ASUHAN KEPERAWATAN PADA PASIEN IBU HAMIL

DENGAN ABORTUS INKOMPLIT

oleh:
Afni Nahdhiya Damayanti, S.Kep
NIM 212311101005

PROGRAM STUDI PENDIDIKAN PROFESI NERS

FAKULTAS KEPERAWATAN
UNIVERSITAS JEMBER
2021
 PROGRAM STUDI PENDIDIKAN NERS
FAKULTAS KEPERAWATAN
UNIVERSITAS JEMBER

PENGKAJIAN INTRANATAL

I. Identitas Klien
Nama : Ny. W No. RM : 42xxx
Umur : 27 tahun Pekerjaan : Ibu rumah tangga
Jenis Kelamin : Perempuan Status Perkawinan : Kawin
Agama : Islam Tanggal MRS : 13 Maret 2019
Pendidikan : SMK Tanggal Pengkajian : 13 Maret 2019
Alamat : Jalan Abdul Kadir Sumber Informasi : Klien dan keluarga
No.18 Kota
Makassar

II. Riwayat Kesehatan

1. Diagnosa Medik :
Abortus Inkomplit
2. Keluhan Utama :
Nyeri abdomen bagian bawah.

3. Riwayat Penyakit Sekarang :

Nyeri dirasakan 2 hari yang lalu karna adanya perdarahan pervaginam, nyeri yang
dirasakan hilang timbul, nyeriny dirasakan seperti kram, lokasi nyerinya menetap,
lamanya keluhan yang dirasakan ± 5-10 menit dan upaya yang dilakukan untuk
mengatasi nyeri yaitu dengan cara berbaring. Klien mengatakan perdarahan pada
pervaginam dan nyeri pada abdomen bagian bawah skala nyeri yang dirasakan klien
4 (sedang).

4. Riwayat Kesehatan Terdahulu :

Klien mengatakan tidak pernah dirawat sebelumnya di rumah sakit.
5. Riwayat Penyakit Keluarga:
Klien mengatakan keluarganya juga tidak memiliki riwayat penyakit kronis seperti
hipertensi, diabetes melitus, atau yang lainnya.

6. Riwayat Obstetri :
a. Riwayat penggunaan kontrasepsi :
 Klien mengatakan melakukan kontrasepsi jenis suntuk yang dilakukan dalam 3
bulan sebelum post kuret.
b. Riwayat mentruasi :
Menarche : Ketika usia 13 tahun
Lamanya : Klien mengatakan biasanya seminggu (7 hari)
Siklus : 28 hari
c. Riwayat kehamilan terdahulu :
Klien mengatakan ini merupakan kehamilan keduanya, dan baru kali ini
mengalami keguguran
d. Riwayat kehamilan sekarang :
Status obstetri G2P1A1, usia kehamilan 10 minggu, klien mengatakan 1 kali
melakukan PNC, HPHT klien 20-12-2018 dan tafsiran persalinan 27-09-2019.

III. Pengkajian Keperawatan

1. Persepsi Kesehatan & Pemeliharaan Kesehatan :
Klien mengatakan penyakit adalah apa yang Allah SWT berikan kepada setiap
manusia sebagai suatu ujian dan itu tidak bisa dirubah oleh siapapun kecuali Allah
SWT.
Interpretasi: Pasien dan keluarga memiliki persepsi kesehatan dan pemeliharaan
kesehatan yang baik.

2. Pola Nutrisi / Metabolik (ABCD) :

- Antropometeri : Keterangan IMT:
 Berat Badan : 64 kg < 17,0 = sangat kurus
 Tinggi Badan : 155 cm 17,0 - 18,4 = kurus
18,5 – 25,0 = normal
 IMT = 64 kg : 1,55 m2 25,1 – 27,0 = gemuk
= 26,64 kg/m2 > 27,0 = sangat gemuk

Interpretasi : IMT pasien dalam kategori gemuk.

 Berat Badan Ideal (kg) :
[Tinggi Badan (cm) – 100] – [(Tinggi Badan (cm) – 100) × 10%]
= [155 – 100] – [ (155– 100) × 10%]
Keterangan BB Ideal:
= [55] – [ (55) × 10%] Bentuk badan kecil = 48 – 51
= 55 – 5,5 Bentuk badan sedang = 50 – 56
= 49,5 kg Bentuk badan besar = 54 – 61
 Interpretasi : Bentuk badan pasien dalam kategori kecil

Biomedical sign :

Pemeriksaan Hasil Nilai Normal

Hemoglobin 12,1 g/dL 11,0 – 14.0 g/dL
Hematokrit 36,8 % 30 – 46 %
Interpretasi : Hasil pemeriksaan laboratorium klien berada dalam rentang normal.

- Clinical Sign :
Keadaan umum lemah, kesadaran composmentis, GCS 456, konjungtiva anemis,
mukosa bibir kering.
Interpretasi : Terdapat masalah pada kondisi klinis pasien.

- Diet Pattern (intake makanan dan cairan) :

Sebelum MRS (masuk rumah sakit) klien memiliki nafsu makan yang baik,
dengan frekuensi makan 3x sehari jenis makannya nasi, sayur, ikan dan ayam.
Dalam cairan, Minum 6-8 gelas perhari. Setelah MRS nafsu makan klien mulai
kurang baik namun klien masih mau makan sehari 3x dengan menu nasi, sayur,
ikan, dan ayam. Jenis minuman selama MRS yaitu air putih dan susu, dengan
frekuensi 3-5 gelas perhari.
Interpretasi : Intake nutrisi kurang adekuat.

3. Pola Eliminasi :
Sebelum MRS (masuk rumah sakit) klien buang air kecil  4 × dalam sehari dengan
karakteristik berwarna kuning dan bau khas urin. Buang air besar 1 × dalam sehari
denga karakteristik berwarna kuning kecoklatan, bau khas feses, dan konsistensi
lembek. Setelah MRS klien buang air kecil  3 × dalam sehari dan belum buang air
besar selama di rumah sakit.
Interpretasi : Keluaran urin menurun dan tidak teraturnya buang air besar.

4. Pola Aktivitas & Latihan :

Klien mengatakan saat sebelum sakit yaitu dirumah masih bisa beraktivitas secara
mandiri seperti menyapu, memasak, dan mencuci pakaian. Namun saat di rumah
sakit, klien merasa lemas sehingga memerlukan bantuan dari orang lain untuk
melakukan aktivitasnya.
Interpretasi : klien mengalami intoleransi aktivitas.
5. Pola Tidur & Istirahat :
Sebelum MRS (masuk rumah sakit) klien dapat tidur  8 jam/hari, sedangkan selama
dirumah sakit klien hanya tidur  6 jam/hari.
Interpretasi : Kualitas tidur klien menurun.

