Steps:

1. Obtain consent (verbal or written).
2. May premedicate with misoprostol 200mcg, 2 tabs pv the night before the procedure and/or Toradol or other NSAID po 30 minutes prior to procedure to prevent cramping.
3. Perform a bimanual examination to dertermine the position of the uterus.
4. Insert a vaginal speculum, and visualize the cervix.
5. Cleanse the cervix with Betadine swabs.
6. Introduce the Pipelle through the cervical canal, into the uterine cavity, and up to the fundus (a tenaculum may be used but is usually not necessary). If unsuccessful, use uterine sound to dialte cervical os.
7. Stabilize the sheath with one hand, and draw the piston completely back in one continuous motion to create negative pressure within the lumen.
8. Rotate the sheath between the thumb and index finger, and move it in and out between the fundus and the internal os three to four times. Slowly withdraw the Pipelle in a spiral fashion moving from the fundus toward the cervical os. Fill the lumen with tissue as completely as possible. Sometimes several passes may be required.
9. Withdraw the Pipelle. The tissue sample should resemble dark red worm-like material.
10. You may need to reinsert Pipelle and repeat steps 5 to 8 if tissue sample is insufficient.
11. Expel the sample into the formalin by advancing the piston into the sheath.
12. Remove the speculum from the vagina.