Treatment

The medical management of complications arising from criminal abortions, such as septic abortion, follows a standardized clinical protocol.

Initial Care at a Basic Medical Center:

• Immediate Reception and Bed Rest: Upon arrival, the patient should be promptly received, assessed, and placed in bed to stabilize her condition.

• Counselling and Hospital Referral: Provide initial supportive counseling. Crucially, emphasize the need for comprehensive hospital care and arrange for immediate transfer to a hospital facility.

• Initiation of Antibiotics: Begin broad-spectrum antibiotic therapy without delay. For example, administer Ceftriaxone 1 gram intravenously as a stat (immediate) dose. If Ceftriaxone is unavailable, use alternative broad-spectrum antibiotics in high therapeutic dosages.

• Resuscitation Measures: Assess the patient’s vital signs and clinical condition. Initiate resuscitation measures as needed, based on her presenting condition (e.g., intravenous fluids for shock, oxygen therapy if hypoxic).

• Hospital Referral for Comprehensive Management: Expedite the referral to a hospital equipped for managing septic abortion and related complications.

• Report and Examination Documentation: Prepare a detailed referral report summarizing the patient’s initial presentation, interventions performed, and relevant findings from a general examination.

• Reassurance: Provide psychological reassurance and support to the patient during this stressful situation.

Hospital Management:

• Admission and Isolation Considerations: Upon arrival at the hospital, admit the patient, ideally to an isolation room, particularly if sepsis is suspected, to minimize the risk of cross-infection to other patients and to provide focused care.

• Physician Consultation: Immediately inform the attending physician or on-call doctor about the patient’s arrival and condition. While waiting for the physician, initiate preliminary actions.

• History and Examinations:

  • Detailed History: Obtain a comprehensive medical history from the patient, including details about the abortion attempt, methods used (if known), and relevant past medical and obstetric history.

  • General Physical Examination: Perform a thorough general physical examination to assess overall condition, vital signs, and signs of sepsis or complications.

  • Vaginal Examination: Conduct a gentle vaginal examination to assess for vaginal bleeding, discharge, cervical status, and any signs of infection or retained products of conception.

• Immediate Intravenous Therapy for Sepsis: If sepsis is diagnosed or highly suspected, commence intravenous drug therapy promptly. A common antibiotic regimen includes Gentamicin (e.g., 160mg once daily for 5-7 days) and Metronidazole (e.g., 500mg every 8 hours for 5-7 days). Adjust antibiotic choices based on local antibiotic resistance patterns and patient-specific factors.

• Evacuation of Uterine Contents: After initiating antibiotic therapy and stabilizing the patient, the next critical step is the evacuation of the products of conception from the uterus. This is typically done via surgical evacuation (dilation and curettage – D&C) or medical evacuation, depending on gestational age and clinical scenario.

Dangers of Criminal Abortions

Criminal abortions carry severe and potentially life-threatening risks:

• Mortality from Hemorrhage: Severe bleeding (hemorrhage) is a major cause of death in criminal abortions, due to uterine perforation or incomplete abortion.

• Pelvic Sepsis: Infection localized to the pelvic organs (pelvic sepsis), including endometritis, salpingitis, and pelvic abscess, is a frequent and serious complication.

• Pelvic Peritonitis: Spread of infection to the peritoneal lining within the pelvis (pelvic peritonitis) can occur, escalating the severity of infection.

• Generalized Peritonitis: If infection spreads beyond the pelvis to the entire abdominal cavity, generalized peritonitis, a widespread and life-threatening infection, can develop.

• Sterility (Infertility): Damage to the reproductive organs from infection or trauma during a criminal abortion can lead to permanent infertility (sterility).

• Acute Renal Failure: Severe sepsis and shock can cause damage to the kidneys, resulting in acute renal failure, a critical condition requiring intensive medical management.

THERAPEUTIC ABORTION

Therapeutic abortion, in contrast to criminal abortion, is a legally and medically sanctioned procedure. It involves the deliberate termination of a pregnancy by evacuating the uterus, performed by a qualified medical doctor. The primary and ethically justifiable indication for therapeutic abortion is to protect the life of the pregnant woman. It is undertaken as a necessary medical intervention when continuing the pregnancy poses a significant and unacceptable threat to the mother’s life.

Therapeutic abortion is conducted only under strict medical and ethical guidelines. It typically requires the informed consent of the woman and, depending on legal and ethical frameworks, often requires the consent of her husband or partner and may involve consultation with a medical ethics committee or other physicians.

Indications for Therapeutic Abortion

Specific medical conditions that may constitute indications for therapeutic abortion, when the mother’s life is deemed to be at risk by continuing the pregnancy, include but are not limited to:

• Chronic Nephritis: Severe chronic kidney disease (nephritis) where pregnancy would critically worsen renal function and endanger the mother’s life.

• Severe Hypertension: Uncontrollable and life-threatening hypertension (high blood pressure), such as severe pre-eclampsia or malignant hypertension, where pregnancy exacerbates the risk of stroke, heart failure, or other critical complications.

• Severe Cardiac Conditions (Heart Defects): Certain pre-existing severe heart conditions or defects where the physiological stresses of pregnancy would impose an unbearable strain on the heart, leading to life-threatening cardiac decompensation or failure.