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Abortion Complications

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Abortion Complications Global Abortion Statistics Approximately 50 million unintended pregnancies are terminated each year. An estimated 20 million are terminated in ... – PowerPoint PPT presentation

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Title: Abortion Complications


1
Abortion Complications
2
Global Abortion Statistics
  • Approximately 50 million unintended pregnancies
    are terminated each year.
  • An estimated 20 million are terminated in an
    unsafe condition.
  • An estimated 68,000 women die every year from
    unsafe abortion.
  • Safe abortion counts only for an estimated 1,300
    deaths.

3
Abortion rate trend in USA
4
Abortions Rate By Gestational Age
                                                                  
5
Abortion Statistics in USA
  • Fifty-two percent of U.S. women obtaining
    abortions are younger than 25.
  • Black women are almost four times as likely as
    white women to have an abortion, and Hispanic
    women are 2.5 times as likely.
  • The abortion rate among women living below the
    federal poverty level (9,570 for a single woman
    with no children) is more than four times of
    women with income of 300 above the poverty level
    (44 vs. 10 abortions per 1,000 women)
  • Missing ectopic pregnancy

6
None-surgical Abortion
  • Indications other than elective abortion
  • When surgical abortion fails, ie uterine fibroids
    and cervical stenosis.
  • Induction of labor in second trimester.
  • Mifeprestone is used for emergency contraception,
    endometriosis and shrinking fibroids.

7
None-surgical abortion
  • Sonogram to confirm IU pregnancy.
  • History physical
  • Social History
  • Consent form
  • Medications
  • Methotrexate for very early pregnancy, ectopic,
    cervical intramural
  • Mifeprestone(RU486) 600 vs. 200 mg.
  • Misoprostol 800 mcg vaginal

8
None-Surgical Abortion Complications
  • Clostridium sordelli toxic shock syndrome
  • C. sordellii is a gram-positive anaerobe and is
    part of the normal vaginal flora in about 5-l0
    of women
  • Septic shock syndrome acute respiratory distress
    syndrome, and multiple organ failure are
    consequences of a poorly controlled inflammatory
    response to infection or injury.
  • Treatment Clindamycin combined with.., TAH BSO,
    Antitoxin, and resuscitative measures.

9
None-surgical abortion complications
  • Other complication
  • Failed Abortion, with Mifeprestone or
    Methotrexate
  • Incomplete abortion
  • Bleeding and Infection.
  • Exacerbation of asthma and hypertension.
  • Lack of access to medical care, issues.

10
Surgical Abortion Complications
  • Factors precipitating abortion complications
  • Surgeons inexperience.
  • Inadequate anesthesia.
  • Gross obesity.
  • Cervical anomalies and stenosis (infantile cx)
  • Uterine anomalies.
  • Placentation anomalies.
  • Inadequate workup of the patient
  • Previous cervical and uterine surgeries Leep, C/S

11
Surgical Abortion Complications
  • Errors in proper diagnosis
  • False positive pregnancy test (inflammatory bowel
    disease).
  • Gestational age errors
  • Pseudo sac.
  • Didelphic uterus
  • Ectopic pregnancy
  • Gestational Trophblastic Disease
  • Prevention confirming pregnancy by a vaginal and
    or abdominal ultrasound.
  • Post operative sonogram

12
Surgical Abortion Complications
  • Anesthesia complications
  • Local inadequate pain management, seizure,
    allergy, and anaphylaxis.
  • Sedation and general anesthesia hypoxia, apnea,
    aspiration

13
Surgical Abortion Complications
  • Cevical injuries
  • Laceration, tenaculum tears.
  • fracture secondary to excess and forceful
    dilatation.
  • Bleeding due to trauma and cervicitis.
  • Cervical stenosis.
  • False tunneling.
  • Extreme flexion of the cervix, and ensuing
    perforation.

14
Surgical Abortion Complications
  • Uterine Complications
  • Failed Abortion.
  • Incomplete abortion.
  • Bleeding.
  • Trauma perforation, scaring, fistula, and
    infertility.
  • Infection.
  • Retained boney fragments in uterus and cervix

15
Surgical Abortion Complications
  • Uterine Bleeding
  • Recognition from cervical bleeding.
  • Trauma and atony.
  • Uterine atony, grand mutiparous,
  • Rx Misoprostol before and after the procedure,
    Methergin, and Hemobate IV.
  • Bleeding disorders
  • Post abortion syndrome (hematometria)
  • due to excessive cervical flexion,
  • Pre-operative bleeding due to Misoprostol.

16
Surgical Abortion Complications
  • Uterine perforation
  • locations , instrument type ie canula, curette,
    forceps, and sound.
  • Treatment
  • Observation, antibiotics, laparoscopy,
    Laparotomy, hysterectomy, adenexectomy, and bowel
    resection .

17
Second Trimester
  • Cervical dilation is the hallmark.
  • Laminaria, Foley catheter., Mifeprestone and
    Cytotech
  • Color Doppler sonogram in cases of previous
    uterine surgeries, to R/O accreta
  • Amniotic fluid emboli, and DIC
  • Grand multiparous do sonogram for Placenta
    accreta percreta
  • Previous perforation and accreta percreta

18
Preventive Measures
  • Ultrasound.
  • Medications.
  • Preoperative evaluation examination.
  • Adequate anesthesia.
  • Adequate cervical dilation.
  • Surgical techniques.
  • Patients follow up and ultrasound

19
Preventive Measures
  • Pelvic ultrasound
  • Vaginal, vs. abdominal,
  • Preoperative, intra, postoperative, on follow
    up
  • Color Doppler flow to R/O accreta percreta
  • Placental localization in previous C/S

20
Preventive Measures
  • Medications
  • Narcan Romazicon.
  • Misoprostol.
  • Mifeprestone.
  • Antibiotics Doxycycline, Metronidazole.

21
Preventive Measures
  • Surgical technique
  • Examination.
  • Dilation and dilator.
  • Suctioning upper vs. lower segment
  • Canula size, drawing vs. pushing.
  • Sounding none.
  • Curettage for exploration.
  • Pace of the procedure.

22
Physicians Shortage
  • Medical students for choice.
  • Residents training.
  • Family planning fellowships.

23
(No Transcript)
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