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Abortion Complications

Abortion Complications. 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.

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Abortion Complications

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  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 BS&O, 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.

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