SUMMARY POINTS

 

SKILL

  • Performing uterine aspiration requires the development of hand-eye coordination and an awareness of internal uterine landmarks.
  • Correctly assessing position and angle of the uterus and cervical canal will are critical to the safety of dilation. With experience, you will develop appreciation for the variability of cervical length and curvature, as well as the amount of pressure you need to exert.
  • Become skilled at differentiating products of conception (POC; including gestational sac, membranes, villi, and fetal parts) from decidua (mucous membrane lining the uterus, which is modified during pregnancy and shed during menses or aspiration).

 

SAFETY

  • The risk of abortion complications is minimal, with < 0.5% of patients experiencing a major complication requiring hospitalization (Upadhyay 2015, White 2015).
  • Abortion-related mortality in the U.S. is more than 14 times lower than continuing a pregnancy to delivery (Zane 2015, Raymond 2012)
  • If you are having trouble dilating the cervical canal, there are various strategies to try, but it is important know when to stop. Rescheduling may improve success.
  • Routine post-abortion tissue examination by a pathology lab confers no incremental clinical benefit, although is required in some institutions (Paul 2002).
  • Both sharp and excessive curettage increase procedure time, bleeding, pain, and scarring risk (Asherman’s), and should be avoided (Gilman 2014, Tunçalp 2010).
  • Early abortion safety, efficacy and acceptability are found to be equivalent between physicians and well-trained advanced practice clinicians (Bernard 2015Weitz 2013). The similarity of safety and efficacy is true for both experienced and newly trained providers (Jejeebhoy 2011, Warriner 2006).

 

ROLE

  • Considering risk factors for a challenging procedure ahead of time allows providers to customize care and minimize complications.
  • It is optimal to work in concert with an assistant who can provide support for both you and the patient during uterine aspiration. Your leadership and “normalization” of the experience will ensure a respectful, supportive environment for all.

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