Managing Abortion Complications

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Managing Abortion Complications

When appropriately trained personnel perform abortion, complications are rare. Nevertheless, every service delivery site at every level of the health system should be equipped and have personnel trained to recognize abortion complications and to provide or refer women for prompt care, 24 hours a day (world health organization 1994) facilities and skills required to manage abortion complications are similar to those needed to care for women have had a miscarriages.

Incomplete abortion

Incomplete abortion is uncommon with vacuum aspiration when a skilled provider performs the abortion. It is more common with medical methods of abortion. Signs and symptoms include vaginal bleeding, abdominal pain and signs of infection.

It should also be suspected if, upon visual examination, the tissue aspirated during surgical abortion does not confirm to estimate duration of pregnancy. Staff at every health care facility should be trained and equipped to treat incomplete abortion by re-evacuating the uterus with vacuum aspiration, paying attention to the possibility of hemorrhage or infection.

Failed abortion

Failed abortion can occur in women who have undergone either surgical or medical methods of abortion. If, at the follow-up visit after either type of procedure, the pregnancy is continuing, termination of the pregnancy requires vaccum aspiration or D&E for second-trimester pregnancies.

Hemorrhage

Hemorrhage can result from retained products of conception, trauma or damage to the cervix or, rarely, uterine perforation. Depending on the cause, appropriate treatment may include re-evacuation of the uterus and administration of uterotonic drugs to stop the bleeding, intravenous fluid replacement and in severe cases, blood transfusion laparoscopy or exploratory laparotomy.To reduce of the incidence of hemorrhage it is advised to use oxytocins routinely.If hemorrhage is heavy it constitutes an emergency. However, every service delivery site must be able to stabilize and treat or refer women with hemorrhage as quickly as possible.

Infection

Infection rarely occurs following properly performed abortion. Common symptoms include fever or chills, foul-smelling vaginal or cervical discharge, abdominal or pelvic pain, prolonged vaginal bleeding or spotting, uterine tenderness, and/or an elevated white blood cell count. When infection is diagnosed, health care staff should administer antibiotics and, if retained products of conception are a likely cause of infections, re-evacuate the uterus,. Women with severe infections may require hospitalization. As discussed in section other sections, prophylactic prescription of antibiotics has been found to reduce the risk of post-abortion infection and should provide where possible.

Uterine perforation

Usually, uterine perforation goes undetected and resolves without the need for intervention. A study of more than 700 women undergoing concurrent first-trimester abortion and laparoscopic sterilization found that 12 out of the 14 uterine perforations were so small that they would not have been recognized had laparoscopy not been performed. Where available, laparoscopy is the investigative method of choice. If the laparoscopy examination and/or the status of the patient give rise to any suspicion of damage to bowel, blood vessel or other structures, a laparotomy to repair damaged tissues may not be needed.

Anesthesia –related complications

Local anesthesia is safer than general anesthesia, both for vacuum aspiration in the first trimester and for dilatation and evacuation in the second trimester. Where general anesthesia is used, staff must be skilled in stabilization management of convulsion and impairment of cardio respiratory function. Narcotic reversal agents should always be readily available.