MANAGEMENT OF INCOMPLETE ABORTION

1. Hospital Admission: Admit the patient to a gynecology unit for specialized care and monitoring.

2. Patient History: Gather a detailed medical history from the patient, including details about the pregnancy, symptoms, and any pre-existing conditions.

3. Emotional Support: Reassure the patient and their family to reduce anxiety and provide emotional comfort during this difficult time.

4. Laboratory Investigations: Inform the doctor to order essential blood tests, including Hemoglobin levels (HB), blood grouping, and cross-matching in preparation for potential blood transfusion.

5. Fluid Resuscitation: Start intravenous fluids to restore and maintain blood volume, especially if the patient has experienced significant blood loss.

6. Thermal Management (if in shock): If the patient is showing signs of shock, ensure they are kept warm to prevent hypothermia.

7. Vital Signs Monitoring: Regularly check and record vital signs such as blood pressure, pulse rate, respiration rate, and temperature to closely monitor the patient’s condition.

8. Informed Consent: Obtain informed consent from the patient for any medical or surgical procedures after explaining the necessary treatments and potential risks and benefits.

9. Uterotonic Medication: Administer medications like oxytocin or misoprostol to help the uterus contract strongly, expel any remaining pregnancy tissue, and control excessive bleeding.

10. Manual Removal of Tissue (if visible): If products of conception are visible in the vagina, carefully remove them using sterile gloves to prevent infection and further bleeding.

11. ABCs Assessment: Continuously monitor the patient’s Airway, Breathing, and Circulation to ensure they are stable and to promptly address any emergencies.

12. Blood Transfusion (if needed): Transfuse blood products according to the patient’s Hemoglobin results and clinical condition to correct anemia and blood loss.

13. Theatre Preparation: Prepare the patient for a potential surgical procedure in the operating theatre. This includes shaving the area if necessary, dressing the patient in a sterile gown, and informing the theatre staff about the case.

14. Surgical Evacuation: Once the patient is stable, surgically evacuate the uterus under general anesthesia in the operating theatre. Manual vacuum aspiration is generally recommended as an effective method to remove any retained products of conception.

15. Post-Evacuation Medication: Misoprostol (400-800 mcg every 6 hours orally) or Oxytocin may be prescribed after the procedure to further help contract the uterus and minimize ongoing blood loss.

16. Rh Immunoglobulin (if Rh-negative): If the patient is Rhesus negative, administer Anti-D immunoglobulin 300 μg intramuscularly as a single dose to prevent Rh sensitization.

17. Prophylactic Antibiotics: Administer antibiotics to prevent infection, a potential complication following an incomplete abortion or surgical evacuation.

18. Iron and Folic Acid Supplementation: Prescribe ferrous sulfate and folic acid supplements to help replenish iron stores and prevent iron-deficiency anemia, especially after blood loss.

19. Nutritional Support: Encourage a well-balanced, nutritious diet to aid in recovery and overall health.

Discharge Advice:

• Rest: Advise the patient to get adequate rest at home to facilitate physical and emotional recovery.

• Nutrition: Emphasize the importance of maintaining a nutritious diet to support healing and regain strength.

• Follow-up Appointments: Ensure the patient understands the need to return for all scheduled follow-up reviews to monitor their recovery and address any complications.

• Medication Adherence: Instruct the patient to take all prescribed medications as directed, completing the full course, even if symptoms improve.

• Antenatal Care: Advise the patient to attend antenatal care clinics if they plan future pregnancies for preconception counseling and optimal pregnancy management.