Uterine Aspiration

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Elective abortion up to 12 weeks of estimated gestational age
  • Treatment for early pregnancy failure or spontaneous abortion for uterine sizes up to 12 weeks
  • Postabortal hematometra
  • Backup for medication abortion
CONTRAINDICATIONS

Absolute Contraindications

  • Hemodynamic instability
  • Active pelvic infection

Relative Contraindications

  • Uncontrolled hypertension
  • Uncontrolled diabetes
  • Molar pregnancy (based on gestational age)
  • Coagulopathy
EQUIPMENT
  • Medium Graves' speculum
  • Single-toothed or atraumatic tenaculum
  • Syringe with 3-inch, 22- to 27-gauge spinal needle, or 22- to 27-gauge needle on 3-inch needle extender
  • Anesthetic agent for cervical block
  • Rigid cervical dilators for mechanical dilation: Pratt, Hegar, or Denniston
  • Osmotic dilators: Laminaria japonica inserted into the cervical os 6 to 18 hours before the procedure
  • Cervical softening agents: Misoprostol, available in 200-mcg dose
  • Povidone-iodine or other antiseptic solution or sterile water
  • Ring forceps
  • 4 × 4 gauze pads
  • Manual vacuum syringe
  • Disposable suction cannulas
  • Suction machine with tubing as an alternative to MVA syringe
  • Metal bowl for products of conception (if using MVA)
  • Medium sharp uterine curette
  • Formalin jar (if products of conception are to be sent for pathology)
  • IV solutions, tubing, and oxytocics (for treatment for excessive bleeding)
ANATOMY

Neurovascular Supply of the Cervix

  • The cervical arteries lie at the 3- and 9-o'clock positions on the cervix.
  • Because of the rich nerve supply to the cervix, endocervical procedures can cause a reflex bradycardia and a vasovagal response in some women.

Anatomic Impediments to Successful Uterine Aspiration

  • A vaginal septum may interfere with achieving visualization of and access to the cervix.
  • Cervical stenosis may occur as the result of previous surgical procedures.
  • Dilation of the os may be more difficult in nulliparous teenagers, particularly at early gestational ages.
  • Müllerian anomalies may interfere with successful uterine aspiration. Intraoperative ultrasound can facilitate the procedure.
  • Adnexal masses or uterine fibroids may result in inaccurate gestational age dating, and fibroids can interfere with cervical dilatation.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Prescribe doxycycline 100 mg orally twice a day for 3 days for routine surgical antibiotic prophylaxis. Give the first dose before or soon after the procedure is performed.
  • Methylergonovine 0.2 mg may be administered orally every 6 hours for six doses to assist in contracting the uterus and to prevent bleeding.
  • Offer effective contraception to the patient.
  • Advise the patient to abstain from sexual activity for 1 week.
COMPLICATIONS
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  • Less than 0.5% of women will experience a complication during a first-trimester surgical abortion, and the risk for death is about one-tenth of that associated with childbirth.
  • Pre-procedure Complications

    • Misdiagnosis of pregnancy, miscarriage, advanced gestational age, or ectopic pregnancy.
    • Problems with laminaria: Migration, the laminaria falls out, or it fragments. The patient may have a vasovagal reaction during insertion.
    • Problems with a paracervical block: Bleeding at the site of injection, intravascular injection.

    Procedural Complications

    • The clinician may be unable to successfully dilate the cervix and enter the uterine cavity.
    • Inability to evacuate the uterus caused by uterine fibroids or anomalies of the uterus.
    • Uterine perforation (rare).
    • Hemorrhage: Due to laceration or perforation.
    • Atony.

    Post-procedure Complications

    • Bleeding: Incomplete abortion, hematometra
    • Infection
    • Retained products of conception, requiring further intervention
    RESULT ANALYSIS
    • After the procedure has been completed, the POC must be examined by conducting the float test or by sending the specimen to a laboratory for pathologic analysis.
    • If scant tissue is noted or a molar pregnancy is suspected, evaluation by a pathologist should be considered.
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