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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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References

  1. Regan L, Rai R. Epidemiology and the medical causes of miscarriage. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14:839.

    Article  CAS  PubMed  Google Scholar 

  2. Goddijn M, Leschot NJ. Genetic aspects of miscarriage. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14:855.

    Article  CAS  PubMed  Google Scholar 

  3. ACOG Practice Bulletin No. 135: second-trimester abortion. Obstet Gynecol. 2013;121:1394. Reaffirmed 2019.

    Google Scholar 

  4. Magnus MC, Wilcox AJ, Morken NH, et al. Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study. BMJ. 2019;364:l869.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wyatt PR, Owolabi T, Meier C, Huang T. Age-specific risk of fetal loss observed in a second trimester serum screening population. Am J Obstet Gynecol. 2005;192:240.

    Article  PubMed  Google Scholar 

  6. Frazier T, Hogue CJR, Bonney EA, et al. Weathering the storm; a review of pre-pregnancy stress and risk of spontaneous abortion. Psychoneuroendocrinology. 2018;92:142.

    Article  PubMed  Google Scholar 

  7. Xiong YQ, Tan J, Liu YM, et al. The risk of maternal parvovirus B19 infection during pregnancy on fetal loss and fetal hydrops: a systematic review and meta-analysis. J Clin Virol. 2019;114:12.

    Article  PubMed  Google Scholar 

  8. Metwally M, Ong KJ, Ledger WL, Li TC. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil Steril. 2008;90:714.

    Article  PubMed  Google Scholar 

  9. Maraka S, Ospina NM, O’Keeffe DT, et al. Subclinical hypothyroidism in pregnancy: a systematic review and meta-analysis. Thyroid. 2016;26:580.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ozgu-Erdinc AS, Tasdemir UG, Uygur D, et al. Outcome of intrauterine pregnancies with intrauterine device in place and effects of device location on prognosis. Contraception. 2014;89:426.

    Article  PubMed  Google Scholar 

  11. Avalos LA, Roberts SC, Kaskutas LA, et al. Volume and type of alcohol during early pregnancy and the risk of miscarriage. Subst Use Misuse. 2014;49:1437.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pineles BL, Park E, Samet JM. Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol. 2014;179:807.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Li DK, Ferber JR, Odouli R, Quesenberry C. Use of nonsteroidal antiinflammatory drugs during pregnancy and the risk of miscarriage. Am J Obstet Gynecol. 2018;219:275.e1.

    Article  CAS  PubMed  Google Scholar 

  14. Centers for Disease Control and Prevention. Radiation and pregnancy: a fact sheet for clinicians. 2014. https://emergency.cdc.gov/radiation/prenatalphysician.asp. Accessed on 28 Jan 2019.

  15. Tuuli MG, Norman SM, Odibo AO, et al. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol. 2011;117:1205.

    Article  PubMed  Google Scholar 

  16. Romero ST, Geiersbach KB, Paxton CN, et al. Differentiation of genetic abnormalities in early pregnancy loss. Ultrasound Obstet Gynecol. 2015;45:89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Smits MAJ, van Maarle M, Hamer G, et al. Cytogenetic testing of pregnancy loss tissue: a meta-analysis. Reprod Biomed Online. 2020;40:867.

    Article  CAS  PubMed  Google Scholar 

  18. Young BK. A multidisciplinary approach to pregnancy loss: the pregnancy loss prevention center. J Perinat Med. 2018;47:41.

    Article  PubMed  Google Scholar 

  19. Everett C. Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice. BMJ. 1997;315:32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Hasan R, Baird DD, Herring AH, et al. Patterns and predictors of vaginal bleeding in the first trimester of pregnancy. Ann Epidemiol. 2010;20:524.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sapra KJ, Joseph KS, Galea S, et al. Signs and symptoms of early pregnancy loss. Reprod Sci. 2017;24:502.

    Article  PubMed  Google Scholar 

  22. Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013;369:1443.

