MEDICAL EVALUATION PRIOR TO ASPIRATION

History and Physical

  • Review medical, obstetrical, gynecologic, psychosocial history: medications and allergies
  • Review information for the following medical conditions: (Paul 2009)
    • Cardiovascular (hypertension, cardiac valvular disease or arrhythmias)
    • Pulmonary (asthma, respiratory infection)
    • Hematologic (bleeding / clotting disorders, anticoagulant use, severe anemia)
    • Hemorrhage risk factors: See Chapter 5: Managing Complications Table
    • Endocrine (diabetes, hyperthyroidism)
    • 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

Diagnostic Tests

  • 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).
  • Rh (D) immune globulin: See Chapter 4 for details
  • Hemoglobin / Hematocrit
    • Consider Hgb or Hct with history of anemia (complete CBC not needed)
    • Although limited data support routine screening (NAF CPGs 2016), a baseline POCT may inform the decision for treatment (FeS04) post-aspiration.
  • Tests pertinent to underlying conditions
    • Glucose for IDDM patients
    • INR for patients on anti-coagulants

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