perinatologist Safe abortion WHO abortion in countries where abortion law is not restrictive abortion is legally permitted for social or economic reasons or without specification as to ID: 934574
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Slide1
UNSAFE ABORTION
Dr.Nooshin-Eshraghi
perinatologist
Slide2Safe
abortion
WHO :abortion
in countries
where
abortion law is not restrictive (abortion is legally permitted for social or economic
reasons
or
without
specification as to
reason
Slide3unsafe
abortion
performed
by people
lacking
the necessary
skills
using
hazardous
technique
in
an environment that does not meet minimum medical standards.
Slide4PREVALENCE AND EPIDEMIOLOGY OF UNSAFE ABORTION
It is estimated that 25 million unsafe abortions occur worldwide, and 97 percent of these abortions occur in the
developing world
Slide5women
themselves induce
,classified into four broad categories:
oral and
injectable
treatments
;
preparations placed in the cervix,
vagina, or rectum
intrauterine instrumentation
;
trauma
to the abdomen
Slide6Oral and
injectable
:
metal
salts, phosphorus, lead, kerosene, turpentine, detergent
solutions
uterinestimulants
(
misoprostol
or
oxytocin
)
Preparations placed in the cervix, vagina, or rectum include
:
potassium permanganate tablets,
herbal,
misoprostol
, enemas.
Slide8Instrumentation
:
catheter
insertion followed by infusion of alcohol,
saline…..
insertion of foreign bodies such as coat hanger, knitting needle, stick crochet
hook.
Slide9Trauma to the abdomen
:
self-inflicted blows
abdominal
massage
jumping from a
height
lifting heavy weights.
Slide10Misoprostol
in
successful
abortion
causes
uterine bleeding by initiating the abortion process without the risks of instrumentation
Slide11side effects:
high
fever, shaking chills, abdominal cramping, vomiting, diarrhea, tremor, agitation, confusion,
rhabdomyolysis
, hypoxemia, and hypotension
.
Slide12toxicity
have been
reported
Mild to moderate toxicity symptoms have been reported with doses of 3 mg to 8.5 mg
Slide13Reported:
stomach
necrosis, distal esophagus, upper gastrointestinal bleeding, sepsis,
multiorgan
failure, and ultimately death after ingesting 12 mg of
misoprostol
These
doses are much higher than the recommended guidelines for safe abortion
Slide14Factors that increase morbidity and mortality at the time of unsafe abortion include
Lack of provider skill
●Poor technique
●Unsanitary
conditions
●Lack of appropriate equipment
Slide15●Use of toxic substances
●Poor maternal health
●Increasing gestational age
●Lack of access to
postabortion
care
Slide16Death
One in eight pregnancy-related deaths worldwide is the result of unsafe abortion
and
an estimated 47,000 women die every year from unsafe abortion
Slide17Hemorrhage
Hemorrhage is the most common complication of unsafe abortion, and may result in
hypovolemic
shock,
coagulopathy
, and death
Slide18Infection
Infection related to unsafe abortion is caused by retained products of conception, trauma, and
nonsterile
techniques
.
sepsis, septic shock, organ failure, disseminated intravascular coagulation, and future sterility
Slide19Incomplete abortion
more
common
:
self-induced abortion
,abortion
by an untrained provider, at later gestational ages, in the presence of uterine anomalies, or with distorting uterine pathology (
eg
, uterine
leiomyomas
).
Patients generally present with bleeding or infection
Slide20Trauma
Vaginal and cervical lacerations generally present with overt vaginal bleeding; however, internal bleeding can mask the total estimated blood loss.
Lacerations
to the cervix and lateral uterus are particularly dangerous due to the risk of lacerating one of the vessels in the
parametrial
space
.
Slide21MANAGEMENT OF COMPLICATIONS
Initial
evaluation:
assessment
of vital signs, gestational age, vaginal bleeding and total blood loss, vaginal discharge, and examination for signs of uterine infection
Slide22.
Stabilization
airway
and respiratory
stabilization
fluid
resuscitation
management of pain,
control
of bleeding with uterine massage,
uterotonic
agents (
eg
,
misoprostol
800
mcg)
or
methylergonovine
0.2mgintramuscularly)
placement of a vaginal/intrauterine pack an intrauterine balloon
Slide23Signs of potential surgical emergency include:
●Heavy bleeding
●Abdominal pain
●
Shock
Slide24Laparotomy
is needed to repair lacerations extending into the peritoneal cavity and trauma to
intraabdominal
organs and blood vessels
.
In stable patients, initial laparoscopy may be appropriate to assess
intraabdominal
trauma if
bleeding is controlled and bowel and blood vessels are intact.
Slide25retained
products
are suspected:
the patient should first undergo surgical evacuation of the uterus using suction evacuation or dilatation and evacuation
.
Antibiotics
should be given prior to instrumentation.
use
broad spectrum antibiotics that have anaerobic coverage
Slide26septic
abortion
:
fever, chills, malaise, abdominal pain, vaginal bleeding,
anddischarge
Physical
examination
:tachycardia
,
tachypnea
, lower abdominal
tenderness,
tender uterus with dilated cervix.
Slide27Infection
:
Staphylococcus
aureus
, Gram negative bacilli, or some Gram positive
cocci
. Mixed infections, anaerobic
organisms
Slide28Antibiotic therapy and evacuation of the uterus are the mainstays of management.
Slide29The route of
antibiotic,
depends on degree of infection.
Postabortal
infections are typically
polymicrobial
and thus a broad-spectrum antibiotic is needed
Slide30oral
regimen
:
the
patient is clinically stable, not
immunocompromised
, does not have signs of a pelvic
abscess
Slide31option
for patients with mild to moderate pelvic inflammatory disease (PID) is one dose of
cefoxitin
2 grams intramuscularly plus one dose of
probenecid
1 gram orally, followed by
doxycycline
100 mg twice daily orally for 14 days
Slide32DIC
:
is a rare but life-threatening complication of abortion
.
It is associated
with,
excessive blood loss, and amniotic fluid embolism.
Slide33DIC can be diagnosed by drawing a 10 cc tube of whole blood and assessing whether it forms a stable clot after 10 minutes without movement of the tube
.
Slide34