    Article  CAS  PubMed  Google Scholar 

  23. Abdallah Y, Daemen A, Kirk E, et al. Limitations of current definitions of miscarriage using mean gestational sac diameter and crown-rump length measurements: a multicenter observational study. Ultrasound Obstet Gynecol. 2011;38:497.

    Article  CAS  PubMed  Google Scholar 

  24. Connolly A, Ryan DH, Stuebe AM, Wolfe HM. Reevaluation of discriminatory and threshold levels for serum β-hCG in early pregnancy. Obstet Gynecol. 2013;121:65.

    Article  CAS  PubMed  Google Scholar 

  25. McPherson E. Recurrence of stillbirth and second trimester pregnancy loss. Am J Med Genet A. 2016;170A:1174.

    Article  PubMed  Google Scholar 

  26. McNamee KM, Dawood F, Farquharson RG. Mid-trimester pregnancy loss. Obstet Gynecol Clin N Am. 2014;41:87.

    Article  Google Scholar 

  27. Allanson B, Jennings B, Jacques A, et al. Infection and fetal loss in the mid-second trimester of pregnancy. Aust N Z J Obstet Gynaecol. 2010;50:221.

    Article  PubMed  Google Scholar 

  28. Tunçalp O, Gülmezoglu AM, Souza JP. Surgical procedures for evacuating incomplete miscarriage. Cochrane Database Syst Rev. 2010;(9):CD001993.

    Google Scholar 

  29. Abortion. In: Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS, editors. Williams obstetrics, 24th ed. McGrawHill-Education; 2014. p. 366.

    Google Scholar 

  30. Harris LH, Dalton VK, Johnson TR. Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care. Am J Obstet Gynecol. 2007;196:445.e1.

    Article  PubMed  Google Scholar 

  31. World Health Organization Novel coronavirus—China. 2020. https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/

  32. World Health Organization report 15 Mar 2021.

    Google Scholar 

  33. Demetroulis C, Saridogan E, Kunde D, Naftalin AA. A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure. Hum Reprod. 2001;16:365.

    Article  CAS  PubMed  Google Scholar 

  34. Allen RH, Goldberg AB. Cervical dilation before first-trimester surgical abortion (<14 weeks’ gestation). Contraception. 2016;93:277.

    Article  PubMed  Google Scholar 

  35. Kim C, Barnard S, Neilson JP, et al. Medical treatments for incomplete miscarriage. Cochrane Database Syst Rev. 2017;1:CD007223.

    PubMed  Google Scholar 

  36. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. ACOG practice bulletin no. 200: early pregnancy loss. Obstet Gynecol. 2018;132:e197.

    Article  Google Scholar 

  37. Creinin MD, Huang X, Westhoff C, et al. Factors related to successful misoprostol treatment for early pregnancy failure. Obstet Gynecol. 2006;107:901.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP. Expectant, medical, or surgical management of first-trimester miscarriage: a meta-analysis. Obstet Gynecol. 2005;105:1104.

    Article  PubMed  Google Scholar 

  39. Nanda K, Lopez LM, Grimes DA, et al. Expectant care versus surgical treatment for miscarriage. Cochrane Database Syst Rev. 2012;(3):CD003518.

    Google Scholar 

  40. Neilson JP, Gyte GM, Hickey M, et al. Medical treatments for incomplete miscarriage (less than 24 weeks). Cochrane Database Syst Rev. 2010;(1):CD007223.

    Google Scholar 

  41. Shelley JM, Healy D, Grover S. A randomised trial of surgical, medical and expectant management of first trimester spontaneous miscarriage. Aust N Z J Obstet Gynaecol. 2005;45:122.

    Article  PubMed  Google Scholar 

  42. Trinder J, Brocklehurst P, Porter R, et al. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ. 2006;332:1235.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Peterson WF, Berry FN, Grace MR, Gulbranson CL. Second-trimester abortion by dilatation and evacuation: an analysis of 11,747 cases. Obstet Gynecol. 1983;62:185–90.

