Abortion Complications

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Abortion Complications
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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.

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Abortion rate trend in USA
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Abortions Rate By Gestational Age
                                                                  
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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

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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.

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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

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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.

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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.

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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

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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

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Surgical Abortion Complications

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

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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.

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Surgical Abortion Complications

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

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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.

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Surgical Abortion Complications

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

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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

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Preventive Measures

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

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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

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Preventive Measures

• Medications
• Narcan Romazicon.
• Misoprostol.
• Mifeprestone.
• Antibiotics Doxycycline, Metronidazole.

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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.

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Physicians Shortage

• Medical students for choice.
• Residents training.
• Family planning fellowships.

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