Abortion Complications Treatment & Management

  • Author: Slava V Gaufberg, MD; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Feb 5, 2010
 

Prehospital Care

Prehospital care for patients with suspected abortion complications includes the following:

  • Monitor vital signs.
  • Stabilize with intravenous fluids (eg, normal saline, Ringer's lactate), if the patient is hemodynamically unstable.
  • Administer oxygen.
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Emergency Department Care

  • Screen all patients with postabortion complications for Rh factor. Administer Rho(D) immune globulin (RhoGAM) if results indicate that the patient is Rh-negative and unsensitized.
  • Patients with the postabortion triad (ie, pain, bleeding, low-grade fever) may respond to treatment with oral antibiotics and ergot preparations. Immediately initiate these agents. In most cases, however, blood clots or retained products of conception must be evacuated from the uterus. In these cases, administer medications parenterally, as the patient will undergo anesthesia.
  • Hemorrhage or hematometra
    • Monitor vital signs and rate of bleeding. Administer fluids and blood as needed.
    • Administer intravenous oxytocin for treatment of uterine atony.
    • Alternative treatments for uterine atony include intracervical vasopressin or carboprost tromethamine and bimanual uterine massage.
    • If bleeding persists, screen for coagulopathy/DIC and obtain immediate gynecologic consultation with the intention of transferring the patient to the operating room (OR) for repeat curettage and, if necessary, hysterectomy.
  • Uterine perforation, bowel injury, and bladder injury: If one or any combination of these complications is suspected or diagnosed in the ED, treat as follows:
    • Hemodynamically stabilize the patient.
    • Insert a Foley catheter.
    • Transfer to the OR for laparoscopy/laparotomy and further treatment.
  • Failed abortion, continued pregnancy, and ectopic pregnancy
    • If the patient is stable, perform ultrasonography and obtain a beta-human chorionic gonadotropin (hCG) level to establish the diagnosis and further treatment.
    • If the patient is unstable, transfer to the OR for dilation and curettage (D&C) and/or laparoscopy/laparotomy.
  • Suspected septic abortion
    • Administer intravenous fluids through a large-bore angiocatheter.
    • For patients who are unstable, administer oxygen and insert a Foley catheter.
    • Early antibiotic treatment may be guided by Gram stain, but broad-spectrum coverage is recommended.
    • Perform evacuation of retained tissues from the uterine cavity, preferably by D&C. If D&C is not immediately available, high doses of oxytocin can be used.
    • Laparotomy may be needed if the above measures elicit no response.
    • A hysterectomy may be necessary in cases of uterine perforation, bowel injury, clostridial myometritis, and pelvic abscess.
    • Management of septic shock is discussed in Shock, Septic.
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Consultations

  • Consult an obstetrician/gynecologist (OB/GYN) in all cases of postabortion complications.
  • Consult surgery and urology if bowel or bladder injury is diagnosed.
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Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Slava V Gaufberg, MD  Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance

Slava V Gaufberg, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Roy Alson, MD, PhD, FACEP, FAAEM  Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare

Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: Air Medical Physician Association, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and World Association for Disaster and Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark Zwanger, MD, MBA  Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University

Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

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