    CAS  PubMed  Google Scholar 

  44. Fox MC, Hayes JL. Cervical preparation for secondtrimester surgical abortion prior to 20 weeks of gestation. Contraception. 2007;76:486–95.

    Article  PubMed  Google Scholar 

  45. Newmann S, Dalve-Endres A, Drey EA. Clinical guidelines. Cervical preparation for surgical abortion from 20 to 24 weeks’ gestation. Society of Family Planning. Contraception. 2008;77:308–14.

    Article  PubMed  Google Scholar 

  46. Darney PD, Sweet RL. Routine intraoperative ultrasonography for second trimester abortion reduces incidence of uterine perforation. J Ultrasound Med. 1989;8:71.

    Article  CAS  PubMed  Google Scholar 

  47. Autry AM, Hayes EC, Jacobson GF, Kirby RS. A comparison of medical induction and dilation and evacuation for second-trimester abortion. Am J Obstet Gynecol. 2002;187:393–7.

    Article  PubMed  Google Scholar 

  48. Bryant AG, Grimes DA, Garrett JM, Stuart GS. Secondtrimester abortion for fetal anomalies or fetal death: labor induction compared with dilation and evacuation. Obstet Gynecol. 2011;117:788–92.

    Article  PubMed  Google Scholar 

  49. Grossman D, Constant D, Lince N, Alblas M, Blanchard K, Harries J. Surgical and medical second trimester abortion in South Africa: a cross-sectional study. BMC Health Serv Res. 2011;11:224.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Grimes DA, Smith MS, Witham AD. Mifepristone and misoprostol versus dilation and evacuation for midtrimester abortion: a pilot randomised controlled trial. BJOG. 2004;111:148–53.

    Article  CAS  PubMed  Google Scholar 

  51. Kerns J, Vanjani R, Freedman L, Meckstroth K, Drey EA, Steinauer J. Women’s decision making regarding choice of second trimester termination method for pregnancy complications. Int J Gynaecol Obstet. 2012;116:244–8.

    Article  PubMed  Google Scholar 

  52. Jain JK, Mishell DR Jr. A comparison of misoprostol with and without laminaria tents for induction of secondtrimester abortion. Am J Obstet Gynecol. 1996;175:173–7.

    Article  CAS  PubMed  Google Scholar 

  53. Borgatta L, Chen AY, Vragovic O, Stubblefield PG, Magloire CA. A randomized clinical trial of the addition of laminaria to misoprostol and hypertonic saline for second-trimester induction abortion. Contraception. 2005;72:358–61.

    Article  CAS  PubMed  Google Scholar 

  54. Borgatta L, Kapp N. Clinical guidelines. Labor induction abortion in the second trimester. Society of Family Planning. Contraception. 2011;84:4–18.

    Article  PubMed  Google Scholar 

  55. Kapp N, Borgatta L, Stubblefield P, Vragovic O, Moreno N. Mifepristone in second-trimester medical abortion: a randomized controlled trial. Obstet Gynecol. 2007;110:1304–10.

    Article  CAS  PubMed  Google Scholar 

  56. Dickinson JE, Jennings BG, Doherty DA. Mifepristone and oral, vaginal, or sublingual misoprostol for second-trimester abortion: a randomized controlled trial. Obstet Gynecol. 2014;123(6):1162–8.

    Article  CAS  PubMed  Google Scholar 

  57. Jain JK, Mishell DR. Comparison of intravaginal misoprostol with prostoglandin E2 for termination of 2nd-trimester pregnancy. N Engl J Med. 1994;331:290.

    Article  CAS  PubMed  Google Scholar 

  58. Jansen NE, Pasker-De Jong PC, Zondervan HA. Mifepriston and misoprostal versus Dialpan and sulprostone for second trimester termination of pregnancy. J Maternal Fetal Neonatal. 2008;21(11):847.

