Original Publication
Open Access

Simulation for Managing Hemorrhage as a Complication of Uterine Aspiration

Published: December 7, 2015 | 10.15766/mep_2374-8265.10296

Included in this publication:

  • Instructor's Guide.pdf
  • Clinic Simulation.pdf
  • Equipment List.pdf
  • Human Simulation Template.pdf
  • Managing Hemorrhage as a Complication of Uterine Aspiration.ppt
  • Pre-Post Complication Evaluation.pdf
  • Provider Observation Complication Evaluation.pdf
  • Simulation Photo Diagrams.pdf
  • Ultrasound Images for Complication Simulation.pdf

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: More than half of pregnancies experienced by U.S. women are unintended, one in five ends in miscarriage, and one in four ends in abortion. Uterine aspiration is a procedure used to manage miscarriage or incomplete or therapeutic abortion. Because complications of uterine aspiration are rare, trainees may benefit from supplemental complication training. To practice managing hemorrhage as a complication of uterine hemorrhage, this training module uses a fruit (i.e., pitaya/dragonfruit) model for practicing hands-on skills, cases, and a helpful mnemonic (6 Ts) for learning causes and management steps. Methods: The instructor uses the provided PowerPoint to review safety, potential risks, and complications of uterine aspiration. Next, the instructor undertakes fishbowl demonstration of uterine aspiration using a case complicated by hemorrhage. An interactive brainstorm helps review causes and management steps for hemorrhage, using the 6 Ts mnemonic for causes (i.e., tissue, tone, trauma, and thrombin) and management (i.e., transfer, treatment) of bleeding. Next, learners split into groups of three (provider, assistant, and evaluator) so each can practice and be evaluated on integration of all management steps. The larger group then reunites to discuss pitfalls and keys for integration into clinical settings. Results: We evaluated the workshop among a group of medical and nursing professionals with varied uterine aspiration experience. A total of 46 learners participated in the trainings and session evaluations. Knowledge scores improved from pre- to posttest, with a mean overall improvement of 9%. Further, 19 participants were asked additional questions following the training. The majority agreed that the simulation helped prepare them for specific skills of cannula test (94%), uterine tamponade with foley (94%), and assessment of the cervix for bleeding (83%). Discussion: Given the fact that complications of uterine aspiration are rare, trainees will benefit from this supplemental complication training. Compared to sophisticated models, this simulation is inexpensive and materials are easily attainable in most parts of the world. Pitaya fruit simulates both the grittiness of the uterus after aspiration, pliability of uterine involution, and those varieties with red pulp nicely simulate bleeding (although red food dye can also be added to saline). If pitaya is seasonally unavailable, papaya can also be substituted.

Educational Objectives

By the end of this session, learners will be able to:

  1. Review indications, safety, and risks of uterine aspiration.
  2. Recall the “6 Ts” mnemonic for hemorrhage to review causes (tissue, tone, trauma, thrombin) and management (treatment, transfer), with two action items for each T.
  3. Learn and practice skills of the cannula test and assessment of cervical bleeding used in management of postaspiration hemorrhage.
  4. Learn and practice uterine tamponade with a foley catheter or bakri balloon used in management of postaspiration hemorrhage.
  5. Review risk factors for postaspiration hemorrhage.
  6. Recognize significant ultrasound findings in hemorrhage.

Author Information

  • Suzan Goodman, MD, MPH: University of California, San Francisco
  • Sarah McNeil, MD: Contra Costa Regional
  • Grace Shih, MD: University of Washington School of Medicine

None to report.

None to report.


Goodman S, McNeil S, Shih G. Simulation for managing hemorrhage as a complication of uterine aspiration. MedEdPORTAL. 2015;11:10296. https://doi.org/10.15766/mep_2374-8265.10296