Randomised Trial of Oral Misoprostol Versus Manual Vacuum Aspiration for the Treatment of Incomplete Abortion at a Nigerian Tertiary Hospital.

OBJECTIVES: This study aimed to compare the efficacy of oral misoprostol with manual vacuum aspiration (MVA) in first trimester incomplete abortions. METHODS: This randomised controlled trial study was conducted at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between April 2014 and November 2015. Pregnant women who presented with clinical features of incomplete abortion at a gestational age of 13 weeks or less were included. Patients who had profuse vaginal bleeding, an intrauterine device in situ, signs of pelvic infections or who were younger than 18 years old and had no accompanying adults to give informed consent were excluded. A total of 200 participants were randomly and equally allocated to either the MVA or misoprostol treatment group. The treatment group were given 600 µg of misoprostol orally. The primary outcome measure was complete uterine evacuation, while secondary outcome measures included the need for additional surgical evacuation for failed treatment, adverse effects/complications, acceptability of and satisfaction with the treatment. RESULTS: Both misoprostol and MVA had high complete evacuation rates, yet MVA was significantly higher (99% versus 83%, relative risk [RR]: 0.84, confidence interval [CI]: 0.766-0.918; P <0.001). Significantly more women in the misoprostol group required additional MVA for failed treatment than in the MVA treatment group (17% versus 1%, RR: 16.67, CI: 2.260-12.279; P <0.001). No significant difference was found between the misoprostol and MVA treatment groups in terms of satisfaction (92.7% versus 89.8%, RR: 1.04, CI: 0.946-1.127; P = 0.473). CONCLUSION: Treatments with misoprostol and MVA had high complete uterine evacuation rates, as well as high rates of acceptability and satisfaction. However, MVA had a significantly higher complete evacuation rate than misoprostol.

Early surgical abortion: safe and effective.

OBJECTIVES: To evaluate patients' characteristics and complications of surgical abortion performed at an early gestation, compared to later gestations. METHODS: A total of 4310 women with unintended pregnancies attending the family planning unit of a government maternity hospital in Konya, Turkey, were included retrospectively. Abortions were carried out from 6 weeks' up to 10 weeks gestation. RESULTS: The gestational age in 62% of the cases was between 6 weeks and 6 weeks + 6 days. Only 8.5% of the 4310 women had used a modern contraceptive method, and 16% had had a surgical abortion for an unplanned pregnancy previously. These women were younger, had more siblings, and a shorter time had elapsed since their last pregnancy when compared to women who never had an abortion. There were four failures (0.09%). The rate of retained products of conception (RPCs) was 1.9% in women aborted between six and six (+ 6) weeks' gestation, and 6.2% (p < 0.001) in those aborted later. Women who had had a surgical abortion previously more often had RPCs than those who never had (16% vs. 1%, respectively, p < 0.001). Of the 151 women with RPCs, 65 (43%) had been using an intrauterine device prior to surgical abortion. CONCLUSION: Early surgical abortion (at six-six(+ 6) weeks' gestation) generates few complications. Delaying surgical abortion until a somewhat later gestation causes complication rates (particularly RPCs) to increase.

Evaluation of nurse providers of comprehensive abortion care using MVA in Nepal.

BACKGROUND: Although Nepal's maternal mortality ratio has fallen over the past decade, unsafe abortion remains a leading cause of maternal morbidity and mortality. A key strategy for improving access to safe abortion services is to train mid-level providers such as nurses in comprehensive abortion care (CAC). The Family Health Division of the Nepal Ministry of Health trained an initial cohort of 96 nurses to provide first trimester CAC services using manual vacuum aspiration (MVA) between September 2006 and July 2009. This study evaluates the acceptability and quality of CAC services provided by trained nurses in Nepal. METHODS: Five assessments were used to evaluate post-training service provision on CAC: facility logbooks registry, nurse provider interviews, facility assessments, facility manager interviews and procedure observation checklists. Ninety-two nurses from 50 facilities participated in the evaluation. Descriptive statistics are reported. RESULTS: Overall, 5,600 women received CAC services from 42 facilities where nurses were providing services between June 2009 and April 2010. Complications were experienced by 68 surgical abortion clients (1.6%) and 12 medical abortion clients (1.2%). All nurses reported that clients were happy to receive care from them, and 67% of facility managers reported that clients preferred nurse providers over physicians or had no preference. Facility managers and nurses reported a need for additional support, including further training and improved drug and equipment supply. CONCLUSIONS: Trained nurses provide high quality CAC services in Nepal. Additional support in the form of facilitative supervision and training should be considered to strengthen CAC service provision.