    Article  CAS  Google Scholar 

  59. Alavi A, Rajaei M, Amirian M, et al. Misoprostol versus high döşe oxytocin and laminaria in termination of pregnancy in second-trimester pregnancies. Electron Physician. 2013;5(4):713.

    PubMed  PubMed Central  Google Scholar 

  60. Boza AV, de Leon RG, Castillo LS, et al. Misoprostol preferable to ethacridine lactate for abortion at 13-20 weeks of pregnancy: Cuban experience. Reprod Health Matters. 2008;16(31 Suppl):189.

    Article  PubMed  Google Scholar 

  61. Achiles SL, Reeves MF. Society of Family Planning: prevention of infection after induce abortion: relase date October 2010.SFP guideline 20102. Contraception. 2011;83(4):295.

    Google Scholar 

  62. Grimes DA, Schulz KF. Morbidity and mortality from second-trimester abortions. J Reprod Med. 1985;30:505–14.

    CAS  PubMed  Google Scholar 

  63. Allen RH, Fortin J, Bartz D, et al. Women’s preferences for pain control during first-trimester surgical abortion: a qualitative study. Contraception. 2012;85:413.

    Article  PubMed  Google Scholar 

  64. Wiebe ER, Rawling M. Pain control in abortion. Int J Gynaecol Obstet. 1995;50:41.

    Article  CAS  PubMed  Google Scholar 

  65. Braaten KP, Hurwitz S, Fortin J, Goldberg AB. Intramuscular ketorolac versus oral ibuprofen for pain relief in first-trimester surgical abortion: a randomized clinical trial. Contraception. 2014;89:116.

    Article  CAS  PubMed  Google Scholar 

  66. Cansino C, Edelman A, Burke A, Jamshidi R. Paracervical block with combined ketorolac and lidocaine in first-trimester surgical abortion: a randomized controlled trial. Obstet Gynecol. 2009;114:1220.

    Article  CAS  PubMed  Google Scholar 

  67. O’Connell K, Jones HE, Simon M, et al. First-trimester surgical abortion practices: a survey of National Abortion Federation members. Contraception. 2009;79:385.

    Article  PubMed  Google Scholar 

  68. Renner RM, Nichols MD, Jensen JT, et al. Paracervical block for pain control in first trimester surgical abortion: a randomized controlled trial. Obstet Gynecol. 2012;119:1030.

    Article  CAS  PubMed  Google Scholar 

  69. Allen RH, Fitzmaurice G, Lifford KL, et al. Oral compared with intravenous sedation for first-trimester surgical abortion: a randomized controlled trial. Obstet Gynecol. 2009;113:276.

    Article  CAS  PubMed  Google Scholar 

  70. Sawaya GF, Grady D, Kerlikowske K, Grimes DA. Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis. Obstet Gynecol. 1996;87:884–90.

    CAS  PubMed  Google Scholar 

  71. Low N, Mueller M, Van Vliet HA, Kapp N. Perioperative antibiotics to prevent infection after first-trimester abortion. Cochrane Database Syst Rev. 2012;(3):CD005217.

    Google Scholar 

  72. Achilles SL, Reeves MF. Society of Family Planning. Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102. Contraception. 2011;83:295.

    Article  PubMed  Google Scholar 

  73. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 195: prevention of infection after gynecologic procedures. Obstet Gynecol. 2018;131:e172.

    Article  Google Scholar 

  74. Manual of medical standards and guidelines. Washington, DC: Planned Parenthood Federation of America; 2016.

    Google Scholar 

  75. Guyatt GH, Akl EA, Crowther M, et al. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141:7S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Jurkovic D, Gruboeck K, Tailor A, Nicolaides KH. Ultrasound screening for congenital uterine anomalies. Br J Obstet Gynaecol. 1997;104:1320.

    Article  CAS  PubMed  Google Scholar 

  77. Pennes DR, Bowerman RA, Silver TM, Smith SJ. Failed first trimester pregnancy termination: uterine anomaly as etiologic factor. J Clin Ultrasound. 1987;15:165.

