Nursing post abortal care presention.pptx

Post abortion care

1. POST ABORTAL CARE presented by Nalutaya carol Kibone carol Nabasirye Lydia

2. OBJECTIVES Definition Components of PAC. Importance of PAC Comprehensive management. Barriers to PAC Complication of abortion. Prevention of abortion.

3. POST ABORTAL CARE Post abortion care , is an approach for reducing injuries and death from incomplete and unsafe abortions and their related complications. Post abortion care is an integral component of   comprehensive abortion care and includes five essential elements

4. COMPONENTS OF PAC Treatment of incomplete and unsafe abortion and their complications. Counselling to identify and respond to women’s emotional and physical health needs. Family planning services to help women prevent future unwanted pregnancies and abortions Links to comprehensive reproductive health services , that are preferably provided on-site or via referrals to other accessible facilities. Community and service provider partnerships . To prevent unwanted pregnancies and unsafe abortions.

5. IMPORTANCE OF PAC PAC is life saving services. Reduces abortion related maternal mortality & morbidity. Reduces fertility problems due to unsafe abortion. Most unwanted pregnancies and abortion are prevented. Quality PAC health services are accessible. It improves the physical, social, spiritual & psychological aspect of the mother. Improves the referral management. Improves client seeking behavior.

6. COMPREHENSIVE ABORTION CARE. It refers to the primary, secondary and tertiary prevention of unsafe abortion as well as linking abortion care to other reproductive health services and aims at minimizing and preventing the undesirable outcomes of an abortion. Components of comprehensive abortion care 1. Prevention of intended pregnancies a. Sexuality education b. Safe sex practices c. Contraception and family planning d. Emergency contraception e. Community involvement 2. Provision of abortion services to the full extent of the law 3. Post abortion care which has 5 elements

7. Mgt ; Triage the patients with abortion for: Shock; by taking vitals eg BP, Pulse, Excessive pain; Level of consciousness; Poor general condition; Excessive vaginal bleeding; Fever.

8. Cont ; If the patient is in any of these conditions resuscitative measures must be taken before history taking. Some history may be taken from accompanying relatives. If she does not have relatives, wait for condition to subside , then prepare for history taking.

9. THREATENED ABORTION Admit on maternity ward for 1/7 & do close monitoring Administer ; Tabs ferrous sulphate 200mgs for 1/12 Tabs Nifedipine 10mgs every after 15mins Tabs Nospa 40mgs Advise to avoid strenuous activity including sexual intercourse. Strict bed rest is mandatory. If the bleeding stops, follow up in antenatal clinic. Reassess if bleeding recurs . If bleeding persists, assess for fetal viability (beta HCG, Ultra sound scanning to exclude ectopic pregnancy/ hydatidiform mole.

10. INEVITABLE ABORTION Requires hospitalization Do blood grouping and cross matching, CBC Pregnancy <16 weeks: Do MVA to evacuate uterine contents. Give IM/IV Oxytocin 10 IU or IM ergometrine 0.2 mg or oral misoprostol 600 mg. Pregnancy >16 weeks, augmentation of labour with oxytocin infusion 10 units in 500mls saline at 40 drops per minute till expulsion of products of conception. Give return date for review and offer PAC.

11. INCOMPLETE ABORTION Requires hospitalization Do blood grouping and cross matching, CBC. Minimal bleeding, pregnancy <16 weeks: Finger or ring(or sponge) forceps to evacuate products of conception protruding through the cervix. Profuse bleeding, pregnancy <16 weeks: Evacuate the uterus using MVA. Pregnancy >16 weeks, augmentation of labour with oxytocin infusion 10 units in 500mls saline at 40 drops per minute till expulsion of products

12. Cont ; of conception or misoprostol 600mg orally to complete the abortion. Assess for need to evacuate remaining products of conception. Do post abortion care (PAC)before discharge. COMPLETE ABORTION Evacuation of the uterus is usually not necessary. Observe for any bleeding. Do PAC before discharge. Offer antibiotics before discharge (Doxycycline 100 mg 12 hourly for 7 days and Metronidazole 400 mg 8 hourly for 7 days.

13. COMPLICATIONS OF ABORTION Acute Complications Incomplete abortion Sepsis Haemorrhage Uterine Perforation Bowel injury

14. Cont ; Long-term Complications Chronic pelvic pain Pelvic inflammatory disease Tubal blockage and secondary infertility Ectopic pregnancy Increased risk of spontaneous abortion or premature delivery in subsequent pregnancies.

15. BARRIERS TO PAC Knowledge gap by the health workers Inadequate infrastructures like hospitals Failure of the supportive laws & polices Long distances Inadequate equipment to be used Mandatory waiting period High costs Stigma Refusal of health workers to provide an abortion based on personal conscience.

16. PREVENTION OF ABORTION Primary prevention Here we avoid the unwanted pregnancy Secondary prevention Here we prevent unsafe abortion Tertiary prevention Post abortion care, management of complications & prevent future unsafe abortion

17. Cont ; counselling Ensure universal access to family planning ‘ Increase the availability of safe abortion services to the extent allowed by law . Improve the quality and accessibility of post-abortion care . Educate communities about reproductive health and unsafe abortion. Work for changes in policies to safeguard women’s reproductive health. Promote gender equality and decision making. Education for the girl child. Employment for women.

18. Cont ; Attending antenatal service centers Provision of social protection to the abandoned ones provision of non judgmental counselling Access to emergency contraceptives.

19. References for Further Reading • WHO. Unsafe abortion. Fifth edition, 2007 • The Lancet Series on SRH. Unsafe abortion,2006 • UN. World Abortion Policies, 2007 • MOH abortion protocol