Is ward evacuation for uncomplicated incomplete abortion under systemic analgesia safe and effective? A randomised...

To compare evacuation under systemic analgesia (fentanyl and midazolam) in a treatment room (ward group) with evacuation under general anaesthesia in theatre.

A prospective randomised clinical trial.

A tertiary medical centre serving a black urban population.

One hundred and forty-two patients with uncomplicated incomplete abortions.

Randomisation into two groups, those for evacuation under systemic analgesia and those for evacuation under general anaesthesia.

Both groups were compared in terms of safety, efficacy, acceptability, blood consumption and time delay between admission and evacuation.

Significantly less blood was used in the ward group (37 units for 13 patients) than in the theatre group (65 units for 24 patients) (P < 0.03). Significantly less time was taken between admission and evacuation in the ward group (median 7 hours 15 minutes) than in the theatre group (median 12 hours 38 minutes) (P < 0.0003). Evacuation under fentanyl and midazolam was safe, effective and acceptable for the majority of patients compared with evacuation under general anaesthesia.

Patients with uncomplicated incomplete abortions (uterine size equivalent to a pregnancy of 14 weeks' duration or less) can undergo evacuation safely and effectively under fentanyl and midazolam and have a significantly smaller chance of requiring a blood transfusion.