|Clinical Management of Abortion Complications: A practical Guide (WHO - OMS, 1994, 86 p.)|
|CHAPTER 3 - MANAGEMENT OF MODERATE TO LIGHT VAGINAL BLEEDING|
It is very important to completely evacuate the uterus and remove all products of conception. Therefore, with every uterine evacuation, examine the products of conception to check for completeness and to judge whether the amount of tissue is appropriate. Products of conception include villi, fetal membranes, or, after 9 weeks LMP, fetal parts. Absence of villi may suggest an ectopic pregnancy.
It is always important to examine the specimen, even in cases of incomplete abortion. In some cases, evidence of products of conception will be clearly visible. In other cases, however, no placental tissue will be seen, indicating incomplete abortion. To examine the tissue, strain and rinse the tissue to remove excess blood clots, then place the tissue in a clear container of water or weak acetic acid (vinegar) to examine visually. Samples of tissue may also be sent to the pathology lab as indicated. If no products of conception are found, consider the possible explanations, based on clinical judgement, and treat accordingly. Explanations for lack of tissue include:
· Early abortion - further evacuation may not be necessary.
· Abortion already completed before evacuation - further evacuation may not be necessary unless the clinical picture still suggests an incomplete abortion.
· Ectopic pregnancy - delay in treatment of an ectopic pregnancy is particularly dangerous. The possibility is greater if the patient has any of the following risk factors: history of previous ectopic pregnancy, history of pelvic infection, and/or history of IUD use. If ectopic pregnancy is suspected, check again for signs of an ectopic pregnancy as detailed in Chapter 5 and quickly prepare the woman for referral if laparotomy is not available. Rupture of the ectopic pregnancy is a real and life-threatening possibility and, if this happens, death can only be prevented by stopping the haemorrhage through the surgical removal of the ectopic pregnancy, stopping bleeding, and replacing blood loss. (See WHO, Essential Elements of Obstetric Care at First Referral Level, 1991.)