This document provides guidance on the management of different types of abortions: - Threatened abortions should be managed conservatively with bed rest, avoiding intercourse, ultrasound to check fetal heart activity, and potentially progesterone therapy. Anti-D should be given if the mother is Rh-negative. - Inevitable abortions require immediate evacuation of the pregnancy through suction or oxytocin depending on gestation. Shock may require resuscitation. - Incomplete, missed, and septic abortions also generally require uterine evacuation along with antibiotics and potentially ripening agents for the cervix. Resuscitation and blood transfusion may be needed in severe cases of septic abortion.

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.