COMPREHENSIVE ABORTION CARE Flashcards
Full meaning of the following
PAC
STIs
WHO
HIV
MTP
MVA
GA
FFH
FP
• PAC- Post abortion care
•STIs – Sexual transmitted infections
•WHO – World health organization
•HIV – Human immunodeficiency virus
•MTP – Medical Termination of Pregnancy
•MVA – Manual Vacuum Aspiration
•GA – Gestation Age
•FF – Fundal Height
•FP – Family planning
•Comprehensive abortion care (CAC) is an intervention proven to prevent maternal death or injury. Comprehensive abortion care (CAC) includes all of the elements of PAC as well as safe induced abortion for all legal indications (i.e. as allowed by national law).
Abortion
•It is a spontaneous loss of a fetus before it is viable (has the potential to survive outside the womb). i.e before 20 weeks
•WHO defines it as expulsion or extraction of an embryo or fetus weighing 500mg or less/approximately 24wks.
•For developing countries ˂ 28weeks
• Period of viability in Ghana— was defined as
⎯ From 28 completed weeks from the LMP, or
⎯ Birthweight greater than or equal to 1000g
Unsafe abortion
⎯ A procedure for terminating an unwanted pregnancy either by
persons lacking the necessary skills, or in an environment lacking the minimal medical standards, or both. (WHO (1992))
⎯ A procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills, or in an environment lacking the minimal medical standards, or both, and which causes, or is likely to cause acute or chronic ill-health or impaired reproductive function, or even death.
Spontaneous abortion (miscarriage)
Risk factors
• Reproductive history (increasing parity, hx of previous miscarriages, etc)
• Maternal age—frequency of clinical miscarriage increases with increasing maternal age
• Paternal age—rate of clinical miscarriage increases with increase in paternal age
Causes of miscarriage
• Clinically, miscarriage is categorised as early (first trimester) and late (second trimester)
• More than 80% of clinical miscarriage occur in first trimester, with majority of this occuring in the embryonic period (6-8 weeks).
First trimester causes
•Chromosomal
•Immunological factors
•Hostile endometrium
•Luteinizing hormone hypersecretion during follicular phase
Second trimester causes
•Cervical incompetence
•polycystic ovary syndrome (PCOS) - Polycystic ovary syndrome (PCOS) is a condition where the ovaries are larger than normal. It’s caused by hormonal changes in the ovaries.
•Infections such as bacterial vaginosis, HIV, syphilis, chlamydia
•Fibroids
•Endocrine factors such as uncontrolled diabetes mellitus and hypothyroidism
Both trimester causes
•Idiopathic causes
•Febral illness such as severe malaria
•Lower genital tract infection
CLINICAL CATEGORIES OF MISCARRIAGE
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Epidemiology
•The true incidence of spontaneous abortion is not clearly known but at least 15-20% of all pregnancies end in spontaneous abortion.
•More than 50% of all conception losses in the first 12 weeks are due to chromosomal anomalies of the zygote, embryo, early fetus or at times the placenta
•Illegally performed abortions are unsafe, and are important cause of maternal deaths being responsible for up to 13% of maternal death worldwide.
•In Ghana unsafe abortion contributes up to 15% of all maternal deaths annually.
Classification of Abortions
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Missed abortion is also called blight ovum
Causes of abortion
Causes of abortion
•Abnormal conceptus
•Chromosomal abnormalities
•Structural abnormalities like neural tube
•Uterine abnormalities
•Congenital malformation
•Uterine fibroid
•Cervical incompetence
•Second trimester abortion
•Endocrine diseases
•Luteal phase abnormalities
•Thyroid disease especially hypothyroidism
•Poorly controlled diabetes mellitus
•Infections
•Trans placental infections including STIs
•Acute maternal infection leading to high temperature
•Toxic/ environmental factors
•Alcohol, smoking
•Toxics like anesthetic gases, organic solvent and heavy metals (mercury, lead)
•Trauma
•Direct injury
•Major surgery
•Unknown
Pathophysiology
Pathophysiology
•Hemorrhage occurs in the basalis and necrotic changes in the tissue adjacent to the bleeding usually accompanies abortion.
•The ovum detached and this stimulates uterine contraction that results into expulsion.
Management
Management
**First thing to do is to take a scan
Threatened abortion
•Adequate bed rest at home
•Avoid strenuous activities and sexual intercourse
•Schudele a follow up within 7 days
•Return if;
•Heavy bleeding
•Offensive discharge
•Severe abdominal pain
Inevitable abortion
•ABC
•Do FBC, blood grouping, cross matching
•Give IV RL/NS 2litres (blood if needed)
•MVA if GA ˂ 12weeks
•Augment the process by administering oxytocin 20 IU in 500mls RL/NS at 40-60 drops/minute if GA ˃ 12 weeks
•Manage as incomplete if after augmentation some products of conception remain
Incomplete abortion
•Apply ABC
•Do FBC, Blood grouping, cross matching
•Give 2 litres of NS/RL (blood if needed)
•Evacuation of product of conception
•MVA if GA is ˂ 12weeks
•D&C if GA is ˃ 12 weeks
Complete abortion
•Give amoxicillin 500mg tds for 5 days
•Metronidazole 500mg tds for 5days
•Fefol 1 tb bd for 3 months and reassess after every 4 weeks
Septic absortion
•Do FBC
•Endocervical swabs for CS
•Evacuate the uterus with sharp wide curette
— Pharmacology
•Ampicillin 1g iv 6hrly for 24 – 48 hours
•Metronidazole 500mg 8hrly for 24 – 48 hours
•Gentamicin 80mg iv 12hrly for 7 days
•After CS result treat accordingly
Missed abortion
•Abdominal pelvic ultrasound scan
•Induce with misoprostol if ˃ 12 weeks
•Evacuate if ˂ 12 weeks
•After evacuation
•Give amoxicillin 500mg 8hrly for 5 days
•Metronidazole 400mg 8hrly for 5 days
Investigation
Investigation
•B-hCG (urine and quantitative)
• USG (transabdominal, transvaginal)
• Others, depending on the situation
Complication
Complication
•Anemia
•Sepsis
•Depression
•Uterine perforation
•Ectopic pregnancy from blockage and damage to tube
•Tubal infertility
•Pelvic infection
Postabortal care (PAC)
Postabortal care (PAC)
•For women/ girls who wants children immediately after birth, WHO recommend waiting for at least 6 months
•It is an approach from reducing morbidity and mortality from complication of unsafe and spontaneous abortion
The PAC essential elements
•Treatment
•Counselling
•Contraceptive + family planning
•Reproductive and other health services
