New Zealand College of Sexual & Reproductive Health

Abortion Training

Module 3: Early surgical abortion theory

4. Review of medical history and examination

A medical and surgical history and physical examination should have been performed as part of the consultation and decision-making process (Table 5); this may have been completed by a different healthcare provider. Ensure that you have reviewed the patient’s history and performed a risk assessment, including allergies, and have agreed on management plans for complications with the patient before starting the procedure. For example, if you are in a community setting, the management of an intraoperative complication such as a perforation of the uterus will be different to when the abortion is being provided in theatre under a general anaesthetic.

Table 5. Selected health considerations and management in early surgical abortion.

Health Condition Considerations


  • Mild to moderate hypertension is not a contraindication; referral for treatment may be required as needed.
  • Symptomatic and/or severe hypertension (>160/110 mm/Hg) should be treated prior to procedure or referred for additional management
  • Ergometrine should be avoided for patients with hypertension

Seizure disorder

  • Anti-seizure medicines should be taken as prescribed on day of early surgical abortion and resumed as usual following procedure
  • There is no contraindication to receiving procedural benzodiazepines or opiates
  • Uncontrolled seizure disorder or seizure in last two weeks is a contraindication to out of hospital (community) abortion
  • Some anti-seizure medicine interact with hormonal contraception; options should be reviewed for medical eligibility


  • If recent history or symptoms, check pre-procedure haemoglobin. If < 100 g/L, refer to hospital setting or be prepared to manage bleeding appropriately.

Blood-clotting disorders

Insulin-dependent disorders

  • No changes in diet or medicines are recommended for early surgical abortion, but consider scheduling the procedure for early in the day
  • Low glucose levels require dextrose or food prior to procedure
  • High glucose levels are not a contraindication, but levels ≥ 15 mmol/L warrant evaluation for diabetic ketoacidosis; this requires treatment or referral prior to procedure

Heart disease

  • If symptomatic underlying heart disease, or severe disease, early surgical abortion may be performed in operating room with monitoring by an anaesthetist


  • Patients with mild asthma may have a routine early surgical abortion. Advise taking routine asthma medicines before the procedure and bringing these medicines along to the clinic.
  • Patients with acute or poorly controlled asthma may need to delay abortion care until better controlled
  • Misoprostol is safe for use in patients with asthma

Active respiratory infection

  • Consider delaying the procedure. If unable, consider personal protective equipment (PPE) for both the patient and staff.
  • In the context of COVID-19 community transmission, recommend PPE that assumes infection if status is unknown

Cervical stenosis

  • Consider use of an Os finder, or perform early surgical abortion under ultrasound guidance
  • A cervical preparation agent such as misoprostol or mifepristone may be helpful
  • Medical abortion may be offered

Uterine fibroids

  • Fibroids may inhibit ability to complete early surgical abortion depending on size and location in relation to pregnancy. Ultrasound guidance may be a helpful adjunct.
  • Consider referral to a hospital care with an experienced provider
  • Medical abortion may be considered as an alternative

Previous caesarean delivery

  • Patient may be at increased risk of haemorrhage. Ensure uterotonic medicines are readily accessible. Consider performing with ultrasound guidance.
  • Additional rare risk of uterine scar pregnancy if multiple previous caesarean deliveries; consider ultrasound and/or referral to hospital with experienced provider

Alcohol or substance use disorders

  • Alcohol use disorder – may need larger benzodiazepine doses due to tolerance
  • Opiate use disorder – may need larger opiate doses due to tolerance

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