6. Pola Kognitif & Perceptual :

Fungsi Kognitif dan Memori :
Klien tahu dan mengerti bahwa klien mengalami abortus.
Fungsi dan keadaan indera :
Klien tidak menggunakan alat bantu terhadap indera penciuman, pengecap,
pendengaran, peraba, penglihatan saat pengkajian.
Interpretasi : Fungsi kognitif dan perceptual cukup baik .

7. Pola Persepsi Diri :

Gambaran diri : Klien mengatakan tidak mengalami masalah terkait penampilan
akibat kehamilannya, klien juga mengatakan bahwa keluarga
menanti kelahiran anak pertamanya ini.
Identitas diri : Klien mengatakan tidak ada permasalahan terkait identitas dirinya.
Harga diri : Klien tidak menunjukkan respon harga diri rendah seperti menunduk
saat diajak berbicara, dan tidak malu dengan kondisinya.
Ideal diri : Klien berharap segera sembuh agar dapat beraktivitas seperti
biasanya.
Peran diri : Klien mengatakan dirinya berperan sebagai ibu rumah tangga.
Interpretasi : Pola persepsi diri positif.

8. Pola Seksualitas & Reproduksi :

Klien telah menikah serta tidak memiliki gangguan seksualitas dan reproduksi.
Interpretasi : Pola seksualitas & reproduksi baik.
9. Pola Peran & Hubungan :
Klien mengatakan hubungan klien dengan orang lain baik seperti dengan suami,
orangtua, maupun keluarga.
Interpretasi : Pola peran & hubungan klien dan keluarga baik.

10. Pola Manajemen Koping  Stress :

Klien mengatakan tidak merasa putus asa dengan penyakitnya justru menganngap
yang terjadi ini merupakan penggugur dosa..
 Interpretasi : Manajemen koping dan stres baik.

11. Sistem Nilai & Keyakinan :

Sebelum MRS (masuk rumah sakit) klien beribadah dengan rutin, namun saat sakit
klien beribadah semampunya.
Interpretasi : Sistem nilai dan keyakinan baik

IV. Pemeriksaan Fisik

Keadaan Umum : Tampak pucat, klien tampak meringis, kesadaran composmentis,
konjungtiva anemis, nadi teraba lemah, mukosa bibir kering, CRT
> 2 detik.

Tanda  Tanda Vital :

- Tekanan Darah : 110/80 mmHg
- Nadi : 80 ×/menit
- RR : 20 ×/menit
- Suhu : 36,5 °C

Pengkajian Fisik Head to Toe

1. Kepala :
Inspeksi : Bentuk kepala simetris, rambut bersih dan berwarna hitam, dan
rambut mengalami kerontokan
Palpasi : Tidak terdapat nyeri tekan, tidak ada lesi, tidak terdapat benjolan
massa, dan rambut tidak mudah rontok

2. Mata :
Inspeksi : Tidak ada luka, tidak ada pembengkakan, konjungtiva tampak
anemis
Palpasi : Tidak ada nyeri tekan.
3. Telinga :
Inspeksi : Bentuk simetris, tidak terdapat lesi, tidak terdapat serumen yang
keluar dari telinga, tidak ada gangguan pendengaran, dan tidak
menggunakan alat bantu pendengaran
Palpasi : Tidak ada nyeri tekan
4. Hidung :
Inspeksi : Bentuk normal, tidak menggunakan terapi oksigen, tidak terdapat
pernapasan cuping hidung, dan tidak ada sekret yang keluar dari
lubang hidung
 Palpasi : Tidak ada nyeri tekan
5. Mulut :
Inspeksi : Mukosa bibir kering, tidak terdapat lesi di bibir, gigi lengkap, dan
tidak terdapat sariawan
Palpasi : Tidak ada nyeri tekan
6. Leher :
Inspeksi : Bentuk leher simetris, tidak ada lesi, tidak ada bekas luka, dan
tidak nampak pembesaran vena
Palpasi : Tidak teraba adanya pembengkakan kelenjar getah bening
7. Dada:
Paru
Inspeksi : Bentuk normal, simetris, dan tidak ada lesi
Palpasi : Tidak terdapat nyeri tekan
Perkusi : Sonor
Auskutasi : Vesikuler
Jantung
Inspeksi : Tidak ada lesi, iktus cordis tidak terlihat
Palpasi : Tidak ada nyeri tekan pada jantung
Perkusi : Pekak
Auskutasi : S1 S2 tunggal dan tidak ada suara jantung tambahan
8. Abdomen:
Inspeksi : Tidak tampak striae gravidarum dan tidak tampak linea nigra
P : keluarnya hasil konsepsi
Q : seperti kram
R : abdomen bawah
S : skala nyeri 4
T : saat beraktivitas
Auskutasi : DJJ tidak terdengar dan bising usus 6 ×/menit
Palpasi : Tidak kembung, terdapat nyeri tekan pada daerah bawah perut
9. Urogenital
Tidak terpasang selang kateter
10. Ekstremitas:
Ekstremitas atas
Inspeksi : Tidak ada kesulitan dalam pergerakan dan terpasang infus D5%
20 tpm pada ekstremitas kiri atas
Palpasi : Tidak terdapat edema dan tidak terdapat nyeri tekan
Ekstremitas bawah
Inspeksi : Tidak ada gangguan dalam pergerakan
Palpasi : Tidak terdapat edema dan tidak terdapat nyeri tekan
11. Kulit dan Kuku:
 Inspeksi : Tidak terdapat kemerahan pada daerah kulit, tidak ada
perdarahan, dan tidak ada edema
Palpasi : CRT > 2 detik, akral dingin, dan turgor kulit menurun

V. Terapi
 Infus RL 28 tpm
 Cefadroxil 2x1
 Asam mefenamat 3x1
 Ferrous sulfat 2x1
 Injeksi cefaperazone 1 gr
(Hartika, 2019)
 ANALISA DATA

NO DATA ETIOLOGI DIAGNOSA PARAF

1 DO : Fisisologi organ Nyeri Akut
- Klien tampak meringis saat terganggu, panggul
nyerinya muncul sempit
- Klien tampak lemas
- P : keluarnya hasil konsepsi Afni,
- Q : seperti kram S.Kep.
- R : abdomen bawah
Abortus spontan
- S : skala nyeri 4
- T : saat beraktivitas
- TD : 110/80 mmHg
- N : 80x/menit
- RR : 20x/menit Abortus inkomplit
- S : 36,5°C

