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Abortion an Obstetric and Anesthesiologic Emergency: Skills and Simulation

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Abstract

Abortion refers to pregnancy loss before the 20th gestational week. Approximately more than 80% of abortions develop in the first 12 weeks. Vaginal bleeding and pelvic pain are the most common symptoms. Sometimes it might lead to life-threatening conditions such as serious vaginal bleeding and infections (chorioamnionitis, septic abortion). The diagnosis is basically made by physical examination, pelvic ultrasound, and laboratory examinations. Management becomes difficult and complication risks increase as the gestational age progresses. The treatment methods can be surgical or medical depending on the conditions such as the gestational age, the condition of the patient (active bleeding, presence of signs of infection, medical status), the patient’s preference and the experience of the clinician. Misoprostol is the most commonly used drug in medical treatment. As a surgical treatment vacuum aspiration is used in the first trimester and dilatation evacuation is mainly preferred in the second trimester. In the surgical treatment of second trimester abortions, the cervix should be prepared (Laminaria, misoprostol, mechanical dilators). Antibiotic prophylaxis is applied especially in surgical treatment and prolonged medical treatment.

The use of ultrasound imaging in the management of special cases such as uterine anomaly, and abnormal placentation reduces the risk of complications. The management of patients with such risks should be done in hospital conditions by experienced surgeons with necessary preparations. The most common complication is bleeding. Causes of hemorrhage are uterine atony, cervical lacerations, uterine perforation, uterine rupture and retained pregnancy products. Management of the hemorrhage should be done instantly. Given the high mortality rates associated with septic abortion, evacuation should be accelerated in sepsis patients with chorioamnionitis. Disseminated intravascular coagulopathy may develop in prolonged severe bleeding and septic abortion.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Children’s Health Training and Research Hospital, İstanbul, Turkey

    Resul Karakuş & Önder Tosun

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  1. Resul Karakuş
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  2. Önder Tosun
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Editors and Affiliations

  1. Professor of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy

    Gilda Cinnella

  2. Department of Anesthesia and Intensive Care, Riuniti University Hospital, University of Foggia, Foggia, Italy

    Renata Beck

  3. Department of Biomedical and Human Oncological Science (DIMO) Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy

    Antonio Malvasi

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dilatation evacuation (AVI 49182 kb)

postabortion hemorrhage and its management (AVI 50270 kb)

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Karakuş, R., Tosun, Ö. (2023). Abortion an Obstetric and Anesthesiologic Emergency: Skills and Simulation. In: Cinnella, G., Beck, R., Malvasi, A. (eds) Practical Guide to Simulation in Delivery Room Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-031-10067-3_13

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