect vacuum cannot suck with more pressure than is available in the surrounding environment. Suctions can form on the sea, for example, when a ship founders. When the pressure in one part of a physical system is reduced relative to another, the fluid in the higher pressure region will exert a force relative to the region of lowered pressure, referred to as pressure-gradient force. Pressure reduction may be static, as in a piston and cylinder arrangement, or dynamic, as in the case of a vacuum cleaner when air flow results in a reduced pressure region. When animals breathe, the diaphragm and muscles around the rib cage cause a change of volume in the lungs. The increased volume of the chest cavity decreases the pressure inside, creating an imbalance with t ...
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Chorionic Villi
Chorionic villi are villi that sprout from the chorion to provide maximal contact area with maternal blood. They are an essential element in pregnancy from a histomorphologic perspective, and are, by definition, a product of conception. Branches of the umbilical arteries carry embryonic blood to the villi. After circulating through the capillaries of the villi, blood returns to the embryo through the umbilical vein. Thus, villi are part of the border between maternal and fetal blood during pregnancy. Structure Villi can also be classified by their relations: * Floating villi float freely in the intervillous space. They exhibit a bi-layered epithelium consisting of cytotrophoblasts with overlaying syncytium ( syncytiotrophoblast). * Anchoring (stem) villi stabilize mechanical integrity of the placental-maternal interface. Development The chorion undergoes rapid proliferation and forms numerous processes, the chorionic villi, which invade and destroy the uterine decidua and a ...
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Decidua
The decidua is the modified mucosal lining of the uterus (that is, modified endometrium) that forms every month, in preparation for pregnancy. It is shed off each month when there is no fertilised egg to support. The decidua is under the influence of progesterone. Endometrial cells become highly characteristic. The decidua forms the maternal part of the placenta and remains for the duration of the pregnancy. After birth the decidua is shed together with the placenta. Structure The part of the decidua that interacts with the trophoblast is the ''decidua basalis'' (also called ''decidua placentalis''), while the ''decidua capsularis'' grows over the embryo on the luminal side, enclosing it into the endometrium. The remainder of the decidua is termed the ''decidua parietalis'' or ''decidua vera'', and it will fuse with the decidua capsularis by the fourth month of gestation. Three morphologically distinct layers of the decidua basalis can then be described: * Compact outer laye ...
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Fetus
A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal development begins from the ninth week after fertilization (or eleventh week gestational age) and continues until birth. Prenatal development is a continuum, with no clear defining feature distinguishing an embryo from a fetus. However, a fetus is characterized by the presence of all the major body organs, though they will not yet be fully developed and functional and some not yet situated in their final anatomical location. Etymology The word ''fetus'' (plural ''fetuses'' or '' feti'') is related to the Latin '' fētus'' ("offspring", "bringing forth", "hatching of young") and the Greek "φυτώ" to plant. The word "fetus" was used by Ovid in Metamorphoses, book 1, line 104. The predominant British, Irish, and Commonwealth spelling is '' ...
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Embryo
An embryo is an initial stage of development of a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male sperm cell. The resulting fusion of these two cells produces a single-celled zygote that undergoes many cell divisions that produce cells known as blastomeres. The blastomeres are arranged as a solid ball that when reaching a certain size, called a morula, takes in fluid to create a cavity called a blastocoel. The structure is then termed a blastula, or a blastocyst in mammals. The mammalian blastocyst hatches before implantating into the endometrial lining of the womb. Once implanted the embryo will continue its development through the next stages of gastrulation, neurulation, and organogenesis. Gastrulation is the formation of the three germ layers that will form all of the different parts of the body. Neurulation forms the nervous ...
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Vacuum
A vacuum is a space devoid of matter. The word is derived from the Latin adjective ''vacuus'' for "vacant" or "void". An approximation to such vacuum is a region with a gaseous pressure much less than atmospheric pressure. Physicists often discuss ideal test results that would occur in a ''perfect'' vacuum, which they sometimes simply call "vacuum" or free space, and use the term partial vacuum to refer to an actual imperfect vacuum as one might have in a laboratory or in space. In engineering and applied physics on the other hand, vacuum refers to any space in which the pressure is considerably lower than atmospheric pressure. The Latin term ''in vacuo'' is used to describe an object that is surrounded by a vacuum. The ''quality'' of a partial vacuum refers to how closely it approaches a perfect vacuum. Other things equal, lower gas pressure means higher-quality vacuum. For example, a typical vacuum cleaner produces enough suction to reduce air pressure by around 20%. But hig ...
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Uterus
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment. In the human, the lower end of the uterus, is a narrow part known as the isthmus that connects to the cervix, leading to the vagina. The upper end, the body of the uterus, is connected to the fallopian tubes, at the uterine horns, and the rounded part above the openings to the fallopian tubes is the fundus. The connection of the uterine cavity with a fallopian tube is called the uterotubal junction. The fertilized egg is carried to the uterus along the fallopian tube. It will have divided on its journey to form a blastocyst that will implant itself into the lining of the uterus – the endometrium, where it will ...
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Cannula
A cannula (; Latin meaning 'little reed'; plural or ) is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples. In simple terms, a cannula can surround the inner or outer surfaces of a trocar needle thus extending the effective needle length by at least half the length of the original needle. Its size mainly ranges from 14 to 24 gauge. Different-sized cannula have different colours as coded. Decannulation is the permanent removal of a cannula (extubation), especially of a tracheostomy cannula, once a physician determines it is no longer needed for breathing. Medicine Cannulas normally come with a trocar inside. The trocar is a needle, which punctures the body in order to get into the intended space. Many types of cannulas exist: Intravenous cannulas are the most common in hospital use. A variety of cannulas are used to establish cardiopulmonary bypass in cardiac surgery. A nasal cannula is a piece of plastic tu ...
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Osmotic Dilator
Osmotic dilators are medical implements used to dilate the uterine cervix by swelling as they absorb fluid from surrounding tissue. They may be composed of natural or synthetic materials. A laminaria stick or tent is a thin rod made of the stems of dried ''Laminaria'', a genus of kelp. Laminaria sticks can be generated from ''Laminaria japonica'' and ''Laminaria digitata''. Synthetic osmotic dilators are commonly referred to by their brand names, such as Dilapan. Dilapan-S are composed of polyacrylonitrile, a plastic polymer. The hygroscopic nature of the polymer causes the dilator to absorb fluid and expand. Use in obstetrics and gynecology Osmotic dilators are most commonly used to slowly dilate and soften the cervix prior to surgical abortion, a process referred to as cervical preparation. Adequate cervical preparation is important prior to surgical abortions because it helps to prevent complications of dilation and evacuation (D&E), such as laceration of the cervix. Cervical ...
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Paracervical Block
A paracervical block is an anesthetic procedure used in obstetrics and gynecology, in which a local anesthetic is injected into between two and six sites at a depth of 3–7 mm alongside the vaginal portion of the cervix in the vaginal fornices. It is used for various obstetric and gynecologic procedures, such as hysteroscopy and vacuum aspiration. It is as efficient as intracervical block, according to a study on women undergoing vacuum aspiration with lidocaine as anesthetic agent. Addition of ketorolac Ketorolac, sold under the brand names Toradol, and Biorolac among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain. Specifically it is recommended for moderate to severe pain. Recommended duration of treatment is less ... may offer added benefit of improved pain control. References {{reflist Further reading paracervical block Obstetrical procedures Female genital procedures Regional anesthesia ...
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