MEDICAL EVALUATION PRIOR TO ASPIRATION
History and Physical
- Review medical history, sexual and reproductive history, meds, substance use and allergies. A screening tool can ensure a thorough history is obtained (Raymond 2020).
- Review information for the following medical conditions (Guiahi 2012):
- Cardiovascular (hypertension, valvular disease, arrhythmias)
- Pulmonary (asthma, active respiratory infection)
- Hematologic (bleeding and clotting disorders, anticoagulants, severe anemia)
- Hemorrhage risk factors: See Chapter 5: Managing Complications Table
- Endocrine (diabetes, hyperthyroidism)
- Renal and hepatic disease (affecting drug metabolism and clearance)
- Neurologic (seizure disorder) or psychiatric (severe depression or anxiety)
- Abortion is an essential and urgent service. Minimize delays, especially in people with significant medical problems, as risk increases with advancing gestational age. Medical conditions warrant management or referral prior to abortion (see Table below).
- Physical exam as indicated by history and patient symptoms
- Pelvic exam is not necessary for medication abortion with sure LMP (WHO 2022).
- Bimanual and speculum exam may be performed immediately prior to an aspiration.
- Bimanual for uterine size / position (see Limitations in Table above)
- Speculum exam can assess cervicitis warranting testing / treatment
Lab Tests if Indicated
No routine pre-abortion lab testing is needed in patients without underlying conditions. Some labs are indicated by history, exam or dating. Lack of testing should not be a barrier to access.
- Tests pertinent to underlying conditions:
- Glucose for patients with IDDM
- INR for patients on certain anti-coagulants (Warfarin) > 12 weeks
- Rh (D) testing standards are evolving: < 12 weeks from LMP, may forego Rh testing and Rh-D IG for MAB (NAF May 2022; WHO 2022) (See Ch 5 Rh Isoimmunization)
- May forgo Rh testing if patient wants no future children or declines testing.
- Document Rh status or informed waiver if declining Rh testing
- If Rh negative, can use donor card, chart, patient report, or lab.
- Hemoglobin: If history / symptoms of anemia (fingerstick; not complete CBC).
- Chlamydia (CT) / Gonorrhea (GC): asymptomatic patients ≤ 25 or at increased risk (i.e. new or multiple sexual partners in last year). May refer for testing if not at your facility.
- If cervicitis on exam, test (GC/CT), and treat empirically
- Universal antibiotic prophylaxis is evidence-based for aspiration abortion (Low 2012; Achilles 2011); unclear for EPL aspiration (Lissauer 2019). See Chap 5.
Selected Health Condition Considerations and Management in First Trimester Aspiration Abortion
Adapted from Ipas 2016
|Active respiratory infection||
|Previous Cesarean Delivery||
|Congenital Uterine Anomalies||
|Alcohol or substance use disorders||