DS :
- Klien mengatakan nyeri pada Nyeri akut
bagian perut bawah disertai
dengan keluarnya dara sedikit dei
sedikit
- Klien mengatakan nyeri hilang
timbul
- Nyeri seperti kram
- Nyeri dirasakan 5-10 menit
- Klien hanya berbaring untuk
meredakan nyeri yang dirasakan

2 DO : Fisiologi organ Hipovolemia

- Klien tampak pucat terganggu, panggul
- Konjungtiva anemis sempit
- Klien tampak lemah
- Bibir klien tampak kering Afni,
- Turgor kulit menurun S.Kep.
- Nadi teraba lemah
Abortus
- N : 80 x/menit
- Volume urin menurun

DS :
- Klien mengatakan sudah 2 hari Abortus spontan
keluar bercak dan gumpalan
darahpada vagina
- Klien mengatakan sering merasa
haus Abortus inkomplit
- Klien merasa lemah
Perdarahan

Hipovolemia
 DIAGNOSA KEPERAWATAN
(Berdasarkan Prioritas)

PARAF
TANGGAL
NO DIAGNOSIS KEPERAWATAN DAN
PERUMUSAN
NAMA
1 Nyeri akut (D.0077) b.d agen pencedera fisik Rabu, 3 Nopember
(pelaksanaan kuret) d.d Klien tampak meringis saat
2021
nyerinya muncul, Klien tampak lemas, P : keluarnya
hasil konsepsi, Q : seperti kram, R : abdomen bawah,
S : skala nyeri 4, T : saat beraktivitas, TD : 110/80
Afni,
mmHg, N : 80x/menit, RR : 20x/menit, S : 36,5°C,
Klien mengatakan nyeri pada bagian perut bawah S.Kep.
disertai dengan keluarnya dara sedikit dei sedikit,
Klien mengatakan nyeri hilang timbul, Nyeri seperti
kram, Nyeri dirasakan 5-10 menit, Klien hanya
berbaring untuk meredakan nyeri yang dirasakan.
2 Hipovolemia (D.0023) b.d kehilangan cairan aktif d.d Rabu, 3 Nopember
Klien tampak pucat, Konjungtiva anemis, Klien
2021
tampak lemah, Bibir klien tampak kering, Turgor kulit
menurun, Nadi teraba lemah, N : 80 x/menit, Volume
urin menurun, Klien mengatakan sudah 2 hari keluar
Afni,
bercak dan gumpalan darahpada vagina, Klien
mengatakan sering merasa haus, Klien merasa lemah S.Kep.
 PERENCANAAN KEPERAWATAN

HARI/ NAMA
DIAGNOSA
NO TANGGAL/ TUJUAN DAN KRITERIA HASIL INTERVENSI DAN
KEPERAWATAN
JAM PARAF
1 Rabu/ 03 Nyeri Akut (D.0077) Setelah dilakukan asuhan keperawatan Manajemen Nyeri (I.08238)
November
selama 1 x 2 jam keluhan nyeri akut Observasi
2021/ 11.00
WIB menurun dengan kriteria : 1. Identifikasi lokasi, karakteristik, durasi,
Tingkat Nyeri (L.08066) frekuensi, kualitas, intensitas nyeri Afni,
1. Keluhan nyeri menurun 2. Identifikasi skala nyeri S.Kep.
2. Meringis menurun 3. Identifikasi respon nonverbal
3. Kesulitan tidur menurun 4. Monitor keberhasilan terapi
4. Uterus teraba membulat menurun komplementer yang diberikan
5. Frekuensi nadi membaik 5. Monitor efek samping penggunaan
6. Pola napas membaik analgesik
7. Tekanan darah membaik Terapeutik
6. Berikan teknik nonfarmakologis untuk
mengurangi rasa nyeri
7. Kontrol lingkungan yang memeperberat
rasa nyeri
8. Fasilitasi istirahat dan tidur
Edukasi
9. Ajarkan teknik nonfarmakologis
 mengurangi rasa nyeri
Kolaborasi
10. Kolaborasi pemberian analgetik, jika
perlu
2 Rabu/ 03 Hipovolemia (D.0023) Setelah dilakukan asuhan keperawatan Manajemen Hipovolemia (I.03116)
November selama 1 x 24 jam keluhan Observasi
2021/ 11.30
hipovolemia menurun dengan kriteria : 1. Periksa tanda dan gejala hipovolemia
WIB
Status Cairan (L.03028) 2. Monitor intake dan output cairan Afni,
1. Kekuatan nadi meningkat Terapeutik S.Kep.
2. Turgor kulit meningkat 3. Hitung kebutuhan cairan
3. Perasaan lemah meningkat 4. Berikan posisi modified trendelenburg
4. Suhu tubuh membaik 5. Berikan asupan cairan oral
5. Keluhan haus menurun Edukasi
6. Tekanan darah membaik 6. Anjurkan memperbanyak asupan cairan
oral
7. Anjurkan menghindari perubahan posisi
mendadak
Kolaborasi
8. Kolaborasi pemberian cairan IV isotonis
9. Kolaborasi pemberia cairan IV
hipertonis
10. Kolaborasi pemberian cairan koloid
11. Kolaborasi pemberian produk darah
 IMPLEMENTASI KEPERAWATAN

HARI/TANG NO NAMA DAN

IMPLEMENTASI RESPON
GAL/JAM DX PARAF
Rabu/3-11- 1 Mengidentifikasi lokasi, karakteristik, durasi, Nyeri dibagian perut bawah, nyerinya
21/11.45 WIB frekuensi, kualitas, intensitas nyeri seperti kram, durasinya ± 5-10menit,
nyerinya hilang timbul, nyeri bertambah
ketika pasien duduk.
Rabu/3-11- Mengidentifikasi skala nyeri skala nyeri 4 (sedang)
21/11.47 WIB

Rabu/3-11- Mengidentifikasi respon nonverbal klien merasa tidak nyaman dengan nyeri
21/11.48 WIB yang dirasakan

Rabu/3-11- Mengajarkan teknik nonfarmakologis mengurangi rasa Keluarga dan klien memahami teknik
21/11.53 WIB nyeri pengurangan rasa nyeri dengan aurikular
akupressur yang telah diajarkan
Rabu/3-11- Mengontrol lingkungan yang memperberat rasa nyeri Mengatur suhu ruangan agar klien merasa
21/11.55 WIB nyaman

