Induced Abortion

There are three major methods for termination of a pregnancy: instrumental evacuation by the vaginal route, stimulation of uterine contraction, and major surgical procedures. Complications occur in between 1 and 5 percent of cases,1112 and can be immediate, delayed, or late. Immediate complications, less than 24 h after the abortion, include bleeding and pain. Most immediate complications are arrested at surgery, but many present within 24 h to the emergency department. Retained products of conception, uterine perforation, and cervical lacerations are the most common causes of immediate bleeding and pain. Delayed complications occur between 24 h and 4 weeks post-abortion and include excessive bleeding, primarily due to retained products of conception, and post-abortive endometritis. Late complications include post-abortal amenorrhea, psychological problems, including depressions, and Rh isoimmunization.

If a cervical laceration is noted, treatment includes pressure followed by application of Monsel solution or use of silver nitrate sticks. Suturing may be necessary if there is no resolution of bleeding. Uterine perforation occurs in approximately 1 to 3 per 1000 abortion procedures. Most perforations are noted at the time of surgery and are asymptomatic. However, those that go unnoticed can present with pain and/or bleeding and possibly signs of shock. The incidence of retained products of conception is 0.5 to 1.0 percent. On physical examination, the cervical os is generally open. The uterus is usually boggy, enlarged, and tender. A pelvic sonogram should be obtained to evaluate the uterine cavity for retained products. Repeat dilatation and curretage is necessary. If coexistent endometritis is present, treatment with antibiotics is required for 10 to 14 days. Usual therapy includes "triple antibiotics" (ampicillin, gentamycin, and clindamycin) until the patient is afebrile for 24 to 48 h.

Post-abortal endometritis not associated with retained products of conception presents with a firm, yet tender uterus and closed cervical os. Uncomplicated endometritis requires antibiotics, as previously discussed, and possible reaspiration based on sonographic findings. Rh immune globulin should be given to Rh negative women after a spontaneous or induced abortion. If it is not prescribed, the overall risk of sensitization in the second pregnancy is approximately 3 percent.

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Essentials of Human Physiology

Essentials of Human Physiology

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