New Zealand College of Sexual & Reproductive Health

Abortion Training

Module 3: Early surgical abortion theory

8. Review of key learning points

1. To provide culturally safe and patient-centred early surgical abortion care, abortion service providers should be able to:

  • Communicate clearly with the patient, and any other whānau/people the patient chooses to involve in their care, to explain the procedure and ensure informed consent is given
  • Ensure the patient is aware that counselling is available to them before and after an abortion on request
  • Provide further information and referrals where necessary for alternative abortion or pregnancy pathways; for example if the patient is unsure or chooses not to have an early surgical abortion, or requests pain management requiring hospital level care
  • Take a focused medical history to find out if the patient has any relevant medical history including use of medicines and allergies
  • Have a culturally safe conversation with the patient about their plan for the products of conception, including transporting them home and the service’s management of them
  • Offer anti-D prophylaxis to rhesus negative patients if gestation is greater than 10 weeks (still consider offering it to patients if under 10 weeks having an early surgical abortion)
  • Advise the patient of post-abortion contraceptive options and be prepared to provide their choice of contraception including IUC/implant if this is requested

2. Support the patient receiving early surgical abortion through knowledge and application of pain management options:

  • Cervical priming
  • Pre-operative NSAIDs
  • Local anaesthesia
  • Conscious sedation
  • Anaesthetic assistance is required beyond conscious sedation

3. Lower infection risk resulting from early surgical abortion:

  • Ensure all equipment to be used is sterilised
  • Use the “no-touch” technique throughout the procedure (do not let equipment come in contact with the vagina)
  • Administer prophylactic antibiotics post-procedure

4. Performing an early surgical abortion, including managing complications:

  • Confirm all personnel, equipment and supplies are ready for the procedure
  • Pre-procedure: give cervical priming and analgesic medicines
  • Early surgical abortion steps:
    • Ensure the person is positioned comfortably, and has venous access
    • Begin sedation if using
    • Perform bimanual examination
    • Insert speculum and exam and clean cervix
    • Apply local anaesthetic to the cervix whilst stabilising the cervix
    • Dilate the cervix if required
    • Aspirate the uterine contents by MVA up to 12 weeks or EVA
  • Manage any immediate complications, e.g. cervical dilation difficulties, poor aspiration of uterine contents, blockage of cannula, excessive bleeding, incomplete abortion, vasovagal reaction, allergic reaction
  • Confirm that the abortion is complete by:
    • Visual inspection of products of conception
    • Ultrasound of the uterus
    • Clinical assessment of the uterus
  • Provide IUC/implant/Depo-Provera injection, if requested
  • Administer antibiotic prophylaxis and anti-D immunoglobulin if indicated
  • If there are inadequate products of conception, investigate for continuing, ectopic or molar pregnancy
  • Manage any delayed complications including bleeding, infection or ongoing pregnancy
  • Complete all documentation, including a personal procedure log and the Manatu Hauora Notification of Abortion Form, available here.

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