Rabu/3-11- Memberikan teknik nonfarmakologis untuk Klien merasa nyeri yang dirasakan
21/11.57 WIB mengurangi rasa nyeri (aurikular akupressur) berkurang dengan teknik aurikular
akupresur yang diberikan
Rabu/3-11- Memfasilitasi istirahat dan tidur Klien mulai tertidur setelah nyeri yang
21/12.08 WIB dirasakan mereda
Rabu/3-11- Mengolaborasi pemberian analgetik Memberikan asam mefenamat 3x1
21/12.10 WIB

Kamis/4-11- 1 1. Mengidentifikasi lokasi, karakteristik, durasi, Nyeri dibagian perut bawah, nyerinya
21/08.00 WIB seperti kram, durasinya ± 3-5menit,
frekuensi, kualitas, intensitas nyeri
nyerinya hilang timbul

Kamis/4-11- 2. Mengidentifikasi skala nyeri Skala nyeri 3

21/08.02 WIB

Kamis/4-11- 3. Mengidentifikasi respon nonverbal klien tampak sedikit mengerutkan wajah

21/08.05 WIB saat nyerinya muncul

Kamis/4-11- 4. Memonitor keberhasilan terapi komplementer Klien merasa terapi yang diberikan
21/08.07 WIB yang diberikan berhasil mengurangi nyei yang dirasakan.

Kamis/4-11- 5. Memonitor efek samping penggunaan analgesik Klien tidak mengalami efek samping dari
21/08.08 WIB asam mefenamat yang diberikan.

Kamis/4-11- 6. Memberikan teknik nonfarmakologis untuk Klien merasa nyeri yang dirasakan
21/08.10 WIB mengurangi rasa nyeri (aurikular akupressur) berkurang dengan teknik aurikular
akupresur yang diberikan
 EVALUASI KEPERAWATAN
PARAF
NO
HARI/TGL/JAM EVALUASI DAN
DX
NAMA
Rabu/03-11- 1 S:
21/12.10 WIB Klien mengatakan nyeri pada bagian perut
bawah disertai dengan keluarnya darah sedikit
demi sedikit, nyerinya hilang timbul, Nyerinya
dirasakan seperti kram, Skala nyeri 4 ( sedang ) Afni,
Lokasi nyerinya menetap, Lamanya nyeri
S.Kep.
dirasakan ± 5-10 menit
O:
Klien tampak meringis saat nyerinya muncul,
Klien tampak lemas
P : Keluarnya hasil konsepsi
Q : seperti kram
R : Abdomen bawah
S : Skala nyeri 4 ( sedang )
T : pada saat beraktivitas
TD : 110/80mmHg
N : 80x/menit
P : 20x/menit
S: 36,5 °C
A : masalah nyeri akut belum teratasi
P : Lanjutkan Intervensi 1, 2, 3, 4, 5, 6
I:
 Mengidentifikasi lokasi, karakteristik,
durasi, frekuensi, kualitas, intensitas nyeri
 Mengidentifikasi skala nyeri
 Mengidentifikasi respon nonverbal
 Memonitor keberhasilan terapi
komplementer yang diberikan
 Memonitor efek samping penggunaan
analgesik
 Memberikan teknik nonfarmakologis untuk
mengurangi rasa nyeri (aurikular
akupressur)
E:
Klien dan keluarga bersedia melakukan terapi
 komplementer yang telah diajarkan saat nyeri
timbul.
Kamis/04-11- 2 S:
21/09.00 WIB Klien mengatakan masih nyeri pada bagian
perut bawah disertai dengan keluarnya darah
sedikit demi sedikit, nyerinya hilang timbul,
Nyerinya dirasakan seperti kram, Skala nyeri 3 Afni,
( ringan ) Lokasi nyerinya menetap, Lamanya
S.Kep.
nyeri dirasakan ± 5-10 menit
O:
Klien tampak meringis saat nyerinya muncul,
Skala nyeri 3 ( ringan ),
P : Keluarnya hasil konsepsi
Q : seperti kram
R : Abdomen bawah
S : Skala nyeri 3 ( ringan )
T : pada saat beraktivitas
TD : 110/70mmHg
N : 80x/menit
P : 20x/menit
S: 36°C
A : masalah nyeri akut belum teratasi
P : Lanjutkan Intervensi 1, 2, 3.
I:
 Mengidentifikasi lokasi, karakteristik,
durasi, frekuensi, kualitas, intensitas nyeri
 Mengidentifikasi skala nyeri
 Mengidentifikasi respon nonverbal
E:
Klien masih melakukan terapi komplementer
yang telah diajarkan jika nyeri muncul.
 ANALISIS JURNAL
“AURICULAR ACUPUNCTURE AS AN ADJUNCT FOR PAIN MANAGEMENT
DURING FIRST TRIMESTER ABORTION: A RANDOMIZED, DOUBLE-BLINDED,
THREE ARM TRIAL”

Auriculotherapy untuk mengobati rasa sakit menggunakan area anatomi yang telah
ditentukan di telinga yang sesuai dengan morfologi tubuh. Kemungkinan besar metodologi
akupunktur terdiri dari lima titik akupunktur aurikularis, mendukung pemrosesan dan
modulasi nyeri di Sistem Saraf Pusat yang melibatkan hipotalamus, thalamus, cingulate
gyrus, dan struktur korteks serebral. Akupunktur memiliki potensi untuk melengkapi anestesi
lokal dengan memberikan efek analgesik dan ansiolitik tambahan dan sinergis. Pengobatan
tradisional Tiongkok telah menempatkan lebih dari 360 titik akupunktur di seluruh tubuh.
Tekanan, tusuk jarum atau listrik dapat merangsang titik akupuntur ini.
Percobaan acak, tersamar ganda, tiga lengan ini mendaftarkan wanita yang menjalani
aspirasi uterus untuk aborsi spontan atau diinduksi. Peserta penelitian diacak 1:1:1 untuk
menerima akupunktur aurikularis, plasebo, atau perawatan biasa saja. Peserta di semua
kelompok menerima ibuprofen dan blok paraservikal (perawatan biasa). Hasil utama adalah
nyeri maksimum yang dilaporkan pada akhir prosedur yang diukur menggunakan Skala
Analog Visual; kami membandingkan mereka yang menerima akupunktur aurikularis dengan
mereka yang menerima perawatan biasa saja. Kami juga membandingkan akupunktur telinga
dengan plasebo dan plasebo dengan perawatan biasa saja. Akhirnya, kami membandingkan
skor kecemasan maksimum antara peserta yang diacak dengan akupunktur auricular, plasebo,
dan perawatan biasa saja. Berdasarkan hasil penelitian, 94% wanita yang menjalani
akupunktur menilai perawatan mereka secara keseluruhan baik atau sangat baik dibandingkan
dengan 76% pada kelompok perawatan biasa; 63% pada kelompok akupunktur dibandingkan
dengan 48% pada kelompok perawatan biasa menilai "sejauh mana rasa sakit saya
dikendalikan" sebagai baik atau sangat baik.
Selain itu, akupunktur aurikularis secara efektif mengurangi kecemasan, yang dikenal
sebagai modulator nyeri yang dirasakan. Mengingat hasil yang menjanjikan ini,
mengeksplorasi kemanjuran protokol ini untuk mengelola rasa sakit dan kecemasan yang
terkait dengan prosedur ginekologi lainnya seperti pemasangan alat kontrasepsi dalam rahim
dan aborsi medis akan bermanfaat (Ndubisi dkk., 2019).
 DAFTAR PUSTAKA

