My Clinical Notes

• Accurate ultrasound assessment of the gestation of pregnancy must be made to guide management
• Swab for Chlamydia, Gonococcus and bacterial vaginosis with high vaginal and endocervical swabs to prevent subsequence problems with infection
• Blood group must be assessed to determine the need for ant-D prophylaxis
• Contraceptive advice should be given

 

Medical termination

 

• Antiprogesterone Mifepristone (allows uterus to become more responsive to prostaglandins) is given orally 36-48hr before insertion of a prostaglandin E1 analogue pessary. This is offered up to 9 weeks gestation and is normally 95% effective at inducing abortion
• After 12 weeks synthetic prostaglandins are placed in the posterior vaginal fornix every 3 hours (max of 5 doses). In this case incomplete abortion is common and surgical evacuation is performed
• When late terminations are performed intracardiac potassium chloride may be given to the fetus to arrest the heart before abortion

 

Surgical termination

 

• Up to 12 week, the cervix is dilated and a suction curette is inserted to suck out the contents of the uterus
• Beyond 12 weeks crushing of fetal parts may be required to allow removal (this has been almost totally superseded by medical termination in the 2^nd trimester)
• Prostaglandin preparation can be used to ripen the cervix before surgical termination to prevent the risk of trauma and to minimise blood loss
• Complications of surgical termination, haemorrhage, infection and uterine perforation  

 

General complications

• Infection – therefore screen for Chlamydia pre-operatively or give prophylactic antibiotics
• Trauma – uterine perforation, cervical incompetence due to repeated procedures
• Haemorrhage

 

This entry was posted on Saturday, September 29th, 2007 at 4:25 pm and is filed under Gynaecology/Obstetrics. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.