Endometrial aspiration cytology by various techniques.

The demand for testing endometrium for detecting pathological as well as hormonal status is increasing and cytodiagnosis is extended very rapidly in malignant and non-malignant conditions. The gynaecologists have responded to this trend by providing cost effective care without compromising the quality. With this in mind, uterine aspiration curettage, ambulatory procedure, for endometrial sampling was studied. Dilatation and curettage (D&C) is probably most commonly performed gynaecological surgery. It accounts for large proportion of hospital bed use and operating room time, the cost is significant and patient also risks the complication of anaesthesia. Consequently various alternative procedures for endometrial sampling like endometrial brush, uterine lavage, jet wash vabra aspiration and endometrial biopsy have been reported.

Efficacy of Shirodkar cervical suture in securing hemostasis following surgical evacuation of Cesarean scar ectopic pregnancy.

OBJECTIVES: To assess the efficacy of a Shirodkar cervical suture in arresting hemorrhage following surgical removal of a Cesarean scar ectopic pregnancy. METHODS: The study included women with an ultrasound diagnosis of Cesarean scar ectopic pregnancy who were scheduled for surgical evacuation. After administration of general anesthetic, a Shirodkar cervical suture was inserted using the standard surgical technique. The suture was left untied and the Cesarean scar pregnancy was evacuated under ultrasound guidance using suction curettage. Once the pregnancy had been successfully removed, the suture was tied and 500 microg ergometrine was administered intravenously to ensure uterine contraction. The patients were prescribed prophylactic antibiotics and the suture was removed 7 days later in the outpatient setting, under local anesthetic. RESULTS: Over a 4-year period a total of 33 Cesarean scar pregnancies were diagnosed, and 28 (85%) had surgical evacuation. A cervical suture was necessary to achieve hemostasis in 22/28 (79%; 95% CI, 64-94) cases. In the remaining 6/28 (21%; 95% CI, 6-36) cases, the bleeding was minimal and the suture was not tied. The median estimated intraoperative blood loss was 50 (range, 50-1500) mL. Six of 28 (21%; 95% CI, 6-36) women suffered blood loss > or = 300 mL and two (7%; 95% CI, 0-17) required blood transfusion. One woman (5%; 95% CI, 0-14) required repeat surgery because of retained products of conception. There were no other significant complications and the uterus was preserved successfully in all cases. CONCLUSIONS: Insertion of a Shirodkar cervical suture during the evacuation of a Cesarean scar pregnancy is an effective method for securing hemostasis; it minimizes the need for blood transfusion and ensures preservation of fertility.

[Comparative study of manual vacuum aspiration and uterine curettage for treatment of abortion]. / Tratamento do abortamento incompleto por aspiração manual ou curetagem.

OBJECTIVES: To compare manual vacuum aspiration (MVA) and uterine curettage (D and C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. RESULTS: Groups were similar regarding gestational age (9.93 +/- 2.40 vs 9.73 +/- 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 +/- 4.80 vs 22.68 +/- 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D and C group (p = 0.02). CONCLUSION: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments.

