A randomized controlled trial comparing surgical termination of pregnancy with and without continuous ultrasound guidance.

CONTEXT Approximately 50 million abortions are performed worldwide each year, and the majority of them are surgical terminations of pregnancy (STOP). Therefore, the safety of this procedure is a global public health concern. It is not known whether routine use of intraoperative ultrasound guidance improves the outcome of first trimester STOP. OBJECTIVE To investigate whether surgical termination of pregnancy in the first trimester with continuous ultrasound guidance is safer than the conventional procedure without ultrasound guidance. DESIGN A randomized controlled trial. SETTING A teaching hospital in London, UK. PARTICIPANTS Women undergoing STOP in the first trimester. INTERVENTION PARTICIPANTS were randomized to have the procedure with or without continuous ultrasound guidance. OUTCOME MEASURES The primary outcome measures were intraoperative and short-term complications (anaesthetic complication, haemorrhage, ongoing pregnancy, cervical trauma, uterine perforation, need for laparoscopy and/or laparotomy, repeat evacuation, and infection). The secondary outcomes were the blood loss, procedure time, and convalescence time. RESULTS A total of 230 women (115 in each arm of the trial) participated in the study. Follow-up data were available for analysis in all but 15 (8 in control group and 7 in intervention group) cases. Baseline characteristics were similar in both groups. The overall complication rate was 9.8 percent. STOP under ultrasound guidance had a complication rate of 3.7% (4/108) in comparison to 15.9% (17/107) without ultrasound (RR 0.23, 95% CI 0.08-0.67). Intraoperative ultrasound guidance also had a statistically significant beneficial effect in reducing the blood loss, procedure time, and convalescence time. CONCLUSION STOP in the first trimester under continuous ultrasound guidance was associated with a lower rate of complications than the conventional procedure without ultrasound.