Incomplete abortion

Incomplete abortion

Abortion is said to be incomplete when, after expulsion, some of the products of conception are retained in the uterine cavity.

Clinical presentation

• Severe cramping lower abdominal pain

• Moderate to severe per vaginal bleeding

• Fundus smaller than dates

• The cervix is dilated, and products of conception may be felt on or through the cervix on digital examination

Management of incomplete abortion in dispensary and health centre (BEmONC facilities)

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

• Check haemoglobin level

• Give compound sodium lactate (IV) or 0.9% sodium chloride (IV), depending on the amount of blood loss

• If feasible, perform digital evacuation of products of conception to minimize per vaginal bleeding

• Perform Manual Vacuum Aspiration (MVA) if gestational age is below 12 weeks

Pharmacological treatment in places where uterine evacuation is accessible

Give one of the following:

• Oxytocin (IM) 10 IU

OR

• Misoprostol (sublingual) 600 µg

After evacuation, give:

• Erythromycin (PO) 500 mg every 8 hours for 5 days

OR

• Amoxicillin + clavulanic acid (FDC) (PO) 625 mg every 8 hours for 5 days

AND

• Metronidazole (PO) 400 mg every 8 hours for 5 days

AND

• Paracetamol (PO) 1 g every 8 hours for 5 days

Referral

• Resuscitate the patient and refer to hospital level with a nurse escort if bleeding continues

Management in a hospital

• If the patient is in shock, call for help and mobilize resources

• Apply ABCD principles of resuscitation

• Obtain blood for Hb, grouping, and cross-matching

• Give blood transfusion if indicated

• Give compound sodium lactate (IV) or 0.9% sodium chloride (IV), aiming to replace three times the amount of estimated blood loss

• Perform digital evacuation of products of conception if feasible to minimize per vaginal bleeding

• Perform Manual Vacuum Aspiration (MVA) if gestational age is below 12 weeks

• Evacuate the uterus in theatre with a sharp curette under general anaesthesia if pregnancy is more than 12 weeks

Pharmacological treatment

After evacuation, give:

• Erythromycin (PO) 500 mg every 8 hours for 5 days

OR

• Amoxicillin + clavulanic acid (FDC) (PO) 625 mg every 8 hours for 5 days

AND

• Metronidazole (PO) 400 mg every 8 hours for 5 days

AND

• Paracetamol (PO) 1 g every 8 hours for 5 days

AND

• Ferrous sulfate + folic acid (FDC) (PO) 1 tablet every 24 hours for 4 weeks

Patient education

• Counsel and educate the patient on possible reasons for abortion and future fertility

• Provide family planning counselling and an appropriate contraceptive method before the patient leaves the facility premises

• Provide linkage to other reproductive and non-reproductive health services depending on patient needs.