Hartika, W. 2019. Karya Tulis Ilmiah Asuhan Keperawatan Pada Klien Ny. W Yang
Mengalami Abortus Inkomplit Dengan Masalah Keperawatan Nyeri Di Ruangan Nuri
Rumah Sakit Bhayangkara Makassar. Akademi Keperawatan Mappa Oudang Makassar.

Ndubisi, C., A. Danvers, M. A. Gold, L. Morrow, dan C. L. Westhoff. 2019. Auricular

acupuncture as an adjunct for pain management during first trimester abortion: a
randomized, double-blinded, three arm trial. Contraception. 99(3):143–147.
 Contraception 99 (2019) 143–147

Contents lists available at ScienceDirect

Contraception

journal homepage: www.elsevier.com/locate/con

Original research article

Auricular acupuncture as an adjunct for pain management during first

trimester abortion: a randomized, double-blinded, three arm trial☆,☆☆
Chioma Ndubisi a,1, Antoinette Danvers a,1, Melanie A. Gold b,c, Lisa Morrow d, Carolyn L. Westhoff a,c,⁎
a
Dept. of Obstetrics and Gynecology, Columbia University Irving Medical Center (CUIMC), NY, NY
b
Dept. of Pediatrics, CUIMC
c
Heilbrunn Dept. of Population & Family Health, Mailman School of Public Health, CUIMC
d
Montefiore Medical Group, Bronx, NY 10458

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: To assess pain-management using auricular acupuncture as an adjunct to ibuprofen and paracervical
Received 3 August 2018 block during first trimester uterine aspiration, and to assess auricular acupuncture's effect on anxiety.
Received in revised form 16 November 2018 Study design: This randomized, double-blinded, three-arm trial enrolled women undergoing uterine aspiration
Accepted 18 November 2018 for spontaneous or induced abortion. Study participants were randomized 1:1:1 to receive auricular acupuncture,
placebo, or usual care alone. Participants in all groups received ibuprofen and paracervical block (usual care). The
Keywords:
main outcome was maximum pain reported at the end of the procedure measured using a Visual Analog Scale;
Auricular acupuncture
Abortion
we compared those receiving auricular acupuncture to those receiving usual care alone. We also compared au-
Pain ricular acupuncture to placebo and placebo to usual care alone. Finally, we compared the maximum anxiety
Anxiety scores between participants randomized to auricular acupuncture, placebo, and usual care alone.
Randomized controlled trial Results: We randomized 153 women over 9 months, and analyzed 52 participants in the auricular acupuncture
group, 49 in the placebo group, and 49 in the usual care group. The groups had similar baseline characteristics.
After uterine aspiration, participants reported median maximum pain scores as follows: auricular acupuncture
39.5 (interquartile range (IQR) 11, 64.5), placebo 70.0 (IQR 40.5, 84), and usual care alone 71.0 (IQR 32, 91.5)
(pb0.01). In pairwise comparisons, the median maximum pain score after auricular acupuncture was lower
than placebo and usual-care groups (pb0.01 for both). Post-procedure median anxiety scores were 11.5, 31.0
and 44.0, respectively (p=.01).
Conclusions: Women undergoing first trimester uterine aspiration assigned to auricular acupuncture reported
substantially less pain and anxiety than women assigned to placebo or usual care.
Implications: Auricular acupuncture may be a useful adjunct to ibuprofen and paracervical block during first tri-
mester uterine aspiration. This approach to managing pain and anxiety could avoid the operational complexities
and expenses of sedation and opioid use.
© 2018 Published by Elsevier Inc.

1. Introduction
Of the estimated 900,000 abortions performed in the United
States in 2014, 90% were 1st trimester abortions [1]. Most aspiration
abortions are performed in an outpatient setting with a paracervical
block and nonsteroidal anti-inflammatory drug (NSAID) as the only
☆ Funding: The Society of Family Planning Research Fund supported this study.
☆☆ Conflicts of Interest: CN – None. AD – consultant – Cooper Surgical. MAG: Afaxys –
Clinical Advisory Board, Bayer – Consultant, Oxford University Press. LM – None. CLW –
consultant to Merck, Bayer, Cooper Surgical, Agile Therapeutics; research support from
Estetra SPRL, Leon Farma and Medicines360, all managed through Columbia University.
⁎ Corresponding author.
E-mail address: clw3@columbia.edu (C.L. Westhoff).
1
Current affiliation: NYU Langone Hospital- Brooklyn, Brooklyn, NY.
analgesics [2], but patients receiving these interventions still experience
moderate pain [3–5].
Moderate sedation and general anesthesia decrease pain, compared
to paracervical block and NSAIDs [5], but limited availability of these
medications and personnel to administer them, as well as higher
costs, risks, side effects, and delayed recovery time hinder their
use [2]. Thus, pain control during first trimester abortions requires fur-
ther research [6].
Pharmacologic and non-pharmacologic adjuncts to local anesthesia
might decrease pain during aspiration procedures. Premedication with
non-steroidal anti-inflammatory drugs (NSAID) is well established to
improve pain control, but lorazepam, hydrocodone, acetaminophen,
and oral midazolam administered prior to or during the procedure do
not effectively mitigate or reduce pain [5,7–9]. Renner [5] found that
hypnosis and relaxation exercises did not change reported procedural