    Article  CAS  PubMed  Google Scholar 

  78. Gürkan Zorlu C, Aral K, Ekici E, et al. Causative factors in first trimester abortion failure. Adv Contracept. 1996;12:63.

    Article  PubMed  Google Scholar 

  79. Valle RF, Sabbagha RE. Management of first trimester pregnancy termination failures. Obstet Gynecol. 1980;55:625.

    CAS  PubMed  Google Scholar 

  80. Thomas AG, Alvarez M, Friedman F Jr, et al. The effect of placenta previa on blood loss in second-trimester pregnancy termination. Obstet Gynecol. 1994;84:58.

    CAS  PubMed  Google Scholar 

  81. Goyal V. Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review. Obstet Gynecol. 2009;113:1117.

    Article  PubMed  Google Scholar 

  82. Savaris RF, de Moraes GS, Cristovam RA, Braun RD. Are antibiotics necessary after 48 hours of improvement in infected/septic abortions? A randomized controlled trial followed by a cohort study. Am J Obstet Gynecol. 2011;204:301.e1.

    Article  PubMed  Google Scholar 

  83. Finkielman JD, De Feo FD, Heller PG, Afessa B. The clinical course of patients with septic abortion admitted to an intensive care unit. Intensive Care Med. 2004;30:1097.

    Article  PubMed  Google Scholar 

  84. Upadhyay UD, Desai S, Zlidar V, et al. Incidence of emergency department visits and complications after abortion. Obstet Gynecol. 2015;125:175.

    Article  PubMed  Google Scholar 

  85. Hakim-Elahi E, Tovell HM, Burnhill MS. Complications of first-trimester abortion: a report of 170,000 cases. Obstet Gynecol. 1990;76:129.

    CAS  PubMed  Google Scholar 

  86. Kapp N, von Hertzen H. Medical methods to induce abortion in the second trimester. In: Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD, editors. Management of unintended and abnormal pregnancy: comprehensive abortion care. Hoboken, NJ: Wiley-Blackwell; 2009. p. 178–92.

    Chapter  Google Scholar 

  87. Diedrich J, Steinauer J. Complications of surgical abortion. Clin Obstet Gynecol. 2009;52:205–12.

    Article  PubMed  Google Scholar 

  88. Grossman D, Blanchard K, Blumenthal P. Complications after second trimester surgical and medical abortion. Reprod Health Matters. 2008;16:173–82.

    Article  PubMed  Google Scholar 

  89. Kerns J, Steinauer J. Management of postabortion hemorrhage: release date November 2012 SFP guideline #20131. Contraception. 2013;87:331–42.

    Article  PubMed  Google Scholar 

  90. Jacot FR, Poulin C, Bilodeau AP, Morin M, Moreau S, Gendron F, et al. A five-year experience with secondtrimester induced abortions: no increase in complication rate as compared to the first trimester. Am J Obstet Gynecol. 1993;168:633–7.

    Article  CAS  PubMed  Google Scholar 

  91. Altman AM, Stubblefield PG, Schlam JF, Loberfeld R, Osathanondh R. Midtrimester abortion with laminaria and vacuum evacuation on a teaching service. J Reprod Med. 1985;30:601–6.

    CAS  PubMed  Google Scholar 

  92. Patel A, Talmont E, Morfesis J, Pelta M, Gatter M, Momtaz MR, Planned Parenthood Federation of America Buccal Misoprostol Waiver Group, et al. Adequacy and safety of buccal misoprostol for cervical preparation prior to termination of second-trimester pregnancy. Contraception. 2006;73:420–30.

    Article  CAS  PubMed  Google Scholar 

  93. Castleman LD, Oanh KT, Hyman AG, Thuy le T, Blumenthal PD. Introduction of the dilation and evacuation procedure for second-trimester abortion in Vietnam using manual vacuum aspiration and buccal misoprostol. Contraception. 2006;74:272–6.

