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Abortion
Last reviewed: 20.11.2021
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Abortion is the termination of pregnancy until the end of 28 weeks. In 20-40 % of pregnant women, spontaneous abortion occurs, usually in the first trimester.
Stop bleeding in early pregnancy. Please specify the following:
- Is the patient in a state of shock? There may be blood loss, or parts of the fetus located in the cervical canal (remove them with spongy forceps).
- Can this be an ectopic pregnancy?
- Are pain and bleeding more severe than with menstruation?
- Are the parts of the fruit visible? (You can take blood clots for them).
- Is the cervix open? The external opening of the cervical canal many times giving birth to a woman usually misses the tip of the finger.
- Does the size of the uterus correspond to the expected duration of pregnancy?
- Is bleeding from the uterus or from the damaged cervix?
- What is the blood group sick? If RhD is negative, 250 ME of anti-O-immunoglobulin should be administered.
If the symptoms are not very pronounced and the mouth of the cervical canal is closed, then this is a threatening abortion. The patient needs rest, but this probably will not help. In 75% of patients, abortion begins. If the symptoms are pronounced and the mouth of the cervical canal is open, talk about abortion in progress or, if most of the fetal parts have already left, about incomplete abortion. With profuse bleeding appoint ergometrine at a dose of 0.5 mg intramuscularly. It is necessary to remove the remaining parts of the fetus (ERPC).
Unsuccessful abortion. The fetus died, but did not come out. Usually there is bleeding, the uterus does not fit the term of pregnancy (less). The diagnosis is confirmed by ultrasound. It is necessary to remove the remaining parts of the fetus or to perform a "prostaglandin" removal (see the previous section). At terms less than 8 weeks, abortion can be complete and removal of the remaining parts of the fetus may not be required.
It is not always easy to diagnose bleeding in the early stages of pregnancy. Information is ultrasound, but pregnancy tests remain positive for a few days after fetal death.
Abortion in the middle trimester. The causes are usually mechanical in nature, for example, incompetence of the cervix (rapid, painless labor of the live fetus), abnormalities in the uterus, chronic diseases in the mother (eg, diabetes mellitus, SLE).
After the abortion.
Abortion is always a mental trauma. Give the sick time to recover. They will want to know why this happened and whether it will happen again.
Abortions at the earliest stages of pregnancy are due to abnormal fetal development; in 10% of cases - due to diseases in the mother, for example, hyperthermia. Most of the subsequent pregnancies, although they are at risk, end successfully. For three pregnancies that ended with abortions, it is necessary to apply for a genetic, immunological and anatomical examination (mother).
The incompetent cervix can be strengthened by Shirodkar's seam for 16 weeks gestation. The seam is removed before delivery. The best term for a second pregnancy is the one parents want.
Septic abortion. It is usually a consequence of criminal abortion, manifested by acute salpingitis, treatment is similar. Before scraping the uterus intravenously, it is necessary to introduce antibiotics of a wide spectrum of action.
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