https://doi.org/10.1016/j.contraception.2018.11.016
0010-7824/© 2018 Published by Elsevier Inc.
144 C. Ndubisi et al. / Contraception 99 (2019) 143–147
pain. One study found music was associated with less reported pain
during abortion [10], but two trials did not reproduce this result [11,12].
Offering a range of adjuncts to local anesthesia had little effect on
abortion-associated pain [13]. Thus, pain during first trimester abortions
remains sub-optimally managed.
Acupuncture has the potential to complement local anesthesia by
providing additional and synergistic analgesic and anxiolytic effects.
Traditional Chinese medicine has located over 360 acupuncture points
throughout the body. Pressure, needling or electricity can stimulate
these acupoints [14], and using acupuncture might attenuate the per-
ception of painful stimuli and anxiety. Peripheral stimulation of
acupoints mobilizes central neuropeptides involved in the pathway of
anxiety and stress. Acupuncture also activates opioid receptors, de-
creases COX-2 activity, and decreases inflammation, thereby inducing
analgesia [15]. While acupuncture effects on abortion pain have not
been studied, dysmenorrhea may be a related type of pain. A meta-
analysis evaluated randomized controlled trials of acupuncture for dys-
menorrhea relief and found that acupuncture was more effective than
NSAIDs alone [16]. A 2016 Cochrane review also reported some evi-
dence of acupuncture benefiting dysmenorrhea; however, the quality
of evidence was low [17].
Auriculotherapy consists of stimulating designated acupoints on the
external ear with needles, pressure, laser, or electrical stimulation to
alleviate pain in other parts of the body [18]. Some points correspond
to specific internal organs to induce analgesia, while other auricular
acupoints decrease anxiety, and modulate pain perception and nausea
[15,19]. A meta-analysis assessed 13 auriculotherapy pain management
randomized trials that included a wide range of diagnoses (total N=
806) [20]. Most of the included studies treated chronic pain or non-
gynecological post-operative pain; one study treated dysmenorrhea.
The overall effect estimate supported substantial pain reduction, but
the studies exhibited heterogeneity (I2 = 95%), and in several studies
the patient or the assessor was not blinded.
Auriculotherapy to treat pain uses pre-specified anatomic areas in
the ear corresponding to body morphology. Most likely the battlefield
acupuncture methodology, consisting of five auricular acupuncture
points, favors processing and modulation of pain in the Central Nervous
System involving the hypothalamus, thalamus, cingulate gyrus and ce-
rebral cortex structures. We hypothesized that auricular acupuncture,
using the Gold Protocol (see Appendix A), as an adjunct to a paracervical
block and NSAIDs would minimize pain (and anxiety) compared to pain
in women receiving paracervical block and NSAIDs alone during first tri-
mester uterine aspiration.
2. Methods
This randomized, parallel-group, double-blinded, three-arm trial
took place at a single abortion practice at Columbia University Irving
Medical Center (CUIMC). The CUIMC Institutional Review Board (IRB)
approved the study protocol and the study is registered with
ClinicalTrials.gov (NCT03391986). A single-arm pilot study, conducted
in 2015 with 37 patients in the same setting assessed feasibility,
workflow, and acceptability, and gave us experience using the Gold pro-
tocol prior to this randomized controlled study.
Eligible women were age 18 and older, English- or Spanish-speaking,
had pregnancies less than or equal to 13 0/7 weeks gestation, were
seeking first trimester uterine aspiration, and were willing to be random-
ized to receive auricular acupuncture, placebo, or usual care. Exclusion
criteria included congenital anomalies of the ear, and allergies or contra-
indications to adhesives, ibuprofen, or lidocaine.
After approval from the attending physician, as our IRB required, a
bilingual research assistant approached women after clinic registration,
explained the study, and obtained written consent. Enrollment occurred
in a private waiting room area immediately following registration so
that clinic flow would have minimal interruption and participation in
the study would not prolong participant visit time.
At enrollment, we collected demographic information, pregnancy
history, and acupuncture history (ever/never). Participants completed
100-mm visual analog scales (VAS) to report baseline pain and anxiety
level (0-mm = no pain/anxiety, 100-mm = worst pain/anxiety) [21].
VAS as an anxiety scale measure is correlated with measures
from Spielberger's State Trait Anxiety Inventory (STAI) [22]. Participants
entered their baseline information and VAS scores into a pre-
programmed electronic tablet from which all information was transmit-
ted directly into the study REDCap database.
After completing enrollment activities, participants continued with
their usual clinical care, undergoing a pelvic examination, an ultrasound
for gestational dating, and signing the procedure consent with the phy-
sician conducting the procedure. After the procedure consent was
signed, the interventionist opened a sequentially numbered, sealed,
opaque envelope containing the treatment group assignment without
disclosing the assignment to the participant, research staff, or procedure
staff. The three groups were: auricular acupuncture plus usual care, pla-
cebo plus usual care, or usual care alone. Study staff not involved in par-
ticipant recruitment determined the 1:1:1 allocation in blocks of 6 using
a random number table.
The interventionist followed a script to describe the intervention to
participants randomized to receive auricular acupuncture or placebo.
To maintain blinding, the interventionist script noted (correctly) that
the needles may not be felt [23]. After cleaning both ears with alcohol,
the interventionist placed Pyonex™ press needles 0.2 mm in diameter
x 1.2 mm in length on a 12-mm adhesive base (Seirin Corp. Shizuoka,
Japan). The interventionist placed the needles bilaterally, out of the
view of the participant, using the Gold protocol acupoints [cingulate
gyrus, thalamus, Point Zero, Shen Men, Cervix (only left ear), Uterus C
(only right ear)]. An image of left and right ears demonstrates these
points (Fig. 1).
For the placebo group participants, after similarly preparing both
ears, the interventionist placed three to four 12-mm adhesives, out of
the view of the participant, onto flat surfaces of each ear. The interven-
tion required about 3–5 min and the interventionist spent approxi-
mately the same amount of time with both acupuncture and control-
group participants. The interventionist then placed a surgical cap to
cover the ears of participants in all three groups, and exited the proce-
dure room. Two individuals performed all interventions: a licensed
acupuncturist (LM) or an obstetrician-gynecologist (CN). Abortion pro-
viders were not present during the intervention, and thus, they
remained blinded to group assignments. We maintained participant
blinding in the acupuncture and placebo groups, although participants
randomized to the ‘usual care’ arm of the study were aware of their
assignment.
All participants underwent uterine aspiration by an attending gyne-
cologist, family planning fellow, or gynecology resident. All patients re-
ceived ibuprofen 800 mg orally about an hour before the procedure, and
received a paracervical block with lidocaine 1% 20 mL immediately
before the procedure. Uterine aspiration was performed at gestational
ages less than or equal to 13 0/7 weeks.
Immediately following procedure completion, defined as speculum
removal, the interventionist returned to ask the participant to use the
tablet to record her maximum pain and anxiety scores using the same
100-mm VAS as at baseline. Participants responded to satisfaction ques-
tions with a Likert scale ranging from 1 = very dissatisfied to 5 = very
satisfied and participants also reported which treatment they believed
they had received. After data collection, the interventionist removed
all Pyonex™ needles or placebo adhesives. Participants received $25
for participation in the study.
The primary study objective was to evaluate auricular acupuncture
effectiveness as an adjunct to ibuprofen and paracervical block
for pain control during first trimester uterine aspiration. We compared
the maximum pain score, measured by VAS, between women random-
ized to receive auricular acupuncture plus usual care and women
randomized to usual care alone. We also compared maximum pain
 C. Ndubisi et al. / Contraception 99 (2019) 143–147 145

