Treatment of abortion
Last reviewed: 20.11.2021
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With the onset of abortion, cramping pain and spotting are more pronounced than with menacing. The fetal egg exfoliates in a small area, so the size of the uterus corresponds to the period of pregnancy. The cervix is preserved, the canal is closed or slightly ajar. With ischemic-cervical insufficiency, the cervical canal is somewhat enlarged, so the pain is less pronounced or absent. There may be leakage of amniotic fluid.
Differential diagnosis is conducted with a threatening abortion, incomplete abortion, isthmico-cervical insufficiency. With the onset of abortion, the treatment is basically the same as with the threatening treatment. In the presence of bloody discharge in a larger volume than with a threatening miscarriage differential diagnosis is performed:
- possibly bleeding from the second horn of the uterus, with malformations;
- possibly menstrual bleeding in the days of expected menstruation;
- It is possible the death of one embryo from twins and the natural elimination of the deceased embryo;
- abnormal chorion with the formation of retrochoric hematoma or detachment along the edge of the chorion / placenta;
- presentation of the chorion / placenta.
In either of these situations, the tactics will be determined by the general condition of the pregnant woman, the presence of a live embryo, and the amount of detachment and bleeding. It is necessary to immediately determine the blood group, Rh-belonging, make a general blood test, hemostasiogram and ultrasound. With a compensated condition of the patient, after ultrasound and determining the presence of a live embryo and the magnitude of the detachment and its nature (retrochoric or along the edge without the formation of a hematoma), gently inspect the mirrors, remove clots of blood, and examine the cervix. Vaginal examination is inadvisable, since there are ultrasound data, and removing blood from the vagina is necessary to assess the magnitude of blood loss and because infection can be, since blood is a good nutrient medium for microorganisms.
To stop the bleeding, transamin (tranexamic acid, transamchia) produces good results, which promotes the "gluing" of the chorion or placenta and does not affect the haemostasiogram. Transaminum is expediently administered intravenously, dropping 5.0 ml in 200.0 ml of physiological solution 1-2 times a day, can be intramuscularly 2.0 ml 2-3 times a day. After stopping the bleeding continue taking the pill as another 4-5 days.
It is advisable to administer dicycin (etamzilate) 2.0 ml intramuscularly 2-3 times a day, then in 250 mg tablets 3 times a day until the bleeding stops completely. In the absence of transamin - the introduction of fresh frozen plasma is possible. Simultaneously with haemostatic agents prescribe antispasmodics, magne-Vb, anti-anemia drugs. After stopping the bleeding for faster resorption, hematomas are prescribed wobenzym 3 tablets 3 times a day 40 minutes before meals until the hematoma is fully absorbed. With the leakage of amniotic fluid, pregnancy is not advisable. Conduct an instrumental emptying of the uterus (vacuum-exochlearing, scraping).