Transcript Abortion Complications

Abortion Complications
Global Abortion Statistics
• Approximately 50 million unintended
pregnancies are terminated each year.
• An estimated 20 million are terminated in an
unsafe condition.
• An estimated 68,000 women die every year from
unsafe abortion.
• Safe abortion counts only for an estimated 1,300
deaths.
Abortion rate & trend in USA
Abortions Rate By Gestational Age
Abortion Statistics in USA
• Fifty-two percent of U.S. women obtaining abortions
are younger than 25.
• Black women are almost four times as likely as white
women to have an abortion, and Hispanic women are
2.5 times as likely.
Missing
ectopic
pregnancy
• The abortion• rate
among
women
living below the
federal poverty level ($9,570 for a single woman with
no children) is more than four times of women with
income of 300% above the poverty level (44 vs. 10
abortions per 1,000 women)
None-surgical Abortion
Indications other than elective abortion:
• When surgical abortion fails, ie uterine fibroids
and cervical stenosis.
• Induction of labor in second trimester.
• Mifeprestone is used for emergency
contraception, endometriosis and shrinking
fibroids.
None-surgical abortion
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Sonogram to confirm IU pregnancy.
History & physical
Social History
Consent form
Medications:
Methotrexate for very early pregnancy, ectopic, cervical
& intramural
• Mifeprestone(RU486) 600 vs. 200 mg.
• Misoprostol 800 mcg vaginal
None-Surgical Abortion
Complications
• Clostridium sordelli toxic shock syndrome:
• C. sordellii is a gram-positive anaerobe and is part of
the normal vaginal flora in about 5-l0% of women
• Septic shock syndrome: acute respiratory distress
syndrome, and multiple organ failure are consequences
of a poorly controlled inflammatory response to
infection or injury.
• Treatment: Clindamycin combined with.., TAH BS&O,
Antitoxin, and resuscitative measures.
None-surgical abortion
complications
• Other complication;
• Failed Abortion, with Mifeprestone or
Methotrexate
• Incomplete abortion
• Bleeding and Infection.
• Exacerbation of asthma and hypertension.
• Lack of access to medical care, issues.
Surgical Abortion Complications
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Factors precipitating abortion complications:
Surgeons’ inexperience.
Inadequate anesthesia.
Gross obesity.
Cervical anomalies and stenosis (infantile cx)
Uterine anomalies.
Placentation anomalies.
Inadequate workup of the patient
Previous cervical and uterine surgeries Leep, C/S
Surgical Abortion Complications
• Errors in proper diagnosis:
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False positive pregnancy test (inflammatory bowel disease).
Gestational age errors
Pseudo sac.
Didelphic uterus
Ectopic pregnancy
Gestational Trophblastic Disease
Prevention: confirming pregnancy by a vaginal and or abdominal
ultrasound.
• Post operative sonogram
Surgical Abortion Complications
• Anesthesia complications:
• Local: inadequate pain management, seizure,
allergy, and anaphylaxis.
• Sedation and general anesthesia: hypoxia, apnea,
aspiration …
Surgical Abortion Complications
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Cevical injuries:
Laceration, tenaculum tears.
fracture secondary to excess and forceful dilatation.
Bleeding due to trauma and cervicitis.
Cervical stenosis.
False tunneling.
Extreme flexion of the cervix, and ensuing perforation.
Surgical Abortion Complications
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Uterine Complications:
Failed Abortion.
Incomplete abortion.
Bleeding.
Trauma: perforation, scaring, fistula, and
infertility.
• Infection.
• Retained boney fragments in uterus and cervix
Surgical Abortion Complications
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Uterine Bleeding:
Recognition from cervical bleeding.
Trauma and atony.
Uterine atony, grand mutiparous,
Rx Misoprostol before and after the procedure,
Methergin, and Hemobate IV.
• Bleeding disorders
• Post abortion syndrome (hematometria)
due to excessive cervical flexion,
• Pre-operative bleeding due to Misoprostol.
Surgical Abortion Complications
• Uterine perforation:
• locations , instrument type ie canula, curette,
forceps, and sound.
• Treatment:
• Observation, antibiotics, laparoscopy,
Laparotomy, hysterectomy, adenexectomy, and
bowel resection .
Second Trimester
• Cervical dilation is the hallmark.
• Laminaria, Foley catheter., Mifeprestone and Cytotech
• Color Doppler sonogram in cases of previous uterine
surgeries, to R/O accreta
• Amniotic fluid emboli, and DIC
• Grand multiparous do sonogram for Placenta accreta &
percreta
• Previous perforation and accreta percreta
Preventive Measures
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Ultrasound.
Medications.
Preoperative evaluation & examination.
Adequate anesthesia.
Adequate cervical dilation.
Surgical techniques.
Patients’ follow up and ultrasound
Preventive Measures
• Pelvic ultrasound
• Vaginal, vs. abdominal,
• Preoperative, intra, postoperative, & on follow
up
• Color Doppler flow to R/O accreta & percreta
• Placental localization in previous C/S
Preventive Measures
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Medications:
Narcan & Romazicon.
Misoprostol.
Mifeprestone.
Antibiotics Doxycycline, Metronidazole.
Preventive Measures
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Surgical technique:
Examination.
Dilation and dilator.
Suctioning: upper vs. lower segment
Canula: size, drawing vs. pushing.
Sounding: none.
Curettage: for exploration.
Pace of the procedure.
Physicians Shortage
• Medical students for choice.
• Residents training.
• Family planning fellowships.