Made simple

1. MANAGEMENT OF
ABORTION
CapaCare Masanga

2. Threatened Abortion
 Conservative with bed rest and reassurance till
bleeding stops.
 Sexual intercourse best avoided.
 Follow up with ULTRASOUND-presence of fetal
cardiac activity predicts good outcome in 95%of
cases.
 Hormone therapy -400mg natural progesterone
in 2divided doses orally or vaginally on
empirical basis.
 Anti D if mother is Rh negative and pregnancy is
beyond 12 weeks.

3. Inevitable Abortion
 Immediate evacuation of pregnancy.
(If duration of pregnancy less than 12 weeks-
suction evacuation and greater than 12 weeks
oxytocin infusion.)
 Shock-resuscitation with i/v fluids and blood
transfusion.
 Prophylactic antibodies and anti-D.

5. Suction abortion

9. Incomplete Abortion
 Resuscitation if patient is in shock and
evacuation by suction evacuation.
 If the os is closed PGE1 tablets are kept in
vagina for ripening the cervix.
 Prophylactic antibodies and anti D

10. Complete abortion
 Conservative
 Anti D not indicated if pregnancy is less than
12 weeks and there was no operative
intervention.

11. Missed Abortion
 Uterus evacuated as soon as possible. A
donor should be kept ready.
 If uterine size is less than 12 weeks of
gestation PGE1 tablets kept in vagina results
in spontaneous expulsion without the need of
surgical intervention.
 If more than 12 weeks, 6th or 12th hourly PGE1
tablets used vaginally results in spontaneous
expulsion or extra amniotic ethacridine
acetate.
 Anti D and antibiotics.

12. Septic Abortion
 Police notification if a criminal abortion is
suspected.
 Mild cases-broad spectrum antibiotics are
started and uterus evacuated.
 Severe cases-maintenance of perfusion and
ventilation.
 I/v infusion and CVP line is inserted
 Blood transfusion
 Oxygen given by nasal catheter.

13. CVP line

14. Septic Abortion(cont……..)
 Antibiotics commenced after taking a high
vaginal swab.
 Ampicillin,Gentamycin and Metronidazole/third
generation cephalosporin like cefotaxime or
cefuroxime with metronidazole or clindamycin.
 Evacuation of uterus after infection is
controlled.