SUMMARY POINTS

Learn the art of trauma-responsive pelvic care, which includes aspects of establishing rapport, choosing sensitive language, and affirming a person’s control.
Learn hand-eye coordination, tactile feedback, internal landmarks, position and angle of the uterus and cervical canal – all critical to the safety of dilation and aspiration. 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 (mucosal lining the uterus, shed during menses or uterine aspiration).

The risk of abortion complications is minimal although increases with gestational duration; <0.5% of patients experiencing a major complication requiring hospitalization (NASEM 2018, Upadhyay 2015, White 2015). Once a person decides to seek an abortion, it is important to offer care without delay (Upadhyay 2015).
Mortality associated with remaining pregnant (including prenatal, childbirth, and postpartum periods) is over 30 times that of an induced abortion (Stevenson 2023).
The prevalence of complications is similar across settings. TRAP laws (targeted restrictions on abortion providers) requiring clinicians to have hospital admitting privileges, or facilities to meet ambulatory surgical center standards do not improve outpatient abortion safety (White 2015).
Abortion ban exceptions, designed to address serious health complications in pregnancy, are often inadequate, leading to preventable deaths (KFF 2024).
Cervical dilation can be challenging, and may require various trouble-shooting strategies and knowing when to stop and refer.
Routine sharp curettage should be avoided due to increased procedure time, bleeding, pain, and scarring risk (Asherman Syndrome) (WHO 2022).
Provision of aspiration abortion by advanced practice nurses, physician associates, and midwives has been shown to improve access, and be safe and acceptable to people seeking abortion care in multiple countries (Levi 2018, NASEM 2018).

It is helpful to consider risk factors for a challenging procedure ahead of time in order to customize care and minimize complications.
People ideally have a support person and trained assistant during procedural abortion. Your leadership will ensure a respectful, supportive environment for all.
Instructions for home care, medications, contraception, warning signs, and emergency contact information can help minimize stress, phone calls, and need for fragmented or unnecessary follow-up after routine uterine aspiration.

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