Clinical Management of Abortion Complications: A practical Guide (WHO - OMS, 1994, 86 p.): ANNEX 12

Clinical Management of Abortion Complications: A practical Guide (WHO - OMS, 1994, 86 p.)

		(introduction...)
		ABSTRACT
		ACKNOWLEDGEMENTS
		PREFACE
		INTRODUCTION
		CHAPTER 1 - INITIAL ASSESSMENT: DETERMINING THE WOMAN'S NEEDS FOR IMMEDIATE TREATMENT
		CHAPTER 2 - MANAGEMENT OF SHOCK
		CHAPTER 3 - MANAGEMENT OF MODERATE TO LIGHT VAGINAL BLEEDING
		CHAPTER 4 - MANAGEMENT OF SEVERE VAGINAL BLEEDING
		CHAPTER 5 - MANAGEMENT OF INTRA-ABDOMINAL INJURY
		CHAPTER 6 - MANAGEMENT OF SEPSIS
		CHAPTER 7 - GENERAL PRINCIPLES OF EMERGENCY ABORTION CARE
		ANNEX 1 - EQUIPMENT AND FACILITIES FOR ABORTION CARE
		ANNEX 2 - EXAMPLE OF A REFERRAL FORM FOR COMPLICATIONS OF ABORTION CASES
		ANNEX 3 - EMERGENCY RESUSCITATION MATERIALS
		ANNEX 4 - ESSENTIAL DRUGS FOR EMERGENCY ABORTION CARE
		ANNEX 5 - SUPPLIES FOR SURGICAL UTERINE EVACUATION PROCEDURES
		ANNEX 6 - INSTRUMENTS AND EQUIPMENT FOR FIRST TRIMESTER UTERINE EVACUATION
		ANNEX 7 - INSTRUMENTS AND EQUIPMENT FOR SECOND TRIMESTER UTERINE EVACUATION
		ANNEX 8 - INSTRUMENTS AND SUPPLIES FOR LAPAROTOMY
		ANNEX 9 - LABORATORY AND BLOOD MATERIALS
		ANNEX 10 - MANUFACTURERS, SUPPLIERS AND SOURCES OF PROCUREMENT OF EMERGENCY GYNAECOLOGIC EQUIPMENT
		ANNEX 11 - MANUAL VACUUM ASPIRATION (MVA)
		ANNEX 12 - DILATION AND CURETTAGE (D&C)
		SAFE MOTHERHOOD RESOURCE LIST
		BACK COVER

ANNEX 12 - DILATION AND CURETTAGE (D&C)

Assessment

Carry out a general examination to check for anaemia and other diseases, followed by a detailed clinical (including vaginal) examination. Assess the size and position of the uterus and note the condition of the fornices. Check for ectopic or intrauterine pregnancy. Infection is a contraindication to dilatation and curettage, except in cases of septic incomplete abortion (when the patient must also be given antibiotics).

Procedure

1. Give the patient a general anaesthetic or local anaesthesia (paracervical block).
2. Place her in the lithotomy position and clean and drape the area. Introduce a vaginal speculum, identify the anterior lip of the cervix, take hold of the lip with vulsellum forceps.
3. Sound the uterus by passing a uterine sound to assess the length and direction of the uterus. Then progressively dilate the cervix with dilators.
4. Introduce a small sponge holder (or polyp forceps) to check for polyps. Then gently curette each wall and angle of the uterus. All material obtained should be sent for histopathological examination, if required for diagnosis.
5. Apply a vaginal or gauze pad.

Complications

Possible complications include perforation of the uterus, injury to the bladder or bowel, cervical tear, extension of pre-existing infection, and rarely amenorrhoea due to trauma.