elective abortion

8/13/2019 Elective Abortion

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ELECTIVE ABORTION,

THERAPEUTIC ABORTION,AND STERILIZATION

Dr. H. Amir Fauzi, SpOG(K)

Obstetric and Gynecology DepartmentFaculty of Medicine Sriwijaya University

Mohammad Husein Hospital


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Elective (voluntary) Abortion

Definition: the interruption of pregnancybefore viability at the request of the

woman, but not for medical reasons. This prosedure comprise most abortion

done today.


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Elective (voluntary) Abortion

COUNSELLING BEFORE ELECTIVE ABORTION

Three choices available to a woman considering anabortion include:

- Continued pregnancy with its risks, an parentalresponsibilities

- Continued pregnancy with its risks andresponsibilities of arranged adoption

- The choice of abortion with its risks


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THERAPEUTIC ABORTIONIndications :

1. persistent cardiac decompensation

2. pulmonary hypertension

3. advanced hypentensive vascular disorder

4. malignancy

5. rape or incest

6. to prevent birth of a fetus with asignificant anatomical, metabolic, ormental deformity


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TECHNIQUES FOR EARLY ABORTION

Abortion can be performed either medically orsurgically.

Surgical Techniques1. Cervical dilatation followed by uterineevacuationCurettage

Vacuum aspiration (suction curettage)2. LaparotomyHysterotomyHysterectomy


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Medical Techniques1. Intravenous oxytocin

2. Prostaglandin E2, F2, E1, and

analogues Vaginal insertion

Parenteral injection

Oral ingestion3. Various combinations of the above


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Surgical TechniquesDilatation and Curettage

bimanual examination is performed to determine

the size and orientation of the uterusspeculum is inserted

the cervix swabbed with povidone-iodine

the anterior cervical lip is grasped with a toothed

tenaculum


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Surgical TechniquesDilatation and Curettage: The cervix dilated with Hegar, Hank, or Pratt

dilators until a suction cannula of the

appropriate diameter can be inserted Uterine sounding measures the depth and

inclination of the uterine cavity prior to cannulainsertion

The suction cannula is moved toward the fundusand then back toward the os and is turnedcircumferentially to cover the entire surface ofthe uterine cavity.


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Surgical Techniques

Dilatation and Curettage:

When no more tissues is aspirated, a gentle

sharp curettage should follow to removeany remaining placental or fetal fragments

Manipulations should be carried out with

the thumb and forefinger only


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Surgical Techniques

Dilatation and Curettage:

Complications:

1. Perforation of the uterine

2. Cervical laceration

3. Uterine bleeding


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TECHNIQUES FOR EARLY ABORTIONSurgical Techniques

Manual Vacuum Aspiration : Use for early pregnancy failures up to 12

weeks This procedures uses a hand operated 60

ml syringe and cannula A vacuum is created in the syringe and

attaced to the canulla, which is insertedtranscervically into the uterus The vacuum is activated and produces up to

60 mmHg suction


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Medical Techniques

Intravenous oxytocin

Given as a single agent in highdose

Given by mixing the oxytocin in

an isotonic solution such asnormal saline


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Medical Techniques

Prostaglandin E2

Suppositories of 20 mgprostaglandin E2 placed in theposterior vaginal fornix

Side effects: nausea, vomiting, fever,and diarrhea


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Medical Techniques

Prostaglandin E1

Misoprostol can be used easily andinexpensively as a single agent forsecond trimester pregnancy

terminationAdministered 600 g vaginally

followed by 400 g every 4 hours


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STERILIZATION

(TUBAL LIGATION/ TUBECTOMY) Definition:voluntary surgical procedure

to stop the fertility of a woman permanently

Type:- Minilaparotomy

- Laparoscopy

MechanismFallopian tube occlution(binding the tube, cutting the tube, or usingthe ring)the sperm cannot reached the

ovum


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STERILIZATION

(TUBAL LIGATION/ TUBECTOMY)Indicationthe patient were:

age > 26 years

parity > 2

high risk for the next pregnancy

after delivery after abortion

agree and understand about the

procedures


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STERILIZATION

(TUBAL LIGATION/ TUBECTOMY)Contra indication:

- pregnancy was suspected

- abnormal vaginal bleeding- systemic infection or acute pelvic infection

- not allowed for surgical procedure

- uncertain about their fertility in the future

- havent sign the informed consent


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STERILIZATION(TUBAL LIGATION/ TUBECTOMY)

Time:

During the menstrual cycle (make sure thatthe patient is not pregnant)

Day 6 13 from menstrual cycle(proliferation phase)

After the labour

- Minilaparotomy: within 2 day or atfer 6weeks and 12 weeks

- Laparoscopy: not indicated


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STERILIZATION(TUBAL LIGATION/ TUBECTOMY)

Time:

After abortion

- First trimester: within 7 days as long thereis no sign of pelvic infection(minilaparotomy and laparoscopy)

- Second trimester: within 7 days as long

there is no sign of pelvic infection(minilaparotomy)


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STERILIZATION

(TUBAL LIGATION/ TUBECTOMY)Complications:Wound infection

Fever after the surgery (> 38 C)

Laceration in the vesica urinaria, and intestine(rarely happened)

Hematome (sub cutis)

Air embolies cause by laparoscopy (very rarelyhappened)

Pain at the incision

Superficial bleeding


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elective abortion

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