Abortion and its Complications

Clinical Description

Loss of pregnancy before viability (gestational age less than 28 weeks or fetal weight less than 500g)

Signs and Symptoms

• Threatening: LAP, PV bleeding, no POC passed cervical os closed
• Inevitable: LAP, PV bleeding, no POC passed, cervical os open
• Complete: LAP, pv bleeding, POCs passed, os closed.
• Incomplete: : LAP, pv bleeding, some POCs passed, os open.
• Missed: Incidental finding of empty gestation sac or absent fetal cardiac activity on

USS with no symptoms.

• Septic: Incomplete with features of sepsis and foul smelling POCS or discharge.

MANAGEMENT: OPTIONAL

Complications

Post abortal haemorrhage

• Resuscitate and stabilize the patient
• Carry out vaginal examination
• Remove products of conception and/or foreign bodies
• Give Oxytocin 10 units IM
• Give Misoprostol 600mcg PO or 400mcg sublingually
• Comprehensive post abortal management plan
• Counselling for contraception, HTC, future fertility plans/pregnancy care
• Cervical cancer screening
• STI/HIV prevention and treatment

Missed miscarriage:

• Accelerate expulsion of the fetus with 200mg mifepristone as a single dose followed by 800mg misoprostol 48 hours later in first trimester (if mifepristone is not available, use misoprostol alone)
• REFER TO FIGO TABLE FOR A DOSES OF MISOPROSTOL

Inevitable

• Oxytocin 10IU in 1l in the second trimester or Await spontaneous expulsion.

Incomplete:

• MVA in the first trimester. Uterine evacuation for second trimester. For all cases of evacuation or MVA give prophylactic antibiotics prior to surgery: Give single STAT dose Doxycycline 400mg PO and Metronidazole 400mg PO

Complete

• Give single STAT dose Doxycycline 400mg PO and Metronidazole 400mg PO
• If patient is able to take PO medication, then provide full course of antibiotics.
• give Doxycycline 100mg 12 hourly for 7 days and Metronidazole 400mg 8 hourly for 7 days IV antibiotics
• If patient is septic
• Give Ceftriaxone 2g iv daily and Metronidazole 400 mg 8 hourly
• OR Ampicillin 1g 6 hourly/ Benzyl penicillin 2 MU IV 6 hourly, Gentamycin 240mg daily, Metronidazole 5 00mg 8 hourly IV fluids:

N/S or RL

• MVA in the first trimester and blunt curettage in the second trimester