SUMMARY POINTS

Learn the art of trauma-informed pelvic care, including establishing rapport, choosing sensitive language, and affirming the patient’s control to help put patients at ease.
Learn hand-eye coordination, tactile feedback, internal landmarks, position and angle of the uterus and cervical canal that 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 needed during dilation.
Differentiate products of conception (POC; including gestational sac, membranes, villi, and fetal parts) from decidua (mucous membrane lining the uterus, shed during menses or aspiration).

The risk of abortion complications is minimal, with <0.5% of patients experiencing a major complication requiring hospitalization (NASEM 2018, Upadhyay 2015, White 2015). Overall abortion is low risk, although the rate of complications increases with gestational age. Once a person decides to undergo an abortion, it is important to proceed without delay (Upadhyay 2015).
Mortality associated with childbirth is 14 times that of abortion (Raymond 2012).
The prevalence of complications is similar across clinic contexts. TRAP laws requiring facilities to meet ambulatory surgical center standards or hospital admitting privileges do not improve abortion safety in office settings (White 2015).
If cervical dilation is particularly challenging, there are various strategies to try, but it is important to know when to stop.
Routine post-abortion tissue examination by a pathology lab confers no incremental clinical benefit (Paul 2002).
Routine sharp curettage should be avoided due to increased procedure time, bleeding, pain, and scarring risk (Asherman’s Syndrome) (Gilman 2014, Tunçalp 2010).
Early abortion safety, efficacy and acceptability are found to be equivalent between physicians and advanced practice clinicians (Barnard 2015, Weitz 2013).

Considering risk factors for a challenging procedure ahead of time allows providers to customize care and minimize complications.
It is optimal to provide care with a support person and trained assistant during uterine aspiration. Your leadership will ensure a respectful, supportive environment for all.

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