    Article  CAS  PubMed  Google Scholar 

  94. Ashok PW, Templeton A, Wagaarachchi PT, Flett GM. Midtrimester medical termination of pregnancy: a review of 1002 consecutive cases. Contraception. 2004;69:51–8.

    Article  CAS  PubMed  Google Scholar 

  95. Frick AC, Drey EA, Diedrich JT, Steinauer JE. Effect of prior cesarean delivery on risk of second-trimester surgical abortion complications. Obstet Gynecol. 2010;115:760–4.

    Article  PubMed  Google Scholar 

  96. Grimes DA, Kafrissen ME, O’Reilly KR, Binkin NJ. Fatal hemorrhage from legal abortion in the United States. Surg Gynecol Obstet. 1983;157:461–6.

    CAS  PubMed  Google Scholar 

  97. Borgatta L, Chen AY, Reid SK, et al. Pelvic embolization for treatment of hemorrhage related to spontaneous and induced abortion. Am J Obstet Gynecol. 2001;185:530.

    Article  CAS  PubMed  Google Scholar 

  98. Steinauer JE, Diedrich JT, Wilson MW, et al. Uterine artery embolization in postabortion hemorrhage. Obstet Gynecol. 2008;111:881.

    Article  PubMed  Google Scholar 

  99. Ben-Ami I, Schneider D, Svirsky R, Smorgick N, Pansky M, Halperin R. Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections. Am J Obstet Gynecol. 2009;201(2):154.e1–5.

    Article  PubMed  Google Scholar 

  100. Steinauer JE, Diedrich JT, Wilson MW, Darney PD, Vargas JE, Drey EA. Uterine artery embolization in postabortion hemorrhage. Obstet Gynecol. 2008;111:881–9.

    Article  PubMed  Google Scholar 

  101. Haddad L, Delli-Bovi L. Uterine artery embolization to treat hemorrhage following second-trimester abortion by dilatation and surgical evacuation. Contraception. 2009;79:452–5.

    Article  PubMed  Google Scholar 

  102. Whitley KA, Trinchere K, Prutsman W, Quinones JN, Rochon ML. Midtrimester dilation and evacuation versus prostaglandin induction: a comparison of composite outcomes. Am J Obstet Gynecol. 2011;205:386.e1–7.

    Article  PubMed  Google Scholar 

  103. Tang OS, Schweer H, Seyberth HW, Lee SW, Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod. 2002;17:332–6.

    Article  CAS  PubMed  Google Scholar 

  104. Kauff ND, Chelmow D, Kawada CY. Intractable bleeding managed with Foley catheter tamponade after dilation and evacuation. Am J Obstet Gynecol. 1995;173:957–8.

    Article  CAS  PubMed  Google Scholar 

  105. Madden T, Burke AE. Successful management of second-trimester postabortion hemorrhage with an intrauterine tamponade balloon. Obstet Gynecol. 2009;113:501.

    Article  PubMed  Google Scholar 

  106. Olamijulo JA, Doufekas K. Intrauterine balloon tamponade for uncontrollable bleeding during first trimester surgical termination of pregnancy. J Obstet Gynaecol. 2007;27:440–1.

    Article  CAS  PubMed  Google Scholar 

  107. Borgatta L, Chen AY, Reid SK, Stubblefield PG, Christensen DD, Rashbaum WK. Pelvic embolization for treatment of hemorrhage related to spontaneous and induced abortion. Am J Obstet Gynecol. 2001;185:530–6.

    Article  CAS  PubMed  Google Scholar 

  108. Grimes DA, Flock ML, Schulz KF, Cates W Jr. Hysterectomy as treatment for complications of legal abortion. Obstet Gynecol. 1984;63:457–62.

    CAS  PubMed  Google Scholar 

  109. Grossman D, Blanchard K, Blumenthal P. İkinci trimester cerrahi ve tıbbi düşük sonrası komplikasyonlar. Reprod Health Matters. 2008;16:173.

