Medical examinations before surgical abortion

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Presentation transcript:

Medical examinations before surgical abortion Moscow Regional Research Institute of Obstetrics & Gynecology Olga Serova, MD, professor

Abortions and deliveries in Moscow Region Girls up to 14 years 2002г. – 0,11%; 2003г. – 0,08%.

Modern Technologies of Induced Abortion Surgical abortion Vacuum aspiration (mini-abortion) Medical methods (mifepristone)

Early abortion complication Cervical trauma Incomplete abortion / Failed abortion Haemorrhage Uterine perforation

Maternal mortality in Moscow Region

Abortion Complication 14% 12% 10% 8% 6% 4% 2% 2% 0% Haemorrhage Endometritis Incomplete abortion

Risk Factors in developing of abortion complications Chronical inflammatory diseases STI Scar utery Leomyoma uterus Frequent changes sex partners Operations in women’ hystory

Rehabilitation after abortion Before abortion During abortion In early post-abortion period Long-term period

Pre-abortion care Confirming the pregnancy Physical examination and pre-existing conditions Information and counseling

Physical examination before abortion Ultrasound scanning Measuring haemoglobin and haematocrit (Нв, Ht) Tests for ABO and Rhesus (Rh) blood group typing Tests for RW, HIV, HbsAg, HCV Laboratory testing for RTIs Cervix Cytology Others – in special indications

Ultrasound scanning Confirm pregnancy and estimate its duration Detection of ectopic pregnancy Pre-existing conditions (leiomyoma uterus, abnormalities etc) Intrauterine device

Blood Laboratory Testing Measuring hemoglobin and haematocrit – to detect anemia and blood diseases Tests for ABO and Rhesus (Rh) blood group typing – for anti-D immunoglobulin injection Tests for RW, HIV, HBsAg, HCV – for prevention abortion complication

For excluding RTI Bacterioscopy is not enough information RTI – for inflammatory diseases diagnostic’s

Rehabilitation during abortion Methods of abortion Abortion clinics or facilities Pain management Emergency treatment

Rehabilitation in post-abortion period After medical abortion – 2 hours observation, ultrasound – in 7-10 days After surgical abortion - observation in a hospital, physical examination and ultrasound before discharge

Inflammatory Diseases Prevention Medical abortion Vacuum aspiration Surgical abortion Chomical inflammatory diseases Uterus’ scar Repeated operative treatment in women’s life Pre-existing STI Colpitis Bacterial vaginosis In any cases

Inflammatory Diseases Prevention After medical abortion – Cefuroxim 150 mg (one dose) During vacuum aspiration - Cefuroxim 150 mg (one dose) After surgical abortion – antibiotics prevention courses during 5-10 days

Effectiveness prevention' programs after abortion (1 year follow-up)