Fig. 1. Acupoints stimulated during this study of first-trimester aspiration abortion. White dots represent visible points on the outer ear surface and red squares represent points on the
inner ear surface. Each participant underwent stimulation of all 10 points.

scores between auricular acupuncture versus placebo, and placebo ver-
sus usual care. Finally, we compared maximum anxiety scores with the
same group comparisons: auricular acupuncture versus usual care, au-
ricular acupuncture versus placebo, and placebo versus usual care.
We sought to identify a between-group difference in maximum pain
score that would be clinically relevant: at least 15-mm on a 100-mm
VAS [21]. Guerrero el al [11], evaluated music as an adjunct to a
paracervical block that also used lidocaine 1% 20 mL during first trimes-
ter surgical abortion, and reported the mean maximum pain score in the
usual-care group to be 60 with a standard deviation of 25. To detect a
difference of at least 15-mm with 80% power and a two-sided alpha of
0.05, this study required at least 43 analyzable participants per study
group. We expected that approximately 20% of participants, enrolled
in the waiting room, would not have an aspiration procedure the
same day. Thus, we over-enrolled by 20% in anticipation of these losses.
The focus of the primary analysis was the difference in maximum
pain score between groups. Group assignments remained blinded
throughout the analysis. We used IBM SPSS Statistics for Windows,

Assessed for eligibility

(n=280)

Not Enrolled Enrolled but Not Randomized

Declined to participate (n=98) +Excluded due to no procedure (n=24)
Excluded due to ibuprofen allergy (n=3) Acupuncturist not available (n=2)

Randomized
(n=153)

Acupuncture + usual
Placebo + usual care Usual Care Alone
care
(n=50) (n=50)
(n=53)

*Excluded (n=1) *Excluded (n=1) *Excluded (n=1)

Final Analysis Final Analysis Final Analysis

(n=52) (n=49) (n=49)

Fig. 2. Participant flow chart for trial of women randomized to acupuncture plus usual care*, placebo plus usual care, or usual care alone during first trimester abortion (N=153). ⁎Usual
care consisted of ibuprofen 800 mg orally 1 h before the procedure and a paracervical block immediately prior to the procedure. +A procedure was not performed if participants had a
complete abortion, declined an office procedure, or wanted more time to consider her plan. *1 participant excluded from the usual care group due to a randomization error; 1
participant each from the remaining groups excluded due to a procedure not being completed after randomization.
146 C. Ndubisi et al. / Contraception 99 (2019) 143–147

Table 1 Twenty-six women who enrolled did not undergo randomization be-
Baseline characteristics of women randomized to acupuncture plus usual care, placebo cause either no procedure took place or no interventionist was available
plus usual care, or usual care alone during first trimester abortion (N=153).
at the time of the procedure (Fig. 2). Thus, we randomized 153 partici-
Variable Acupuncture Placebo Usual Care pants. We excluded three women, one in each group, after randomiza-
(n=53) (n=50) (n=50) tion. The final analysis included 150 participants: 52 participants in
Age (y), mean ± SD 31.0±6.8 28.7±6.9 30.9±7.6 the auricular acupuncture group, 49 in the placebo group, and 49 in
Parity, n (%) the usual care group (Fig. 2). Study enrollment occurred from August
0 21 (40) 16 (32) 17 (34)
2017 to May 2018.
1 12 (22) 18 (36) 13 (26)
2+ 20 (38) 16 (32) 20 (40) The baseline characteristics of the participants in all three groups
Pregnancy type were similar (Table 1). Participants ranged in age from 18–45 years
Induced abortion 39 (74) 34 (68) 33 (66) old, most identified as Hispanic (79%), and were insured by Medicaid
Spontaneous abortion 14 (26) 16 (32) 17 (34) (82%). Sixty-nine percent presented for induced abortion and 31% pre-
Race/ethnicity, n (%)
Hispanic 43 (81) 39 (78) 39 (78)
sented for care of a spontaneous abortion. Self-reported history of anx-
Non-Hispanic White 6 (11) 4 (8) 5 (10) iety or depression was uncommon (10.5% and 12.4% respectively).
Non-Hispanic Black 1 (2) 5 (10) 4 (8) Thirty percent reported any previous acupuncture use. Table 1 presents
Other* 3 (6) 2 (4) 2 (4) the baseline pain and anxiety scores.
Insurance, n (%)
The median maximum pain scores between the auricular acupunc-
Medicaid 43 (81) 41 (82) 41 (82)
Commercial 10 (19) 9 (18) 9 (18) ture, placebo, and usual care groups were meaningfully different [39.5
Education, n (%) (IQR 11, 64.5); 70.0 (IQR 40.5, 84); 71.0 (IQR 32, 91.5), respectively,
bHigh school 11 (20) 8 (16) 10 (20) pb0.01] (Table 2). The auricular acupuncture group median pain score
Completed high school 12 (23) 20 (40) 12 (24) was 31.5 mm lower than the usual care group, and similarly lower
Some college 12 (23) 12 (24) 12 (24)
than the placebo group. The auricular acupuncture group also reported
Bachelor or more 18 (34) 10 (20) 16 (32)
Employment⁎⁎, n (%) lower anxiety scores compared to both placebo and usual care groups
Working 30 (56) 30 (60) 22 (45) [11.5 (IQR 0.25, 30); 31.0 (IQR 2.0, 68.5); 44.0 (IQR 2.5, 80); respec-
School 3 (6) 4 (8) 7 (14) tively, p=.01] (Table 2).
Both 4 (8) 4 (8) 5 (5)
Pain and anxiety scores were highly similar whether the participants
Neither 16 (30) 12 (24) 15 (34)
Anxiety history⁎⁎, n (%) 5 (9) 7 (14) 4 (8)
received care from an interventionist who was a licensed acupuncturist
Depression history⁎⁎, n (%) 5 (9) 10 (20) 4 (8) or a gynecologist (data not shown). Results were also similar among
Acupuncture history, n (%) 20 (38) 10 (20) 16 (32) Spanish-speaking and English-speaking participants. Finally, results
Baseline pain, median (IQR) 0 (0, 5) 0 (0, 5) 0.0 (0, 44) were similar stratifying for diagnosis (spontaneous abortion versus in-
Baseline anxiety, median 50 (25–65) 50 (20–52) 50 (10–70)
duced abortion). We identified no acupuncture-related adverse events.
(IQR)
At exit from the study, 94% of women who underwent acupuncture
Includes women who self-identified as Asian (4), Hawaiian (1), Native American (3).
rated their overall care as good or very good compared to 76% in the
IQR – interquartile range.
⁎⁎ One woman declined to report employment history in the usual care group; one usual care group; 63% in the acupuncture group compared to 48% in
woman declined to report history of anxiety in the acupuncture group; two women de- the usual care group rated the “degree to which my pain was con-
clined to report history of depression in the acupuncture group. trolled” as good or very good.
About three-quarters of the 99 participants in both the acupuncture
(78%) and placebo (73%) groups correctly identified their treatment as-
version 24 (IBM, Armonk, NY, USA) to evaluate categorical variables signment. English-speaking women were more likely to identify their
with the Pearson chi-square test or Fisher's Exact test; for VAS treatment as placebo (63%), and Spanish-speaking participants were
scores, we used both non-parametric testing (Kruskal-Wallis and more likely to identify their treatment as acupuncture (68%). Within
Mann–Whitney tests) as well as analysis of variance (ANOVA). Due to the acupuncture treatment group, women who incorrectly guessed
VAS scores being non-normally distributed, we report median scores the treatment was placebo had higher pain scores than women who
as the primary outcome, but for ease of comparison with other studies, correctly guessed their treatment was acupuncture. Conversely, within
we also report mean scores in the Supplementary Table. the placebo group, participants who incorrectly guessed their treatment
was acupuncture had lower pain scores than women who correctly
guessed they had received placebo. These subgroup differences are
3. Results not suitable for statistical analysis because the subgroups are quite
small. Those who actually received acupuncture had lower pain scores
The study staff screened 280 women. One hundred one women de- than women who received placebo, no matter what they believed
clined participation, or were ineligible due to an allergy to ibuprofen. they had received.

