OG9.3 | Early Pregnancy Evacuation — Summary & Reflection

KEY TAKEAWAYS

Early pregnancy evacuation is indicated for incomplete, inevitable, missed, and septic abortion, and for MTP in accordance with the MTP Act 2021 (up to 20 weeks: one RMP; 20–24 weeks: two RMPs for specified categories; >24 weeks: State Medical Board for substantial fetal abnormality). The WHO recommends medical abortion (mifepristone 200 mg + misoprostol 800 µg vaginal, up to 63 days LMP) or MVA (first-line surgical, up to 13 weeks) over sharp curettage. MVA technique: bimanual exam → cervical priming if needed → paracervical block → tenaculum → sound → Hegar dilatation → Karman cannula + syringe → evacuation by rotation. Complete evacuation is confirmed by: uterus gripping cannula (gritty feel), foam in syringe, chorionic villi in the bowl, and USG showing an empty cavity. No villi after 6 weeks = suspect ectopic — urgent β-hCG and TVS. Complications include perforation (clear fluid, loss of resistance → stop), haemorrhage (re-evacuation + uterotonics), infection (antibiotics ± re-evacuation), and Asherman syndrome (late — from repeated sharp curettage). Anti-D immunoglobulin is mandatory for all Rh-negative women: 50 µg for <12 weeks, 300 µg for ≥12 weeks, within 72 hours.

REFLECT

You have observed your first MVA procedure. The patient, a 20-year-old, lay still throughout, signed the consent form quickly, and did not ask any questions. After the procedure she seemed relieved. Reflect on: What would you have wanted to know if you were the patient, that she did not ask? How is the standard of informed consent for an MTP procedure different from informed consent for elective surgery? What role do you, as a junior doctor, play in ensuring that a woman asking for a termination has made a genuinely informed and voluntary choice? What would you do if you suspected she was being coerced? And practically — the next time you observe this procedure, what specific step will you watch most carefully, and why?