Medical examinations before surgical abortion
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Transcript Medical examinations before surgical abortion
Medical examinations before
surgical abortion
Moscow Regional Research Institute of
Obstetrics & Gynecology
Olga Serova, MD, professor
Abortions and deliveries in Moscow Region
Girls up to 14 years
2002г. – 0,11%;
2003г. – 0,08%.
100,8
92,8
93,4
91,1
93,8
79,4
52,3
46,2
47,3
44,6
46,3
44,4
75,6
45,9
71,5
44,1
69,3
47,2
63,5
50,9
62,8 61,5
61,4
59,5
54,3
58
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
abortions
delivery
Modern Technologies of
Induced Abortion
• Surgical abortion
• Vacuum aspiration (mini-abortion)
• Medical methods (mifepristone)
Early abortion complication
•
•
•
•
Cervical trauma
Incomplete abortion / Failed abortion
Haemorrhage
Uterine perforation
Maternal mortality in Moscow Region
69,2
70
60
52,5
50
40
24,2
30
20
10
20,8
15,1
8,7
2,6
6,8
0
1981-1992
1993-2004
ectopic pregnancy
induced abortion
criminal abortion
others
Abortion Complication
medical abortion
vacuum aspiration
surgical abortion
14%
12%
10%
8%
6%
4%
0%
Haemorrhage
Endometritis
2% 2%
Incomplete abortion
Risk Factors in developing of abortion
complications
Chronical inflammatory diseases
STI
Scar utery
Leomyoma uterus
Frequent changes sex partners
Operations in women’ hystory
Rehabilitation after abortion
Before abortion
During abortion
In early post-abortion period
Long-term period
Pre-abortion care
• Confirming the pregnancy
• Physical examination and pre-existing
conditions
• Information and counseling
Physical examination before
abortion
• Ultrasound scanning
• Measuring haemoglobin and haematocrit (Нв, Ht)
• Tests for ABO and Rhesus (Rh) blood group typing
• Tests for RW, HIV, HbsAg, HCV
• Laboratory testing for RTIs
• Cervix Cytology
• Others – in special indications
Ultrasound scanning
• Confirm pregnancy and estimate its duration
• Detection of ectopic pregnancy
• Pre-existing conditions (leiomyoma uterus,
abnormalities etc)
• Intrauterine device
Blood Laboratory Testing
• Measuring hemoglobin and haematocrit – to detect
anemia and blood diseases
• Tests for ABO and Rhesus (Rh) blood group typing –
for anti-D immunoglobulin injection
• Tests for RW, HIV, HBsAg, HCV – for prevention
abortion complication
For excluding RTI
• Bacterioscopy is not enough information
• RTI – for inflammatory diseases
diagnostic’s
Rehabilitation during abortion
Methods of abortion
Abortion clinics or facilities
Pain management
Emergency treatment
Rehabilitation in post-abortion
period
After medical abortion – 2 hours observation,
ultrasound – in 7-10 days
After surgical abortion - observation in a hospital,
physical examination and ultrasound before
discharge
Inflammatory Diseases Prevention
Medical abortion
•
Pre-existing STI
•
Colpitis
•
Bacterial vaginosis
Vacuum
aspiration
• Chomical inflammatory
diseases
• Uterus’ scar
• Repeated operative
treatment in women’s life
Surgical abortion
• In any cases
Inflammatory Diseases Prevention
After medical abortion – Cefuroxim 150 mg (one dose)
During vacuum aspiration - Cefuroxim 150 mg (one dose)
After surgical abortion – antibiotics prevention courses
during 5-10 days
Effectiveness prevention' programs after
abortion (1 year follow-up)
4,0%
3,5%
3,0%
2,5%
2,0%
1,5%
1,0%
0,5%
0,0%
4,0%
2,0%
0,0%
surgical abortion
vacuum
aspiration
medical abortion
inflammatory diseases