The preferred method of evacuation of the uterus is by manual vacuum aspiration (see above). Dilatation and curettage should be used only if manual vacuum aspiration is not available.

1	Follow the initial steps as described under Manual Vacuum Aspiration.
2	Gently pass a uterine sound through the cervix to assess the length and direction of the uterus. Gently introduce a large curette. Use graduated dilators only if the curette will not pass. Begin with the smallest dilator and end with the largest dilator that ensures adequate dilatation (usually 10–12 mm) (Figure 12.8). Take care not to tear the cervix or to create a false opening.
Figure 12.8
3	Evacuate the contents of the uterus with a large curette or ring forceps (Figure 12.9). Gently curette the walls of the uterus until a grating sensation is felt.
Figure 12.9
4	Perform a bimanual pelvic examination to check the size and firmness of the uterus. Examine the evacuated material. Send material for histopathological examination, if required.

Post-procedure care