4.3 Complications of Abortion

1. Perforation of the uterus.

2. Severe haemorrhage.

3. Infection.

4. Retained tissue.

5. Cervical injury.

6. Endotoxic shock.

7. Bulky uterus.

8. Failure to recognize an ectopic pregnancy.

9. Bowel and bladder injury.

10. Disseminated Intravascular Coagulation

4.4 Post Abortion Care (Pac)

It refers to a specific set of service for women experiencing problems from all type of spontaneous or induced abortion. It involves management of incomplete abortion and complication which includes retained tissue, hemorrhage, and infection.

Quality post abortion care includes;

• Emergency treatment, 

• Contraceptive counseling and supplies,  

• Follow-up and 

• Referral to other reproductive health services.

Assessment of the Problem

• Take history to establish the abortion e.g. amenorrhoea, positive PT, USS

• Check vital signs

• Palpate the abdomen for tenderness and size of the uterus

• Perform a pelvic examination to establish trauma to the cervix or vagina and presence of cervical excitation tenderness or product of conception

4.5 Treatment for PAC

• Evacuation of the uterus (by manual/electrical vacuum aspiration or use of misoprostol).

• Pain management

• Treatment for suspected infection or other issues.

- Give T.T where indicated

- Set up an IV infusion fluid if necessary

- Resuscitate the patient and treat shock

- Give antibiotics

- Refer if abortion is incomplete, inevitable, or septic after resuscitation and commencement of antibiotics. 

• Contraceptive education and method provision.

4.6 Conditions for Referral in PAC

1. Severe cramps

2. Chills or very high fever

3. Heavy bleeding which exceeds the heaviest day of a normal menstrual periods or soaks through more than 2 maxi-pads in an hour for more than 2 hours.

4. Bad smelling discharge from the vagina.

5. Continuing symptoms of pregnancy

6. Bulky uterus

7. Sepsis.

8. Delay in resumption of menstruation (more than eight weeks)

4.6 Post Abortion Counselling

1. Practice abstinence (no vaginal sex).

2. Use reversible contraceptive methods if married and want more children. Encourage a long acting or permanent methods of contraception if she has completed her family.

3. Discourage the use of tampons (use pads only).

4. Discourage douching.

5. Discourage swimming/ bath (immersion of self in water).

6. Refer for other services like cervical cancer screening.

Test item – Write an assignment on Comprehensive PAC at the PHC level

STUDENTS’ ACTIVITY;

Topic: Abortion

Learning outcome: The student will be able to

• Define Abortion

• Explain the different types of Abortion

• Mention the complications of Abortion

• Describe post abortion care

Task: In groups, describe the different type of abortions with their causes and management