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Abortion

Abortion — abortion for up to 28 weeks, can be spontaneous (misbirth) and induced (artificial abortion). Artificial abortion is caused purposely, influencing by different methods the pregnant woman's organism, a fruit bed or fetal egg. It can be executed in medical institution (medical artificial abortion) or it is illegal, out of a specialized hospital (criminal abortion).
Distinguish the following clinical stages of abortion:

  1. The menacing abortion — an initial stage of a misbirth which symptoms are pains in a bottom of a stomach and in a waist, insignificant bloody allocations from a genital tract at the closed cervical channel and an outside pharynx of a neck of uterus.
  2. The begun abortion — the following stage of process, differs from previous in disclosure of the cervical channel. The same symptoms that at the menacing abortion: pains, bloody allocations in different volume — from insignificant to plentiful.
  3. Abortion "in the course" — the following clinical stage of abortion at which fetal egg separated from a uterus wall, but is in a fruit bed or the cervical channel. In this stage of pain in a bottom of a stomach become very intensive, have skhvatkoobrazny character. Bleeding can be very plentiful, followed by symptoms of the accruing anemia: weakness, pallor of skin and mucous, tachycardia, etc.
  4. Incomplete abortion is characterized by the incomplete birth of fetal egg which parts remain in a cavity of the uterus; usually is followed by bleeding of different intensity, often considerable.
  5. Complete abortion — a final stage of spontaneous extra hospital abortion; it is characterized by full rejection from a uterus of fetal egg. Pains stop allocations sanious, scanty.

Extra hospital abortion quite often is complicated by the inflammatory process (the infected abortion) taking only fetal egg (horioamnionit) or still a myometrium (metritis), or a myometrium with appendages, a pelvic peritoneum (the metritis, sallingooforit, pelvic peritonitis), or with generalization of an infection (sepsis, infectious and toxic shock).
Diagnosis. At extra hospital abortion establish on the basis: instructions on the being available intervention for the purpose of abortion which not always manage to be received; the clinical picture noted above; the symptoms of inflammatory process which are often accompanying this option of abortion.
After artificial medical abortion can be the cause of a call of the doctor bleeding at the expense of the remains of fetal egg, not recognizable perforation of a uterus, a pain syndrome because of disturbance a molding of the allocations (gematometr), the joined inflammatory process (an endometritis, a salpingitis) which accumulated in a uterus.
Acute management. At a pre-hospital stage the patient with considerable bleeding intravenously enter 10% calcium gluconate solution — 10 ml, 40% glucose solution — 20 ml, 5% solution of ascorbic acid — 2 — 5 ml (in glucose solution). Purpose of uterogonichesky means (mammophysin, oxytocin, Hyphotocinum, etc.) at stages of incomplete abortion is not shown as can strengthen bleeding. At symptoms of big blood loss, hemorrhagic, infectious and toxic shock transportation is carried out under cover intravenous by infusions of any saline solutions (isotonic solution of sodium of chloride, laktasol, mafusat, etc.), 5% of solution of glucose — to 500 — 1000 ml, enter 50 mg of dexamethazone or 250 — 500 mg of a hydrocortisone intravenously.
Hospitalization. In all cases of abortion hospitalization in a hospital is shown. Depending on character of a clinical picture (a scanty, plentiful kroveotdeleniye, the accompanying heavy inflammatory process) when transporting accompany the patient to the car, and then to a reception or bring her on a stretcher. In cases of the intensive bleeding or abortion which is followed by symptoms of infectious and toxic shock, the patient is hospitalized in the next gynecology department immediately, in advance informing of her personnel of hospital and directly giving her to the doctor on duty.

 
"APACHE II   Abscess retropharyngeal"