Initial assessment | Asses for shock and sepsis (fever, foul smelling discharge, hypotension, tachycardia). Give NS, at least 500 ml. |
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Incomplete abortion | <16 weeks and slight to moderate bleeding: use fingers or ring forceps to remove products protruding through the cervix. |
<16 weeks and bleeding is heavy: evacuation by SC. If evacuation is not immediately possible: 0.2 mg ergometrine IM or 400 mcg misoprostol orally. | |
>16 weeks: 20 IU oxytocin in 1 L IV NS until expulsion of POC.If necessary, give 200 mcg misoprostol vaginally every 4 hour until expulsion, max 800 mcg. Evacuate any remaining POCa | |
Threatened abortion | Admit and treat with antibiotics. If abdominal pain, give analgesia. |
Inevitable abortion | <16 weeks: give 10 IU oxytocin and plan for evacuationa. |
>16 weeks, no active bleedingb: await spontaneously expulsion. Control pain. If necessary, infuse oxytocin 20 IU in 1 L IV NS. | |
Unsafe abortion | Assess for complications, injuries and sepsis. If blood pressure > 100 mmHg give 500 ml NS, if < 100 mmHg 1 L. Give antibiotics. When stable, consider MVA. |