Table 2.

University of Missouri Protocol for Manual Vacuum Aspiration

Pregnancy Loss Diagnosed by Ultrasound Evaluation
Patient counseling
Consents signed, procedure education, prescriptions provided for preprocedure preparation and postoperative care
Patient preparation 1 day prior to procedure
800 mg ibuprofen PO q 8 h scheduled
100 mg doxycycline PO bid (continue for 7-day course)
400 mcg misoprostol PO × 1 in the evening
Patient preparation day of procedure
Presedation medications 2 h before scheduled start time:
Diazepam 10 mg PO
Meperidine 100 mg PO
Promethazine 50 mg PO
(ibuprofen and doxycycline continued as previously noted)
Patient to surgical suite
Patient positioned in dorsolithotomy for administration of paracervical block containing 22 cc total volume of the following components:
10 cc ropivacaine 0.5%
10 cc lidocaine 1% (without epinephrine)
2 cc fentanyl 50 mcg/ml
*allow 15 min prior to proceeding for optimal analgesia*
Cervical dilation followed by uterine evacuation using manual vacuum aspiration
If patient’s pain is not well controlled by oral sedation agents, consider adjunct use of IV midazolam and/or meperidine
Intramuscular injection of methylergonovine maleate, 0.2 mg, at the end of procedure and Rh-immune globulin if indicated
Patient transferred to recovery; monitored according to conscious sedation protocol
Postoperative care (begin 4 h after procedure)
50 mg meperidine and 25 mg promethazine PO q 4–6 h (continue for the next 12–18 h)
0.2 mg methylergonovine maleate PO q 8 h × 3 doses
800 mg ibuprofen PO q 8 h (convert to prn day after procedure)
Bleeding and infection precautions reviewed 2-week postoperative visit scheduled, nothing per vagina (intercourse, douches, tampons, etc), until seen for follow-up Patient to avoid pregnancy × 2 cycles