Obstetrics and Gynecology - A.M. Gromova 2000

Artificial Abortion
Complications of Artificial Abortion

Pregnancy is a complex process. From the moment of conception, highly intricate changes take place in a woman's body. Essentially, an abortion acts as a destructive force because it abruptly halts the systemic restructuring of the body that began at conception. Such interventions are neither safe for every Organism nor pass without consequence.

Following an abortion, even when performed under optimal conditions in a medical facility, the possibility of complications cannot be ruled out. According to statistics, every fifth abortion is accompanied by complications.

Abortion complications are divided into 3 groups depending on the time of their onset: immediate, early (occurring within 2 months following the abortion), and delayed (occurring at later stages).

1. Immediate complications:

a) uterine perforation and damage to Internal Organs;

b) uterine Hemorrhage associated with retained products of conception.

2. Early complications:

a) hematometra;

b) pelvic inflammatory disease (salpingo-oophoritis, urethritis, cystitis, endometritis, pelvoperitonitis, parametritis);

c) Exacerbation of chronic conditions of the internal genital organs;

d) placental polyp.

3. Delayed complications:

a) damage and scarring of the internal os and cervical canal, which underlie cervical incompetence and pregnancy loss;

b) damage and degeneration of the endometrium, formation of intrauterine adhesions (synechiae), which lead to impaired implantation and nidation of the fertilized ovum, abnormal placental formation, and fetal developmental anomalies;

c) impaired fallopian tube patency resulting in Infertility or Ectopic Pregnancy;

d) Rh-incompatibility isoimmunization;

e) neuroendocrine disorders leading to impaired oocyte maturation and Menstrual cycle irregularities.

In recent years, The rate of maternal mortality (the death of a woman during pregnancy, regardless of its duration and Location, or within 42 days of its termination) caused by septic complications following abortions and childbirth ranks first among all other causes of maternal death.

An infected abortion (abortus febrillis) occurs when microbes penetrate the uterine cavity. Once inside the Uterus, these microorganisms infect the products of conception. Subsequently, the infection may spread to the uterus, fallopian tubes, Ovaries, pelvic Peritoneum, and parametrium. An infected Miscarriage can trigger systemic septic conditions that pose a threat to the woman's life. This is particularly common when the abortion is performed outside of a medical facility.

Depending on the extent of the infection, the following are distinguished:

- uncomplicated infected (febrile) abortion;

- complicated febrile abortion;

- septic abortion.

In an uncomplicated febrile abortion, the infection does not spread beyond the uterus; the uterus is painless upon Palpation; the uterine appendages, pelvic peritoneum, and parametrium remain unchanged. The woman's body Temperature is elevated, and her pulse is accelerated but corresponds to the temperature; her general condition is satisfactory.

In a complicated febrile miscarriage, the infection spreads beyond the uterus; examination reveals uterine tenderness, along with Changes in the area of the appendages, peritoneum, or pelvic Connective Tissue (tenderness, infiltrates, etc.). The woman's general condition is deteriorated, her fever is high, and she is troubled by pain and other symptoms.

The Clinical presentation of septic abortion is characterized by complexity and severity of the clinical course. The patient's condition is severe, Sleep is disturbed, appetite is absent, the Tongue is dry, the Skin is pale, often with a yellowish or grayish tint. Early signs of septic abortion include chills, high fever, and a significant tachycardia that is disproportionate to the temperature. Thrombophlebitis and metastatic abscesses in the Lungs, Kidneys, subcutaneous tissue, and other areas frequently develop.

The management of infected abortions poses a challenging task for the obstetrician-gynecologist. Every woman with an infected abortion must be referred to a medical facility. In uncomplicated febrile abortion, Antibiotics or sulfonamides are prescribed; 5–6 days after normalization of body temperature, careful uterine curettage is performed. Some physicians recommend curettage immediately upon admission of the patient to the inpatient department provided there is no fever.

In complicated and septic abortion, conservative Treatment is administered, which includes The Use of antibiotics, sulfonamides, general tonics, detoxification and analgesic agents, proper nursing care, and Nutrition, among others. In such cases, one waits for the spontaneous expulsion of the retained products of conception, as curettage of the uterine walls is hazardous due to the risk of further spreading the infection. Uterine curettage is performed only in the event of severe hemorrhage that threatens the woman's life. To accelerate the expulsion of infected retained products of conception, uterotonic agents that enhance uterine contractility (oxytocin, quinine, pituitrin) are prescribed.

Considering all of the above, it is essential that physicians of any specialty conduct preventive health education among the population aimed at the Prevention of unwanted pregnancies.

Review Questions

1. What is an abortion?

2. What types of Induced Abortion exist?

3. Medical indications for pregnancy termination in early gestation.

4. Name the contraindications for the Procedure in early and late pregnancy.

5. Methods of anesthesia.

6. Stages of curettage of the pregnant uterus.

7. Medical methods of pregnancy termination in early gestation.

8. Indications for pregnancy termination in late gestation (after 12 weeks).

9. Conservative and Surgical methods of pregnancy termination in late gestation.

10. Complications of induced abortion.