Tratamento do abortamento incompleto por aspiração manual ou curetagem / Comparative study of manual vacuum aspiration and uterine curettage for treatment of abortion

OBJETIVOS: Comparar aspiração manual intra-uterina (AMIU) com curetagem uterina (D&C) em abortamentos no primeiro trimestre no que se refere a eficiência para eliminar restos ovulares do método de aspiração manual intra-uterina com a dilatação e curetagem, ocorrência de complicações (perfuração uterina, laceração cervical, hemorragia pós-tratamento), tempo duração dos procedimentos e tempo de internação das pacientes. MÉTODOS: Cinqüenta pacientes no grupo AMIU e 50 pacientes no grupo D&C foram incluídas prospectivamente de maneira aleatória. Critérios de inclusão: abortamento espontâneo, idade gestacional de até 13 semanas, colo pérvio, espessura endometrial maior que 15 mm, estado afebril, hemoglobina superior a 10 g/dl. Amostras sangüíneas foram colhidas antes e após os procedimentos cirúrgicos para controle dos níveis de hemoglobina; anestesia foi realizada em todos os casos. O tempo para realização de cada procedimento cirúrgico foi cronometrado. RESULTADOS: Os grupos eram semelhantes quanto à idade gestacional (9,93±2,40; 9,73±2,58, p 0,71), espessura endometrial antes da cirurgia (22,14±4,80; 22,68±5,68, p 0,65). Não foram observadas complicações cirúrgicas ou anestésicas em nenhum grupo. Os tempos de realização do procedimento e internação foram significativamente menores nas pacientes do grupo AMIU (3,71; 10,18 min, p < 0,001) (14,18; 23,06 h, p 0,03). O decréscimo nos níveis de hemoglobina após o procedimento cirúrgico foi maior no grupo D&C (p= 0,02). CONCLUSÃO: A AMIU possibilita menor perda sangüínea, requer menor tempo de realização do procedimento e menor tempo de internação hospitalar. Entretanto, ambos os procedimentos cirúrgicos mostraram-se eficientes para o tratamento de abortamentos incompletos no primeiro trimestre da gestação, não havendo complicações após a realização dos tratamentos.

OBJECTIVES: To compare manual vacuum aspiration (MVA) and uterine curettage (D&C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. RESULTS: Groups were similar regarding gestational age (9.93 ± 2.40 vs 9.73 ± 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 ± 4.80 vs 22.68 ± 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D&C group (p = 0.02). CONCLUSION: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments.

Expectant, medical, or surgical management of first-trimester miscarriage: a meta-analysis.

OBJECTIVE: To quantify the relative benefits and harms of different management options for first-trimester miscarriage. DATA SOURCES: MEDLINE, EMBASE, and Cochrane Controlled Trials Register searches (1966 to July 2004), including references of retrieved articles. METHODS OF STUDY SELECTION: Randomized trials assigning women with first-trimester missed or incomplete miscarriage to surgical, medical, or expectant management were included. Primary outcomes were successful treatment and patient satisfaction. Secondary outcomes included moderate or severe bleeding, blood transfusion, emergency curettage, pelvic inflammatory disease, nausea, vomiting, and diarrhea. Comparisons used the risk difference. Between-study heterogeneity and random effects summary estimates were calculated. TABULATION, INTEGRATION, AND RESULTS: Complete evacuation of the uterus was significantly more common with surgical than medical management (risk difference 32.8%, number needed to treat 3, success rate of medical management 62%) and with medical than expectant management (risk difference 49.7%, number needed to treat 2). Success rate with expectant management was spuriously low (39%) in the latter comparison. Analysis of cases with incomplete miscarriage only showed that medical management still had two thirds the chance to induce complete evacuation compared with surgical management, but it was better than expectant management. Data from studies that evaluated outcome at 48 hours or more after allocation indicated again that medical management had a better success rate than expectant management but a worse success rate than surgical management; expectant management probably had much lower success rates than surgical evacuation, but data were very sparse. Patient satisfaction data were sparse. Moderate or severe bleeding was less common with medical than expectant management (risk difference 3.2%) and possibly surgical management (risk difference 2.1%). There was a considerable amount of missing information, in particular for secondary outcomes. CONCLUSION: One additional success can be achieved among 3 women treated surgically rather than medically. Expectant management has had remarkably variable success rates across these studies, depending probably on the type of miscarriage. Greater standardization of outcomes should be a goal of future research.

