Management of some

complications of induced
abortion.
by Dr Dambo D. T.
 INTRODUCTION

• Most hazardous procedure –unsafe abortion

• Unsafe Abortion- procedure of termination of pregnancy
either by a person lacking in the necessary skilled or in
an environment lacking the minimal medical standards or
both (WHO 1992)
• Clinically recognizable abortion -15-17% of pregnancies-
spontaneous or induced.
• Associated with complications
• Induced abortion on its own is a result of failure of the
complex often tricky balance act engaged in human to
reconcile 2 aspects their life-Sexual intercourse &
wish/reluctance to make babies.
 Burden of the problem
• 26-53 million induced abortion annually
• 40% in countries with restrictive laws
• In Nigeria,
.Abortion rates 25 per 1000 women ,
.610,000 abortion per year.
. 40 % of maternal deaths
• Netherlands – 5 per 1000 women.
 Complications
• EARLY • LATE
-Incomplete abortion • -Chronic pelvic inflammatory disease
-septic abortion • -pelvic adhesions
-septic shock • -chronic tubo-ovarian masses
-Injury • -chronic pelvic pain
-vagina, cervix, uterus • -tubal occlusion
-perforation of large /small bowels • Ectopic Gestation
-Acute renal failure • Infertility
-Dissseminated intravascular coagulation • Asherman’s syndrome
-Haemorrhage -infertility
-pelvic abscesses -oligomenorrhoea /amenorrhoea
-septic pelvic thrombophlebitis -intrauterine adhensions
-Septic arthritis
-Tetanus • Psychological factors
Adult respiratory distress syndrome -grief
• Death -regrets
-dejection

•
 Clinical presentation of septic
abortion
• HISTORY:
Hx. of an abortion may or may not be volunteered
There is usually high grade fever
Generalized, Suprapubic, lower abdominal or low back pain
Offensive vaginal discharge
EXAMINATION:
General-Pale, febrile, jaundiced, furred tongue, offensive
CVS-tachycardia and hypotension
Abdomen- guarding, tenderness; generalized or
suprapubic, may be distended with free peritoneal fluid,
reduced bowel sounds
 EXAMINATION Continued
• V/E: There may or may not be bruises on vulva
Vagina is usually hot
Cervical Os may be open or closed
Uterus and adnaexae are usually tender
Pouch of Douglas may be full and tender
Cervical motion tenderness is usually positive
Gloved examining fingers are usually stained
with offensive bloody vaginal discharge
 INVESTIGATIONS
• Full blood count, Hb genotype
• Platelet count and clotting time
• Blood grouping and cross-matching, Rh. Status
• Urinalysis + urine M/C/S
• Serum E/U/Cr
• Abdomino-pelvic USS;
Retained products of conception, abdomino-pelvic
abscesses, peritonitis (dilated bowel loops), gas in the
pelvis and fluid in the pouch of Douglas etc.
• Plain erect abdominal X ray;
gas, foreign body, uterine perforation
 TREATMENT
• Serious gynaecologic emergency that requires the
involvement of senior members of the team as early as
possible.
• Adequate resuscitation is of vital importance
Crystalloids or colloids
Blood transfusion as necessary
Strict input/output chart
Antibiotics-Triple Regimen;
Intraveinous Ampiclox 1-2gm 6hrly for 24- 48hrs
Metronidazole 500mg 8hrly for 24-48hrs
Gentamycin 80mg 8hrly for 5 days
 TREATMENT Continued
• Other useful antibiotics;
Cephalosporins-I.V. cefuroxime 750-1500mg 6-8 hourly for 24-72 hrs,
Ofloxacin, ciprofloxacin 400mg daily
• Evacuate the uterus after 24hrs of commencement of antibiotics.
Switch over to oral antibiotics when appropriate as determined by culture and
sensitivity results.
ERPC should be done under general anaesthesia and extreme cautioned
should be taken not to perforate the uterus if it has not been perforated
already.
• Analgesia;
I.M Pentazocine 30mg 4-6 hrly with I.M promethazine 25mg 8-12hrly 24-48hrs
• Tetanus prophylaxis;
Tetanus toxoid 0.5mg stat, Human Immuno Tetanus Globulin 250-500 I.U. Stat
 INJURIES
• Genital tract laceration-vaginal • Perforation
cervix ,uterine perforation Observe closely,-
• Clinical features cardiovascular compromise.
• Bleeding, abdominal pains •
,marked suprapubic Antibiotics
tenderness, signs of • Present – laparotomy
intraperitoneal hemorrhage. • Laparotomy –Extent of injury
• Treatment Options and effect repairs
• Prompt resuscitation, -hysterectomy
• Repair of vaginal/cervical -extensive damage
lacerations
-clostridium infection
-gangrene/necrosis
-drainage and peritoneal
lavage did not produce an
improvement in condition
 Abscesses and intestinal injuries
• Massive pelvic and abdominal
abscesses
-pouch of douglas, paracolic
gutters,general abdomen
Clinical features
-unrelenting fever, abdominal
distensions, absent or reduced
bowel sounds
Investigations
FBC,U/S scan, Erect plain
abdominal X ray
MGT
• Co-management with the
surgeons
- antibiotics, laparotomy –
midline incision
- N/B No place for culdotomy
- -bowel resection and
anastomosis, colostomy
-Drainage of abscesses
-irrigation of abdomen with normal
saline
-Fascia closed with non
absorbables
-Massive Antibiotics
 Prevention of unsafe abortion
• Preventable cause of maternal mortality
and morbidity
• This involves:
- prevention of unwanted pregnancies
- increasing access to safe abortion
practices
- effective management of abortion
complications through post abortal care
 LEVELS OF PREVENTION
Primary
-provision of reproductive health information and
choices
-prevention of unplanned and unwanted
pregnancies
-provision of quality sexuality education to all
ages.
-Provision of sustainable contraceptive delivery
service.
- National policies on adolescent reproductive
health should be formulated.
• Secondary
-programmes /activities aimed at providing
information and counseling to women
experiencing unwanted pregnancy
N/B: Not available b/c of restrictive laws
Tertiary care
-Provision of services for treatment of
complications of unsafe abortion in 10,20 and 30
health facilities.
 POST ABORTION CARE (PAC)

• Post abortion care is an approach for

reducing morbidity and mortality from
incomplete and unsafe abortion and its
complications and for improving women's
sexual and reproductive health and lives
 Components of post abortion care
• Emergency treatment services for complications
of spontaneous or unsafe abortion.

• Post abortion family planning counseling and

services

• Links between emergency abortion treatment

services and comprehensive reproductive health
care
• Community participation and education about
PAC.
THANKS