PREFACE

This manual is intended to assist health workers in preventing death and serious injury from abortion complications. It outlines the full range of steps in addressing life-threatening complications. It is essential to know what the steps are and to take all possible actions. This document indicates only the general direction of treatment. The guidelines should be adapted on the basis of local conditions, availability of drugs, instruments, training, national standards and regulations (e.g. which category of health workers is authorized to start IV perfusion). This manual is based on WHO's Complications of Abortion: Technical and Managerial Guidelines for Prevention and Treatment.

The information in this manual is organized according to the sequence of decisions that must be made when women present with symptoms of abortion. Information on the management of cases is presented in the form of decision trees with corresponding text that outlines the elements of care.

The manual is divided according to major complications of abortion in order to assist the clinician in identifying and treating the most urgent conditions first. Chapter 1 covers identification of each condition in a “triage” approach, stressing identification and treatment of complications which require immediate attention. It also gives guidance in performing a clinical assessment so that if a woman is suffering from several conditions at once they can all be identified in order to determine what to treat first.

Chapters 2-6 outline the steps in treatment of each of the conditions which may be identified in the assessment: shock, moderate to light vaginal bleeding, severe vaginal bleeding, intra-abdominal injury, and sepsis. For the sake of clarity, these conditions are discussed separately, even though it may be necessary to initiate treatment for more than one condition at the same time.

The text of each chapter is supported by a chart in decision tree form which illustrates the steps to assess and treat the patient. Each decision tree begins with the presenting condition and the initial steps for further assessment and initiation of treatment. The sequence of actions are linked on the chart by arrows which lead the clinician through the process of ruling out conditions until finally they lead to the definitive management or refer to another chart where management may be found.

Chapter 7 gives general considerations about specific elements of treatment that are part of the management of several or all of the complications of abortion.

The accompanying wall charts should be posted prominently for easy reference in the area where abortion complications are treated. The manual should be accessible in the same area where all staff who treat women for abortion complications can use them.