By ULY CLINIC

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Inevitable Abortion

 

Introduction

 

Abortion is said to be inevitable when it is not possible for the pregnancy to continue and the cervix is dilated, but all the products of conception are in situ.

 

Diagnostic Criteria

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• Moderate or severe per vaginal bleeding which may be accompanied with clots 

• Severe lower abdominal pain 

• Significant draining of liquor if membranes have ruptured or the membranes may be intact.

• The cervix is dilated with evidence of imminent expulsion of products of conception.

• Fundal height may correspond with gestational age 

• Presence of uterine contractions  

 

Management of inevitable abortion in Dispensary & Health Centre

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• Apply Airway, Breathing, Circulation and Dehydration (ABCD) principles of resuscitation 

• Check Hb level. 

• Give IV Ringers Lactate (RL)/Normal Saline (NS) 2litres

• Perform Manual Vacuum Aspiration (MVA) in health centre if gestation age is below 12 weeks 

• Augment the process by administering oxytocin 20 IU in 500mls RL/NS at 40– 60 drops/minute if gestation age is above 12 weeks 

• Manage as incomplete abortion if after augmentation some products of conception remain in the uterus

• Manage as complete abortion if all product of conception are expelled  

 

Referral

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Refer to hospital if MVA is not possible and/or bleeding is persisting.

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In the Hospital 

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• Apply Airway, Breathing, Circulation and Dehydration principles of resuscitation 

• Obtain blood for Hb , grouping and cross–matching 

• Give IV RL/NS 2liters 

• Give blood transfusion if indicated  Perform Manual Vacuum Aspiration (MVA) if gestation age is below 12 weeks 

• Augment the process by administering oxytocin 20 IU in 500mls RL/NS at 40– 60 drops/minute if gestation age is above 12 weeks 

• Manage as incomplete abortion if after augmentation some products of conception remain in the uterus 

• Manage as complete abortion if all product of conception are expelled 

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Updated on, 3.11.2020

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References

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1. STG