MANAGEMENT OF ABORTIONS AND ITS COMPLICATONS

•MANUAL VACUUM ASPIRATION (MVA)

•MEDICATION ABORTION

•PAIN MANAGEMENT IN POST-ABORTION CARE

MANAGEMENT OF ABORTIONS AND ITS COMPLICATIONS.

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An
abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion";
these occur in approximately 30% to 40% of all pregnancies. When deliberate steps are taken to
end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage".

MANAGEMENT OF ABORTION

The management of an abortion depends on the type of abortion, the gestational age, and the
patient's condition. Here is a comprehensive overview of management of abortions:

✓ MANUAL VACUUM ASPIRATION (MVA)

MVA is a safe and effective method used for early pregnancy termination (up to 12 week’s
gestation) or for the management of miscarriage. The procedures are as follows:

1. Preparation: Conduct a pre-procedure evaluation, including medical history, confirmation of

gestational age (usually with ultrasound), and ruling out contraindications (e.g., ectopic
pregnancy). Obtain informed consent after explaining the procedure, risks, and possible
complications.

2. Positioning and Sterilization: The patient is placed in a lithotomy position (lying on their back
with legs in stirrups). The vulva and vagina are cleaned with an antiseptic solution to prevent
infection.

3. Anesthesia and Pain Management: Local anesthesia (e.g., lidocaine) is injected around the
cervix to reduce pain. Oral or intravenous analgesics or sedatives may also be administered if
necessary.

4. Cervical Dilation: If needed, the cervix is gently dilated using mechanical dilators or
misoprostol (administered before the procedure to soften the cervix).
5. Insertion of the Cannula: A sterile, flexible cannula of an appropriate size (based gestational
age) is inserted through the cervix into the uterus.

6. Aspiration of Uterine Contents: The cannula is connected to a handheld suction device (a

syringe or pump). Negative pressure is applied to aspirate the uterine contents. The provider
ensures complete evacuation by rotating the cannula and checking for uterine smoothness.

7. Completion: The uterus is examined for completeness of evacuation. The patient is observed
for 30-60 minutes for immediate complications, such as excessive bleeding or severe cramping.

Advantages of Manual Vacuum Aspiration.

1. Safety and Effectiveness: High success rates (98-99%) with minimal complication

2. Early Use: Can be performed as early as 5-6 weeks of gestation.

3. Minimally Invasive: No need for general anesthesia or advanced surgical instruments.

4. Cost-Effective: Equipment is affordable and reusable after proper sterilization

5. Portable: MVA instruments are lightweight and suitable for use in outpatient settings or low-
resource environments.

6. Quick Recovery: The procedure is brief (10-15 minutes), with most patients recovering
within hours and resuming normal activities shortly after.

7. Reduced Risk of Complications: Compared to electric vacuum aspiration or dilation and

curettage, MVA has a lower risk of uterine perforation and cervical trauma.

8. Privacy: Can often be performed in outpatient or low-resource settings, ensuring greater

patient privacy.

Precautions for Manual Vacuum Aspiration

1. Proper Training: The procedure should be performed only by trained healthcare providers to
minimize risks.

2. Sterility: Use sterile instruments and maintain aseptic techniques to prevent infection.

3. Patient Selection: Ensure the patient is within the gestational age limit (up to 12 weeks) and
has no contraindications (e.g., pelvic infections, severe anemia, uterine abnormalities).

4. Pain Management: Administer adequate pain relief and provide psychological support
throughout the procedure

5. Cervical Preparation: Use cervical dilators or misoprostol when necessary to minimize

cervical trauma.
6. Avoid Force: Do not apply excessive force during dilation or aspiration to avoid uterine
perforation or cervical injury.

7. Observation Post-Procedure: Monitor the patient for immediate complications such as

excessive bleeding, severe cramping, or signs of uterine perforation.

