1. Uterine size and position should be assessed during a pelvic examination before the procedure. Ultrasonography is advised if there is a discrepancy of more than 2 weeks between the uterine size and menstrual dating.
2. Tests for gonorrhea and chlamydia should be obtained, and the cervix and vagina should be prepared with a germicide. Paracervical block is established with 20 mL of 1% lidocaine injected deep into the cervix at the 3, 5, 7, and 9 o'clock positions. The cervix should be grasped with a single-toothed tenaculum placed vertically with one branch inside the canal. Uterine depth is measured with a sound. Dilation then should be performed with a tapered dilator.
3. A vacuum cannula with a diameter in millimeters that is one less than the estimated gestational age should be used to evacuate the cavity. After the tissue is removed, there should be a quick check with a sharp curette, followed by a brief reintroduction of the vacuum cannula. The aspirated tissue should be examined as de scribed previously. 4. Antibiotics are used prophylactically . Doxycycline is the best agent because of a broad spectrum of antimicrobial effect. D-negative patients should receive D (Rho[D]) immune globulin.
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