    Article  PubMed  Google Scholar 

  110. Ben-Baruch G, Menczer J, Shalev J. Küretaj sırasında uterus perforasyonu: perforasyon oranları ve postperforasyon yönetimi. Isr J Med Sci. 1980;16:821.

    CAS  PubMed  Google Scholar 

  111. Grimes DA, Schulz KF, Cates WJ Jr. Prevention of uterine perforation during curettage abortion. JAMA. 1984;251:2108–11.

    Article  CAS  PubMed  Google Scholar 

  112. Borgatta L, Kapp N, Society of Family Planning. Clinical guidelines. Labor induction abortion in the second trimester. Contraception. 2011;84:4–18.

    Article  PubMed  Google Scholar 

  113. Berghella V, Airoldi J, O’Neill AM, Einhorn K, Hoffman M. Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review. BJOG. 2009;116:1151–7.

    Article  CAS  PubMed  Google Scholar 

  114. Grobman WA, Gersnoviez R, Landon MB, Spong CY, Leveno KJ, Rouse DJ, et al. Pregnancy outcomes for women with placenta previa in relation to the number of prior cesarean deliveries. National Institute of Child Health and Human Development (NICHD) Maternal–Fetal Medicine Units (MFMU) Network. Obstet Gynecol. 2007;110:1249–55.

    Article  PubMed  Google Scholar 

  115. Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K, et al. Accuracy of ultrasonogof placenta accreta. Obstet Gynecol. 2006;108:573–81.

    Article  PubMed  Google Scholar 

  116. Placenta accreta. Committee Opinion No. 529. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2012;120:207–11.

    Google Scholar 

  117. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. Centers for Disease Control and Prevention (CDC) [published erratum appears in MMWR Morb Mortal Wkly Rep 2011;60:18]. MMWR Recomm Rep. 2010;59(RR-12):1–110.

    PubMed  Google Scholar 

  118. Antibiotic prophylaxis for gynecologic procedures. ACOG Practice Bulletin No. 104. American College of Obste- tricians and Gynecologists. Obstet Gynecol. 2009;113:1180–9.

    Google Scholar 

  119. Lurie S, Feinstein M, Mamet Y. Disseminated intravascular coagulopathy in pregnancy: thorough comprehension of etiology and management reduces obstetricians’ stress. Arch Gynecol Obstet. 2000;263:126–30.

    Article  CAS  PubMed  Google Scholar 

  120. Kimball AM, Hallum AV, Cates W Jr. Deaths caused by pulmonary thromboembolism after legally induced abortion. Am J Obstet Gynecol. 1978;132:169–74.

    Article  CAS  PubMed  Google Scholar 

  121. Lawson HW, Atrash HK, Franks AL. Fatal pulmonary embolism during legal induced abortion in the United States from 1972 to 1985. Am J Obstet Gynecol. 1990;162:986–90.

    Article  CAS  PubMed  Google Scholar 

  122. Clark SL, Hankins GD, Dudley DA, Dildy GA, Porter TF. Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol. 1995;172:1158–67; discussion 1167–9.

    Article  CAS  PubMed  Google Scholar 

  123. Cowett AA, Golub RM, Grobman WA. Cost-effectiveness of dilation and evacuation versus the induction of labor for second-trimester pregnancy termination. Am J Obstet Gynecol. 2006;194:768–73.

    Article  PubMed  Google Scholar 

  124. Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol. 2012;119:215–9.

    Article  PubMed  Google Scholar 

  125. Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, et al. Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol. 2004;103:729–37.

    Article  PubMed  Google Scholar 

  126. Mor G, Aldo P, Alvero AB. The unique immunological and microbial aspects of pregnancy. Nat Rev Immunol. 2017;17:469–82. https://doi.org/10.1038/nri.2017.64.

