abortion and postabortion care and management.pptx

Abortion cand be spontaneous or induced

1. ABORTION AND POSTABORTION CARE BY MWITENDE FRANCINE

2. Objectives By the end of the presentation members should be able to: Define abortion Mention the types of abortion Describe the causes of abortion Explain the management of abortion State the components of post abortion care

3. Definition Abortion is the termination of pregnancy before the period of viability which is considered to occur at 24th week of gestation. For International acceptance, the limit of viability is brought down to either 20th week or fetus weighing 500gm. If the expelled fetus weighs less than 500gms it is called abortus . In an African setting and more especially Uganda fetal viability is considered to begin from 28 weeks of gestation Its an obstetrical emergency

4. Definition Miscarriage is the abortion that occurs spontaneously Miscarriage and abortion can be used interchangeably INCIDENCE: 75% abortions occur before the 16th week and of these, about 75% occur before the 8th week of pregnancy.

5. Causes of abortion Causes of abortion are divided into: Ovular or fetal Maternal environment Paternal factor Unknown Causes can also be classified depending on age of gestation as early miscarriages (below 12 weeks of gestation) or late miscarriages ( 12-28 weeks )

6. CLASSIFICATION OF ABORTION Spontaneous . Recurrent Threatened inevitable Complete Incomplete Missed Septic Induced Legal ( therapeutic) Illegal(Criminal)….. Septic - common

7. Induced abortion The medical indications of termination of pregnancy (therapeutic abortion) include; When the continuation of pregnancy may threaten the life of the woman or seriously impair her health When pregnancy has resulted from rape or incest When the continuation of pregnancy is likely to result in the birth of a child with severe physical deformities or mental retardation

8. Threatened Abortion : It is a clinical entity where the process of abortion has started but h as not progressed to a state in which recovery is impossible . Clinical Features: Bleeding per vagina, Bleeding is usually painless but there may be mild backache or dull pain in lower abdomen.

9. Inevitable Abortion Inevitable Abortion: It is the clinical type of abortion where the changes have progressed to a state from where continuation of pregnancy is impossible. Clinical features : Increased vaginal bleeding, aggravation of pain in the lower abdomen. Internal examination reveals dilated internal os of the cervix through which the products of conception are felt.

10. Inevitable Abortion Principles of Management : Pain mgt : Morphine 15mg is given intramuscularly. Excessive bleeding should be promptly controlled by administering methergin 0.2mg if cervix is dilated and the size of the uterus is less than 12 weeks. The shock is corrected by intravenous fluid therapy and blood transfusion. Management; bed rest, manage as incomplete if products of conception remain. If gestation is <12wks, Manual Vacuum Aspiration (MVA) is done. If >12wks, labor is augmented

11. Incomplete Abortion The fetus is expelled but some products of conception are retained Signs and symptoms ; Heavy and profuse vaginal bleeding Severe abdominal cramps Visible products of conception Cervix is open Fundal height not corresponding with weeks of amenorrhoea Management; dilatation and curettage to remove all the tissues

12. Incomplete Abortion Evacuation is done; If gestation is <12wks, Manual Vacuum Aspiration (MVA) is done. If >12wks, labor is augmented Administer antibiotics Analgesics for pain mgt Replace blood if required Hydrate as required

13. Complete Abortion There is complete expulsion of the products of conception The woman gives a history of heavy vaginal bleeding followed by expulsion of products of conception and light bleeding thereafter On examination the uterus may fill smaller compared to the weeks of amenorrhea The cervix is closed

14. Missed Abortion The fetus dies but does not get expelled from the uterus It may be retained for several weeks Signs and symptoms Amenorrhea may persist in many women but there could be slow progressive bleeding in other women Signs of pregnancy may disappear although the size of the uterus can be maintained

15. Septic Abortion Infection sets in after an abortion Commonly associated with un safe abortion Symptoms; abdominal pain, foul smelling vaginal discharge, intermittent vaginal bleeding Signs; sick looking, jaundiced and febrile with Rise in temperature at least 100 degree Fahrenheit ( 38 degrees Centigrade) The uterus is distended and tender The cervix may be found open Other evidences of pelvic infection such as lower abdominal pain and tenderness.

16. RECURRENT MISCARRIAGE Definition: Recurrent miscarriage is defined as a sequence of three or more consecutive spontaneous miscarriages. Etiology: ( First Trimester Abortion): Genetics Endocrinal: (poorly controlled diabetic patient),Presence of thyroid autoantibodies,

17. Surgical techniques for abortion Dilatation and curettage Performed first by dilating the cervix & evacuating the product of conception Mechanically scraping out of the contents (sharp curettage) Vacuum aspiration (suction curettage) Both can be carried out Before 14 weeks, D&C or vacuum aspiration should be performed. After 16 weeks, dilatation & evacuation (D&E) is performed Wide cervical dilatation Mechanical destruction & evacuation of fetal parts

18. Complications of abortions Asherman’s syndrome; partial or complete obliteration of the uterine cavity. It may follow intrauterine adhesions occurring as result of inflammation secondary to infection. It can lead to infertility Amniotic fluid embolism RhD sensitization Cervical dilation may lead to increased risk of mid-trimester spontaneous abortions and preterm deliveries

19. Post abortion care Support: The affected women need a lot of support from the husband, family & obstetric staff Anti D: In case the woman is Rh – ve , Rhesus incompatibility must be prevented or controlled Contraception should start immediately after abortion if the patient chooses to postpone another pregnancy. Ovulation can occur 14 days after abortion and so pregnancy can occur before the expected next period

20. Essential Elements of Post abortion Care Community and service provider partnerships Community H/E and mobilization are key strategies to combat unsafe abortion, increase access to quality post abortion care programs, and improve women's reproductive health unwanted pregnancies and unsafe abortion can be prevented Mobilize resources to help women receive appropriate and timely care for complications of abortion

21. Essential Elements of Post abortion Care Education to increase contraceptive use to enable women prevent unwanted pregnancy, space births and reduce unsafe abortion Community participation in decisions about availability, accessibility and cost of services Education about obstetric emergencies and appropriate care-seeking behaviors Mobilization of community resources, including transportation, to ensure that women experiencing obstetric emergencies receive timely care

22. Essential Elements of Post abortion Care Special populations of women who should have access to services Adolescents Women with HIV or AIDS Women who have experienced violence or genital cutting Refugees Commercial sex workers, and women with cognitive or physical disabilities

23. Essential Elements of Post abortion Care Counseling Client- centered counseling ensures that women make voluntary choices about their treatment, contraceptive methods and other options Counseling helps women to explore their feelings about abortion, assess their coping abilities, manage anxiety & make informed decisions Identify and respond to women's emotional and physical health needs and other concerns

24. Essential Elements of Post abortion Care Treatment Treat incomplete and unsafe abortion and potentially life-threatening complications All appropriate health services should be provided at the time women receive post abortion care, preferably at the same facility Functional referral systems should be put in place Consistent and accurate record-keeping is very important

25. Essential Elements of Post abortion Care Family planning and contraceptive services Help women practice birth spacing or prevent an unwanted pregnancy Preferably provide on-site, or via referrals to other accessible facilities in provider's network There should be no barriers to offering family planning and contraceptive services when the woman comes for post abortion treatment