Table 2
Pain and anxiety scores recorded immediately following first-trimester abortion among women randomized to acupuncture plus usual care, placebo plus usual care, or usual care alone
(N=150).

Variable Acupuncture (n=52) Placebo (n=49) Usual Care⁎ (n=49) p-value⁎⁎

Pain (mm on VAS)

Maximum pain, median (IQR) 39.5 (11, 63) 70.0 (1, 81) 71.0 (33, 90) b0.01
Change⁎⁎⁎ from baseline (IQR) +21.0 (1.5, 52.5) 51.0 (23, 79) 47.0 (20, 74) .01
Anxiety (mm on VAS)
Maximum anxiety, median (IQR) 11.5 (0.5, 30) 31 (2, 67) 44.0 (3, 80) .01
Change from baseline (IQR) −27.5 (−50, 2) 0 (−30, 10) 2.0 (−10, 30) b0.01

VAS – Visual analog scale, IQR = interquartile range.

⁎ Usual care included ibuprofen and paracervical block for all participants.
⁎⁎ p-value obtained by Kruskal-Wallis Test.
⁎⁎⁎ Change calculated as (post procedure pain – pre procedure pain) or (post procedure anxiety – pre procedure anxiety).
 C. Ndubisi et al. / Contraception 99 (2019) 143–147
4. Discussion
This randomized, three-arm trial demonstrated that women receiving
auricular acupuncture prior to uterine aspiration for first trimester abor-
tion reported a lower level of maximum pain during the procedure com-
pared to women receiving placebo or usual care alone. Participants
receiving usual care were not blinded. Participants assigned to the placebo
intervention and those assigned to usual care reported similar pain scores.
Most women assigned to the placebo intervention (73%) suspected they
did not receive acupuncture indicating that our attempted treatment
blinding had limited success. We asked women what treatment they
thought they had received after the abortion procedure was complete
and we did not ask specifically if they could feel any pinprick in their
ears; possibly, those women who experienced the most procedure pain
guessed they had not received the acupuncture, while those who experi-
enced less pain guessed they had received effective treatment with acu-
puncture. Since subgroup pain scores were lower in the acupuncture
group whether or not women identified their treatment correctly, a
placebo effect seems unlikely to explain the 30-point difference in the
post-procedure pain scores between the groups. In addition to the lower
pain scores, women receiving auricular acupuncture also reported lower
maximum anxiety scores compared to the placebo and usual care groups.
Minimizing use of opiates and benzodiazepenes for sedation, pain,
and anxiety is an urgent goal throughout medical care [23]. Auricular
acupuncture is a low-cost intervention compared to moderate or com-
plete sedation with anesthesia. Giving anesthesia requires staff licensed
to perform sedation along with equipment for intubation and monitor-
ing of heart and lungs, and the anesthetic agents themselves. Post-
anesthesia, women typically need transportation home which increases
costs and limits privacy. In contrast, this auricular acupuncture protocol
uses low-cost, sterile, single-use press-on needles, is easily learned in a
few hours, and in many states does not require additional licensure.
Other studies also suggest that acupuncture can provide relief for
peri-operative pain for gynecological surgical procedures and that
treated women used fewer pain medications in post op recovery and
at home [24,25]. The present study did not assess post-procedure pain
or analgesic use, an area for further study. Dysmenorrhea is cyclic uter-
ine cramping that may be similar to pain during uterine aspiration; ev-
idence that acupuncture may alleviate dysmenorrhea [17,20,26] adds
some plausibility to our findings that auricular acupuncture relieves
cramps associated with uterine aspiration.
In conclusion, our study demonstrated the Gold Protocol for auricu-
lar acupuncture was effective in reducing pain during a first-trimester
uterine aspiration. In addition, auricular acupuncture effectively re-
duced anxiety, a known modulator of perceived pain. Given these
promising results, exploring the efficacy of this protocol to manage
pain and anxiety associated with other gynecologic procedures such
as intrauterine device insertion and medical abortion will be useful.
Given the weak or inconsistent results in previous acupuncture studies,
a research priority should be to replicate these results before wide-
spread training and dissemination. Additional research is also needed
to explore the efficacy of using acupressure seeds or pellets as an
acupoint stimulant rather than acupuncture needles because using acu-
pressure would not be subject to the level of regulation that can prevent
widespread use of the needle intervention studied here.
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.contraception.2018.11.016.
Acknowledgements
The authors would like to thank Yongmei Huan, MD MPH for biosta-
tistical support, Grete King for illustration, and Margaret Carrasco Arias,
Isha Desai, MPH, and Yessica Estrella Vanderpool for research assistance.
147
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