8. Follow-Up: Schedule a follow-up visit within 1-2 weeks to confirm complete uteri evacuation
and address any concerns.

9. Emergency Preparedness: Ensure emergency equipment and medications are available to

manage complications like hemorrhage, uterine perforation, or vasovagal reactions.

10. Counseling and Contraception: Offer counseling and contraception options postprocedure
to prevent unintended pregnancies and address emotional well-being

✓MEDICATION ABORTIONS

Medication abortion (or medical abortion) is a safe, reliable and non-surgical means of
abortion for people who have made an informed decision that is the best option for them.
Medication abortion is an alternative to surgical abortion in the early weeks of pregnancy (up to
9 weeks). It involves taking medications mifepristone and misoprostol to terminate a
pregnancy. Mifepristone (previously known as RU486) is taken by mouth. It ends a pregnancy
by blocking the action of the hormone (progesterone) that supports the pregnancy. Misoprostol
is also taken by mouth. It causes the cervix to soften and the uterus to contract to expel the
pregnancy. Medication abortion is not suitable for everyone. It may not be recommended if you
have certain medical conditions, take some medicines (such as blood thinners or steroids) or
have allergic reactions.

Procedure

1. Initial Consultation: The patient receives counseling and undergoes a medical examination
to confirm the pregnancy and ensure eligibility for medication abortion

2. Mifepristone Administration: The patient takes mifepristone (200-600 mg) orally at the clinic
or healthcare provider's office. Mifepristone blocks the hormone progesterone, which
necessary for pregnancy.

3. Misoprostol Administration: 24-48 hours after taking mifepristone, the patient takes
misoprostol (800 mcg) orally or vaginally at home. Misoprostol causes the uterus to contract
and expel the pregnancy.

4. Follow-up: The patient returns to the clinic or healthcare provider's office 1-2 weeks of
taking misoprostol for a follow-up examination to confirm the abortion is complete

Precautions
1. Eligibility: Medication abortion is only recommended for patients who are less than 10
weeks pregnant, have a confirmed intrauterine pregnancy, and are in good health

2. Contraindications: Patients with certain medical conditions, such as bleeding disorders, liver
or kidney disease, or taking certain medications, may not be eligible for medication abortion.

3. Allergic Reactions: Patients should be aware of the signs and symptoms of allergic reactions
to mifepristone and misoprostol, such as hives, itching, or difficulty breathing

4. Bleeding and Pain: Medication abortion can cause heavy bleeding and cramping. Patients
should be prepared to manage these symptoms with pain medication and sanitary pads.

5. Infection Risk: Patients should be aware of the signs and symptoms of infection, such as
fever, chills, or foul-smelling discharge.

6. Incomplete Abortion: In some cases, medication abortion may not be complete, and surgical
intervention may be necessary.

7. Emotional Support: Patients should have access to emotional support and counseling
before, during, and after the medication abortion process.

Important Considerations

1. Accessibility: Medication abortion should be accessible to all eligible patients, regardless of

geographical location or socioeconomic status.

2. Confidentiality: Patients' confidentiality and privacy should be respected throughout

medication abortion process.

3. Follow-up Care: Patients should receive follow-up care to ensure the abortion is complete
and to address any concerns or complications.

Advantages of medication abortion include:

1. Is effective for around 95 to 98% pregnancies (up to 9 weeks) and no further treatment
needed.

2. Does not need to take place in a hospital or day surgery so it doesn't require a surgeon,
anaesthetist or other medical staff. This makes it a suitable alternative for people in remote
areas as long as they have access to emergency care.

3. Is a less clinical and non-surgical procedure, which some may prefer. Some people feel it is a
more natural process. It happens in a home environment. You usually have more choice about
the timing.

Disadvantages of medication abortion include:

1. Tend to be more time consuming than surgical abortions – there may be more doctor visits
and tests. 2. It may not work for some people so the medication needs to be repeated or a
surgical abortion is needed.

