February 18, 2014

Inevitable abortion

It is the clinical type of abortion where the changes have progressed to a state from where continuation of pregnancy is impossible.

Clinical features -
- Increased vaginal bleeding.
- Pain in the lower abdomen.
- Internal examination reveals dilated internal opening of cervix.

Management -

General measures :-
- Excessive bleeding should be controlled by administering methergin 0.2 mg.
- The shock is corrected by I.V. fluid therapy and blood transfusion.

Active management :-
1. Before 12 weeks - Dilation and evacuation followed by curettage of the uterine cavity by blunt curette under general anaesthesia. Alternatively, suction evacuation followed by curettage is done.

2. After 12 weeks - The uterine contraction is acceleration by oxytocin drip. If bleeding is profuse with the cervix closed evacuation of the uterus may have to be done by abdominal hysterotomy.

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