Safe abortion: WHO technical and policy guidance.

In 2003, the World Health Organization published its well referenced handbook Safe Abortion: Technical and Policy Guidance for Health Systems to address the estimated almost 20 million induced abortions each year that are unsafe, imposing a burden of approximately 67 thousand deaths annually. It is a global injustice that 95% of unsafe abortions occur in developing countries. The focus of guidance is on abortion procedures that are lawful within the countries in which they occur, noting that in almost all countries, the law permits abortion to save a woman's life. The guidance treats unsafe abortion as a public health challenge, and responds to the problem through strategies concerning improved clinical care for women undergoing procedures, and the appropriate placement of necessary services. Legal and policy considerations are explored, and annexes present guidance to further reading, international consensus documents on safe abortion, and on manual vacuum aspiration and post-abortion contraception.

Triaging patients with post-abortion complications: a prospective study in Nepal.

The first manual vacuum aspiration (MVA) services unit in Nepal was established in 1995 at the country's largest national maternity hospital in Kathmandu. This research sought to assess and evaluate the safety, acceptability, and effectiveness of MVA services. This prospective study was conducted during 12 months in 1998, and follow-up was made at six weeks. Two groups of patients were compared: 529 patients treated in the MVA unit and 236 patients who were clinically eligible for treatment in the MVA unit but were treated instead in the main operation theatre (OT) owing to the unavailability of services in the MVA unit during the hours of their admission. The two groups differed with respect to some of their background characteristics but were similar in their clinical characteristics. The MVA group received contraceptive counselling and services and had significantly shorter stays in hospital. However, the direct cost incurred by the patients, regardless of the type of facility they used, was about the same. Follow-up at six weeks revealed that the MVA patients had significantly fewer complaints and were generally more satisfied with the services they had received than their counterparts. Slightly more than half of the women in the MVA group were using contraception at the time of follow-up compared to no women in the OT group. It is concluded that the MVA unit provided safe, effective, and efficient services to about 50% of all the patients admitted to the hospital with post-abortion complications. An additional 25% of the post-abortion patients could be served if the unit were kept open 24 hours a day, saving resources and time for patients and hospital staff. As a parallel development, both MVA and main OT services would need to be more effectively integrated with outside antenatal and family-planning clinics to address the reproductive health needs of women, thereby reducing the number of patients requiring post-abortion care.

Early surgical abortion: efficacy and safety.

OBJECTIVE: Because of concern over the higher rates of failed abortion, many clinicians defer surgical abortion until 7 menstrual weeks or later. We conducted this study to evaluate the efficacy and safety of early surgical abortions that are performed by numerous physicians in a community-based setting. STUDY DESIGN: We prospectively gathered data on all eligible patients who had surgical abortions at <6 weeks of gestation at 3 Planned Parenthood clinics from January 1, 1998, to August 31, 2000. Outcomes were evaluated with the use of proportions with 95% CI and chi(2) analysis. RESULTS: A total of 1132 women had early surgical abortions during the study interval, and follow-up was available for 750 of those women (66%). Seventeen women (2.3%; 95% CI, 1.4%, 3.7%) had failed attempted abortions. Other complications occurred in 13 women. CONCLUSION: Early surgical abortion is safe and effective. In this series, the frequency of complications that required curettage was similar to that reported with mifepristone and vaginal misoprostol.

Factors influencing the detection of uterine cancer by suction curettage and endometrial brushing.

