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ELECTIVE ABORTION, THERAPEUTIC ABORTION, AND STERILIZATION

Dr. H. Amir Fauzi, SpOG(K)

Obstetric and Gynecology Department Faculty of Medicine Sriwijaya University Mohammad Husein Hospital

Elective (voluntary) Abortion


Definition: the interruption of pregnancy before viability at the request of the woman, but not for medical reasons. This prosedure comprise most abortion done today.

Elective (voluntary) Abortion


COUNSELLING BEFORE ELECTIVE ABORTION Three choices available to a woman considering an abortion include: - Continued pregnancy with its risks, an parental responsibilities - Continued pregnancy with its risks and responsibilities of arranged adoption - The choice of abortion with its risks

THERAPEUTIC ABORTION
Indications : 1. persistent cardiac decompensation 2. pulmonary hypertension 3. advanced hypentensive vascular disorder 4. malignancy 5. rape or incest 6. to prevent birth of a fetus with a significant anatomical, metabolic, or mental deformity

TECHNIQUES FOR EARLY ABORTION


Abortion can be performed either medically or surgically. Surgical Techniques 1. Cervical dilatation followed by uterine evacuation Curettage Vacuum aspiration (suction curettage) 2. Laparotomy Hysterotomy Hysterectomy

TECHNIQUES FOR EARLY ABORTION


Medical Techniques 1. Intravenous oxytocin 2. Prostaglandin E2, F2, E1, and analogues Vaginal insertion Parenteral injection Oral ingestion 3. Various combinations of the above

TECHNIQUES FOR EARLY ABORTION


Surgical Techniques
Dilatation and Curettage bimanual examination is performed to determine the size and orientation of the uterus speculum is inserted the cervix swabbed with povidone-iodine the anterior cervical lip is grasped with a toothed tenaculum

TECHNIQUES FOR EARLY ABORTION


Surgical Techniques Dilatation and Curettage: The cervix dilated with Hegar, Hank, or Pratt dilators until a suction cannula of the appropriate diameter can be inserted Uterine sounding measures the depth and inclination of the uterine cavity prior to cannula insertion The suction cannula is moved toward the fundus and then back toward the os and is turned circumferentially to cover the entire surface of the uterine cavity.

TECHNIQUES FOR EARLY ABORTION


Surgical Techniques Dilatation and Curettage:

When no more tissues is aspirated, a gentle sharp curettage should follow to remove any remaining placental or fetal fragments Manipulations should be carried out with the thumb and forefinger only

TECHNIQUES FOR EARLY ABORTION


Surgical Techniques

Dilatation and Curettage:

Complications: 1. Perforation of the uterine 2. Cervical laceration 3. Uterine bleeding

TECHNIQUES FOR EARLY ABORTION


Manual Vacuum Aspiration : Use for early pregnancy failures up to 12 weeks This procedures uses a hand operated 60 ml syringe and cannula A vacuum is created in the syringe and attaced to the canulla, which is inserted transcervically into the uterus The vacuum is activated and produces up to 60 mmHg suction
Surgical Techniques

TECHNIQUES FOR EARLY ABORTION


Medical Techniques

Intravenous oxytocin Given as a single agent in high dose Given by mixing the oxytocin in an isotonic solution such as normal saline

TECHNIQUES FOR EARLY ABORTION


Medical Techniques

Prostaglandin E2 Suppositories of 20 mg prostaglandin E2 placed in the posterior vaginal fornix Side effects: nausea, vomiting, fever, and diarrhea

TECHNIQUES FOR EARLY ABORTION


Medical Techniques

Prostaglandin E1 Misoprostol can be used easily and inexpensively as a single agent for second trimester pregnancy termination Administered 600 g vaginally followed by 400 g every 4 hours

STERILIZATION (TUBAL LIGATION/ TUBECTOMY)


Definition: voluntary surgical procedure to stop the fertility of a woman permanently Type: - Minilaparotomy - Laparoscopy Mechanism Fallopian tube occlution (binding the tube, cutting the tube, or using the ring) the sperm cannot reached the ovum

STERILIZATION (TUBAL LIGATION/ TUBECTOMY)


Indication the patient were: age > 26 years parity > 2 high risk for the next pregnancy after delivery after abortion agree and understand about the procedures

STERILIZATION (TUBAL LIGATION/ TUBECTOMY)


Contra indication: - pregnancy was suspected - abnormal vaginal bleeding - systemic infection or acute pelvic infection - not allowed for surgical procedure - uncertain about their fertility in the future - havent sign the informed consent

STERILIZATION (TUBAL LIGATION/ TUBECTOMY) Time: During the menstrual cycle (make sure that the patient is not pregnant) Day 6 13 from menstrual cycle (proliferation phase) After the labour - Minilaparotomy: within 2 day or atfer 6 weeks and 12 weeks - Laparoscopy: not indicated

STERILIZATION (TUBAL LIGATION/ TUBECTOMY) Time: After abortion - First trimester: within 7 days as long there is no sign of pelvic infection (minilaparotomy and laparoscopy) - Second trimester: within 7 days as long there is no sign of pelvic infection (minilaparotomy)

Complications: Wound infection Fever after the surgery (> 38 C) Laceration in the vesica urinaria, and intestine (rarely happened) Hematome (sub cutis) Air embolies cause by laparoscopy (very rarely happened) Pain at the incision Superficial bleeding

STERILIZATION (TUBAL LIGATION/ TUBECTOMY)