Surgical procedures to evacuate incomplete miscarriage
RHL practical aspects by Kestler E
FIRST CONTACT (PRIMARY CARE LEVEL)
Primary health-care facilities are seldom equipped with complete professional staff. Usually there is a shortage of personnel at this level and those that are available are not trained in uterine evacuation. The application of the uterine aspiration technique could be possible if the staff could be adequately trained and there was a sufficient patient load to maintain skills.
The essential requirements for staff at this level of care are:
- Physical examination including pelvic examination (particularly vital signs and assessment of uterine size).
- Diagnosis of abortion phases such as threatened abortion (no products of conception have been passed) and incomplete abortion (cervical os open and products of conception passed through the cervix).
- Emergency resuscitation and preparation for maintenance treatment (intravenous fluid and uterotonic administration).
- Administration of antibiotics if there are signs and symptoms of infection.
- Management of pain and discomfort by analgesics.
- Transfer to the next level of care for the management of complications.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Trained personnel, medications, and support services should be available for the following procedures:
- Evacuation of retained products of conception through preferably manual aspiration or with curette if suction curettage is not available during the first or second trimester of pregnancy.
- Pregnancy tests (in doubtful cases).
- Determination of blood type and Rh factor.
- Blood transfusion.
- Analgesics, local and general anaesthesia.
- Laparatomy and appropriate surgical facilities for the management of complications such as perforation and haemorrhage, and to perform hysterectomy if necessary.
- Transfer of complicated cases of abortion, such as generalized sepsis, septic shock, peritonitis or renal failure to a more specialized level.
AT HOME OR IN THE COMMUNITY
In many countries, the provision of basic health-care services including health promotion are the responsibility of individuals outside the health care system who provide services door-to-door or in communal places. These health care providers comprise healers, traditional birth attendants, volunteers etc. and fulfill the basic needs of the community.
Its is important that these informal health care workers understand the concepts underlying the cultural beliefs regarding abortion. They should be aware of the potential risks involved in self-induced abortion methods such as mechanical interference so that women can avoid these dangerous methods. Community health workers could be involved in the educational efforts for the prevention of unwanted pregnancies and refer women without delay to the formal health care system when they need care that cannot be given in the community.
This document should be cited as: Kestler E. Surgical procedures to evacuate incomplete miscarriage: RHL practical aspects (last revised: 8 January 2002). The WHO Reproductive Health Library; Geneva: World Health Organization.