OBJECTIVE: To analyze the factors that influence the detection of uterine cancers by Pipelle and Tao Brush endometrial sampling devices. STUDY DESIGN: Seventy-nine Pipelle currettages were followed by Tao Brush sampling. The curettage specimens were fixed in formalin for histology and reported by surgical pathology, whereas the Tao Brush specimens were fixed in CytoRich Red for histology and cytology and reported by cytopathology. Uterine size and features of residual tumors were obtained from hysterectomy reports. Follow-up for clinically benign cases ranged from 16 to 52 months (mean, 33.7; median, 34). RESULTS: There were 10 uterine cancers and 9 hysterectomies. Five cases of centrally located adenocarcinoma, ranging from 0.4 to 3 cm, were detected by both samplers. Additionally, a Tao Brush sampled an adenocarcinoma located near the cornu. An endometrial stromal sarcoma found with a Tao Brush was reported as necrotic tissue by Pipelle. Both samplers missed a microscopic focus of adenocarcinoma, an in situ adenocarcinoma in a polyp and a large leiomyosarcoma. CONCLUSION: The size and type of tumor and its location within the uterine cavity, the mechanism of sampling and preparation method influence the detection of uterine cancer by the Pipelle and Tao Brush.

Interchangeability of gas detection tubes and hand pumps.

Users of gas detection tubes occasionally seek the convenience of using a single hand pump with different brands of tubes, to avoid the need to carry more than one pump. Several professional organizations recommend against such interchange. However, these recommendations appear to be based on a single study of pump designs that mostly are no longer in use. The present study was undertaken to determine if current hand pumps are interchangeable. Both piston-type and bellows-type hand pumps were evaluated by comparing pump flow profiles and test gas measurements with a variety of tubes. The results demonstrate that three piston hand pumps in common use (Sensidyne/Gastec GV/100, RAE Systems LP-1200, and Matheson-Kitagawa 8104-400A) are fully interchangeable. Two bellows pumps (Draeger Accuro and MSA Kwik-Draw) also are interchangeable with each other. Mixing of bellows and piston systems is often possible, but there are enough exceptions to conclude that such practice should be discouraged because it can give inaccurate readings. It is recommended that technical standards be adopted, such as total volume and an initial pump vacuum or a pump flow curve, to assess hand pump interchangeability. When two manufacturers' pumps meet the same standard and routine leak tests are conducted, interchangeability is scientifically valid and poses no risk to the end user while offering greater convenience.

Improving abortion care in Zambia.

PIP: In this commentary, the impact of the introduction of manual vacuum aspiration (MVA) for incomplete abortion patients and for early uterine evacuation is discussed for the University Teaching Hospital in Lusaka, Zambia. This 3-year training and service delivery program was begun in 1988 after it was clear that 15% of maternal deaths were due to illegally induced abortion. The prior procedure of dilation and curettage (D and C) required use of the main operating room and general anesthesia, which resulted in severe congestion and treatment delays. As a result of the new MVA procedure, congestion has decreased substantially, treatment is safer and more timely, and the staff's ability to provide abortions has increased. Family planning counseling is provided to postabortion patients in a more thorough fashion, and the savings in time has improved the quality of patient-staff interactions. Specifically, the patient flow has improved from a 12-hour wait to a 4-6 hour wait and rarely requires overnight hospitalization. The demand for the main operating room had decreased which frees space, time, and commodities for other gynecological treatment. The shorter procedure and release time means a minimal loss of earnings and productivity, and allows for greater privacy in explaining absences to families, schools, or employers. The improved quality of are is reflected in the figures for number treated, i.e., in 1989, 74% were treated with MVA for incomplete abortion 12 weeks and pregnancy termination 8 weeks compared with 26% treated with D and C. In 1990, the figures were 86% with MVA and 14% with D and C. The likelihood of complications from hemorrhage and sepsis have also been reduced. The MVA procedure is also less traumatic for the patient. The increased access to safe legal abortion services is reflected in the ratio of induced to incomplete abortions between 1988-1990 (1:25 to 1:5). Family planning counseling is provided by a full-time counselor who counsels preabortion and postabortion and schedules 2-week follow-up appointment. These achievements have been made in spite of a declining economy and difficulties in the health sector. Unfortunately, conditions throughout Zambia are such that access to safe abortion is restricted. Effort is underway to expand this MVA training and service delivery in provincial hospitals and to conduct research on other effective strategies to reduced unsafe abortion and improve family planning care.^ieng

Suction curettage with a tissue trap compared with sharp curettage for tissue sampling.

