Renal and hepatic disease (affecting drug metabolism, clearance, contraception)
Allergy to latex, iodine, shellfish and medications
Assist client with a contraceptive plan; complete informed consent before sedation given
Perform a focused physical exam:
Vital signs, height and weight (BMI)
Mallampati score (required in some settings prior to moderate sedation)
Cardiac, pulmonary, and / or abdominal exam as indicated by history
If elevated, confirm BP with appropriate sized cuff after sitting quietly; may warrant pre-procedure treatment (i.e. >160/110) or referral
Tachycardia or arrhythmia: consider anxiety, stimulants, etc. If significant and previously undiagnosed, may warrant delay for evaluation
Obesity (may be associated with greater procedural difficulty).
Perform pelvic exam prior to the procedure:
Bimanual for uterine size, position, fibroids, anomalies, pain
Speculum exam for cervicitis or vaginitis warranting testing / treatment
Chlamydia (CT) / Gonorrhea (GC):
For asymptomatic clients, refer to CDC STD Guidelines: annual screening for women <25-years-old; others if increased risk (i.e. new or multiple partner, etc).
If cervicitis is present on exam, test for GC / CT and begin presumptive treatment at least one hour prior to aspiration. Note: Untreated CT / GC increases risk of postabortal endometritis, with associated sequelae.
Even in asymptomatic clients, pre-procedural antibiotic prophylaxis for uterine aspiration is well supported by the available evidence (Low 2012; Achilles 2011).
Goodman S, Flaxman G, and the TEACH Trainers Collaborative Working Group.* TEACH Early Abortion Training Workbook, Fifth Edition. UCSF Bixby Center for Global Reproductive Health: San Francisco, CA (2016).
* Hufbauer E, Amico J, McNeil S, Pau C, Maldonado L, Brahver D, Weber C, Ti A, Wang LF, Wolfe M, Wondolowski L, Rosenstein H, Lazarin M.
TEACH Doc: 2016-001 (07/16)
Based on previous versions:
Goodman S, Wolfe M, and the TEACH Trainers Collaborative Working Group. Early Abortion Training Workbook, Fourth Edition. UCSF Bixby Center for Global Reproductive Health: SF, CA (2012). Bixby Doc: ANSIRH-2012-001 (07/12)
Goodman S, Wolfe M, and the TEACH Trainers Collaborative Working Group. Early Abortion Training Workbook & Trainer’s Workbooks, 3rd & 2nd Editions. UCSF Center for Reproductive Health Research & Policy: SF, CA (2007). CRHRP Docs: ANSIRH-2007-012 & -013 (07/07)
Goodman S, Paul M, Wolfe M, and the TEACH Trainers Collaborative Working Group. Early Abortion Training and Trainer’s Workbooks, 2nd & 1st Editions. UCSF Center for Reproductive Health Research & Policy: San Francisco, CA (2004). CRHRP Docs: FHS-2004-010 & -011 (11/04)
Paul M, Stewart FH, Weitz TA, Wilcox N, Tracey JM. Early Abortion Training Workbook. UCSF Center for Reproductive Health Research & Policy: SF, CA (2003). CRHRP: FHS-2003-009 (9/03)
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