    Article  CAS  PubMed  Google Scholar 

  127. Racicot K, Mor G. Risks associated with viral infections during pregnancy. J Clin Invest. 2017;127:1591–9. https://doi.org/10.1172/JCI87490.

    Article  PubMed  PubMed Central  Google Scholar 

  128. Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, Ng PC, Lam PW, Ho LC, To WW, Lai ST, Yan WW, Tan PY. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191:292–7. https://doi.org/10.1016/j.ajog.2003.11.019.

    Article  PubMed  PubMed Central  Google Scholar 

  129. Baud D, Greub G, Favre G, Gengler C, Jaton K, Dubruc E, Pomar L. Second-trimester miscarriage in a pregnant woman with SARS-CoV-2 infection. JAMA. 2020;323:2198. https://doi.org/10.1001/jama.2020.7233.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  130. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, Li J, Zhao D, Xu D, Gong Q, Liao J, Yang H, Hou W, Zhang Y. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395:809–15. https://doi.org/10.1016/S0140-6736(20)30360-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  131. Chen L, Li Q, Zheng D, Jiang H, Wei Y, Zou L, Feng L, Xiong G, Sun G, Wang H, Zhao Y, Qiao J. Clinical characteristics of pregnant women with Covid-19 in Wuhan, China. N Engl J Med. 2020;382:e100. https://doi.org/10.1056/NEJMc2009226.

    Article  CAS  PubMed  Google Scholar 

  132. Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, Bao Y, Sun Y, Huang J, Guo Y, Yu Y, Wang S. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? Clin Infect Dis. 2021;72(5):862–4. https://doi.org/10.1093/cid/ciaa226.

    Article  CAS  PubMed  Google Scholar 

  133. Sutton D, Fuchs K, D’Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med. 2020;382:2163–4. https://doi.org/10.1056/NEJMc2009316.

    Article  PubMed  Google Scholar 

  134. Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, Liu Y, Xiao J, Liu H, Deng D, Chen S, Zeng W, Feng L, Wu J. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-Centre, descriptive study. Lancet Infect Dis. 2020;20:559–64. https://doi.org/10.1016/S1473-3099(20)30176-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  135. Pettirosso E, Giles M, Cole S, Rees M. COVID-19 and pregnancy: a review of clinical characteristics, obstetric outcomes and vertical transmission. Aust N Z J Obstet Gynaecol. 2020;60(5):640–59. https://doi.org/10.1111/ajo.13204. Epub 2020 Aug 10.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Rotshenker-Olshinka K, Volodarsky-Perel A, Steiner N, Rubenfeld E, Dahan MH. COVID-19 pandemic efect on early pregnancy: are miscarriage rates altered, in asymptomatic women? Arch Gynecol Obstet. 2021;303:839–45. https://doi.org/10.1007/s00404-020-05848-0.

    Article  CAS  PubMed  Google Scholar 

  137. Cosma S, Carosso AR, Cusato J, Borella F, Carosso M, Bovetti M, Filippini C, D’Avolio A, Ghisetti V, Di Perri G, Benedetto C. Coronavirus disease 2019 and first-trimester spontaneous abortion: a case-control study of 225 pregnant patients. Am J Obstet Gynecol. 2020;S0002-9378(20)31177-7. https://doi.org/10.1016/j.ajog.2020.10.005.

  138. la Cour Freiesleben N, Egerup P, Hviid KVR, Severinsen ER, Kolte AM, Westergaard D, Fich Olsen L, Prætorius L, Zedeler A, Christiansen A-MH, Nielsen JR, Bang D, Berntsen S, Ollé-López J, Ingham A, Bello-Rodríguez J, Storm DM, Ethelberg-Findsen J, Hoffmann ER, Wilken-Jensen C, Jørgensen FS, Westh H, Jørgensen HL, Nielsen HS. SARS-CoV-2 in first trimester pregnancy: a cohort study. Hum Reprod. 2021;36(1):40–7. https://doi.org/10.1093/humrep/deaa311.

    Article  CAS  PubMed  Google Scholar 

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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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