Recent reports have shown that various endometrial sampling techniques are comparable to each other. This study showed that suction curettage utilizing tissue traps is superior to sharp curettage in terms of adequacy of sampling. The results show that adequate tissue was obtained in all 114 cases, regardless of which type of curettage was utilized first. However, when sharp curettage was the second procedure, only 43 of 57 procedures yielded adequate tissue, whereas when suction curettage was the second procedure, 56 of 57 procedures yielded adequate tissue. Suction curettage utilizing tissue traps was more thorough than sharp curettage.

Pathologic features of sharp curettings in complete hydatidiform mole. Predictors of persistent gestational trophoblastic disease.

The medical records and pathologic specimens were reviewed from 33 patients with complete molar pregnancy at Brigham and Women's Hospital between 1980 and 1989. Two pathologists (D.R.G. and R.W.R.) reviewed all slides from the original sharp curettage to identify pathologic features that may be associated with persistent gestational trophoblastic tumor (GTT). The pathologic features evaluated were implantation site, presence of myometrium, presence of villi, presence and degree of atypia in cytotrophoblast, syncytiotrophoblast and intermediate trophoblast, presence of fibrinoid, presence of implantation site inflammatory cells, volume of tissue and area of trophoblastic tissue. Only one pathologic feature, fibrinoid deposits, identified in sharp curettings was associated with the development of persistent GTT. While 12 (48%) of 25 patients who attained remission without chemotherapy had fibrinoid deposits, only 1 (12.5%) of 8 patients who developed persistent GTT had them (P less than .10).

Assessment of the manual vacuum aspiration (MVA) equipment in the management of incomplete abortion.

In a study to assess the efficacy of and safety of vacuum aspiration syringe in the management of incomplete abortion 300 patients with non septic abortion were evacuated by the method in the ward. A control group 285 patients was evacuated in theatre by sharp currettage. All patients were followed up for 21 days. 54.7% of the study patients were evacuated without any need for analgesia while all the control patients were given intravenous pethidine and valium. 2.3% of vacuum aspiration and 3.5% of control patients needed revacuation (p greater than 0.05). 70.3% of vacuum aspiration cases were dry by day 7 compared to 64.6% of the control group (p greater than 0.05). Immediate complications of nausea and vomiting were seen in 5.3% study patients (p less than 0.001). There was one uterine perforation in the control group. 5.4% of study and 6.0 of control patients developed mild to severe sepsis (p greater than 0.05). Vacuum aspiration is a safe, simple and quick method of treating incomplete abortion. Its wider use in developing countries is highly recommended.

Evaluation of the Pipelle curette for endometrial biopsy.

The Pipelle endometrial suction curette was evaluated, and its application and effectiveness were compared to those of the Novak curette for endometrial sampling during the midluteal phase. Fifty women underwent an endometrial biopsy with the Pipelle and Novak curettes. Ninety percent of the women preferred the biopsy with the Pipelle. Histologically, tissue obtained with the Pipelle was satisfactory and similar to that with the Novak. The Pipelle curette appears to be an excellent device for midluteal endometrial biopsy during an infertility evaluation.

Vacuum aspiration: an efficient outpatient screening technic for endometrial disease.

In an effort to find a safe, efficient, and inexpensive means of ruling out the existence of a neoplastic process causing abnormal vaginal bleeding form the uterine cavity, 103 patients over 34 years of age had preoperative aspiration (Vabra aspirator) of the endometrial cavity. The tissue obtained at the time of D&C and hysterectomy was correlated with that obtained by the outpatient diagnostic procedure. In this pilot study, the aspirator was 98% accurate in evaluating high-risk women with abnormal uterine bleeding for malignant disease. In the two neoplasms missed, both women had had a recent D&C.