Raymonde Moullier


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    First trimester surgical abortion under local anaesthesia
    Raymonde MOULLIER, Vice-President of ANCIC www.ancic.asso.fr; Martine Hatchuel,
    Sylvie Osterreicher, Nathalie Trignol
    CIVG S. Veil, CHU de Nantes and CIVG C. Vautier, clinique J. Verne, Nantes, France
    In France, abortion was legalized in 1975, and suction vacuum aspiration under local
    anesthesia (LA) became prevalent especially in non-hospital autonomous clinics. As the
    government decided to integrate abortion units within hospitals, surgical abortion under
    local anesthesia decreased while the use of general anesthesia increased particularly for
    the 12 to 14 weeks of amenorrhea. This trend seems to be occurring throughout Europe.
    However, aspiration under LA remains a reliable technique for well trained personnel,
    and ideal for the woman who chose LA when it is combined with psychological guidance
    and an empathetic staff. This support is of prime importance in patience comfort and
    Moreover, since 1975, improvements have been made in the procedure:
    cervical priming with misoprostol 400µg 2 or 3 hours before suction or even better with 200
    mg of mifepriston 36 or 48 hours before suction, or with association of mifepriston and
    misoprostol, especially for the 12 to 14 weeks of amenorrhea.
    local anesthesia with lignocaïne 1% or lignocaïne + adrenalin by local infiltration of the
    cervix or paracervical block or both is used routinely.
    Treatment with ibuprofen (400 mg) 2 hours before suction helps prevent the pain during
    the uterin contraction at the end of the procedure. Consequently, pain is either not
    perceived or is tolerable for most women.
    As adjunct analgesia, some providers are now using auto – inhalation of nitrous oxide and
    some practice acupuncture.
    All these improvements coupled with attention and empathy from the staff should give LA
    a primary place in abortion practice. LA should be routinely proposed to women, and
    medical teams trained in the technique.