3. Pain and bleeding generally last longer than following a surgical abortion.

4. It is difficult to predict when a medication abortion is complete – it may take longer t the
expected 3 to 10 hours, after taking the second medication.

5. A separate appointment is needed if you would like an IUD inserted after your abortion.

6. You need to stay within 1-2 hours of emergency services for 2 weeks after starting your
tablets.

7. Abortion medications are not suitable for some people. Medication abortion is not suitable
for everyone. Medication abortion may not be recommended if you:

• Have certain medical conditions (such as bleeding problems, adrenal failure or high blood
pressure)

• Taken long-term steroid or blood-thinning medication

• Have had allergic reactions to the medication.

COMPLICATIONS OF ABORTION

Abortion, like any medical procedure, can carry risks and potential complications. While many
individuals undergo abortions without significant issues, it is important to be aware the possible
complications that can arise. These may include:

1. Infection: There is a risk of infection in the uterus or surrounding areas, which can occur after
both surgical and medical abortions.

2. Heavy Bleeding (Hemorrhage): Some individuals may experience heavy bleeding, which may
require medical attention or further treatment.

3. Incomplete Abortion: This occurs when some tissue remains in the uterus after the
procedure, which may require a follow-up procedure to remove it.

4. Uterine Perforation: In rare cases, surgical instruments can perforate the uterine wall,
leading to injury to surrounding organs.

5. Cervical Injury: The cervix may be damaged during the procedure, leading to complications
in future pregnancies.

6. Emotional and Psychological Effects: Some individuals may experience feelings sadness,
guilt, or anxiety following an abortion. Counseling and support can be beneficial.
 7. Future Pregnancy Complications: Some studies suggest that there may be a slightly
increased risk of complications in future pregnancies, though this varies depending on
individual circumstances.

8. Anesthesia Risks: For those undergoing surgical abortion with anesthesia, there are risks
associated with anesthesia itself.

9. Blood Clots: There is a risk of developing blood clots, particularly in those with other risk
factors. It is essential for individuals considering an abortion to discuss potential risks and
complications with their healthcare provider to make informed decisions and receive
appropriate care.

PAIN MANAGEMENT IN POST-ABORTION CARE

Effective pain management is a critical aspect of post-abortion care, promoting both physical
and emotional recovery. Pain may arise from uterine cramping, tissue passage, or
complications. Proper management ensures comfort and aids the healing process. Below is a
comprehensive guide to pain management:

1. Pharmacologic Pain Management

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs

• Examples: Ibuprofen, naproxen.

• Action: Reduce uterine cramping by inhibiting prostaglandin production.

• Use: First-line option for mild to moderate pain. • Acetaminophen: • Suitable for mild pain or
as a supplement to NSAIDs.

• Opioids: Used for severe pain or when NSAIDs are insufficient

• Examples: Codeine, tramadol (used with caution).

• Antispasmodics:

• Examples: Hyoscine butylbromide.

• Effective in reducing uterine cramping

• Local Anesthetics (during procedures):

• Lidocaine or similar agents may be administered during surgical abortions to minimize

immediate discomfort.

2. Non-Pharmacologic Pain Management

• Heat Therapy:
• Applying a heating pad or warm compress to the lower abdomen helps relieve cramping.

• Relaxation Techniques:

• Deep breathing or meditation can alleviate pain by reducing stress.

• Massage:

• Gentle abdominal or lower back massage can help ease tension and cramping.

• Hydration and Nutrition:

• Staying well-hydrated and eating light, nutritious meals support overall recovery.

3. Emotional Support and Counseling

• Emotional distress can intensify pain perception. Providing a supportive environment, along
with access to counseling or peer support, is essential for holistic recovery.

REFERENCES.

• The American College of Obstetricians and Gynecologists (ACOG)

• World Health Organization (WHO)

• Peer-reviewed medical journals - Articles in journals like the *American Journal of Obstetrics
and Gynecology* or *The Lancet* often discuss complications associated with abortions.

• Centers for Disease Control and Prevention (CDC)