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Comprehensive Abortion Care PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "COMPREHENSIVE ABORTION CARE” by Dr. Diomede NTASUMBUMUYANGE.

This medical PowerPoint presentation is about comprehensive abortion care, a range of medical and support services provided to individuals seeking an abortion. It includes pre-abortion counseling, medical evaluation, abortion procedures, post-abortion care, and follow-up services. The aim of comprehensive abortion care is to ensure that individuals have access to safe, legal, and high-quality abortion services, regardless of their circumstances.

Comprehensive abortion care involves a multidisciplinary team of healthcare providers, including doctors, nurses, midwives, and counselors. The team works together to provide individualized care that meets the unique needs of each person seeking an abortion.

Pre-abortion counseling involves providing information about the abortion procedure, its risks and benefits, and the individuals options. It may also involve discussing contraceptive options to prevent future unintended pregnancies.

Medical evaluation includes a physical exam, lab tests, and ultrasound to determine the gestational age of the pregnancy and the individuals overall health.

Abortion procedures may include medication abortion (using pills to terminate a pregnancy) or surgical abortion (in-clinic procedures such as aspiration or dilation and curettage). The type of procedure used depends on the individuals health, gestational age, and personal preferences.

Post-abortion care includes follow-up visits to ensure that the individual is recovering well and to address any complications. This may also involve counseling or support services to help the individual cope with the emotional aftermath of an abortion.

Comprehensive abortion care is an important aspect of reproductive healthcare and helps to ensure that individuals have access to safe and legal abortion services. It also involves providing support and resources to individuals throughout the entire process to promote their overall health and well-being.

Tags : abortion care, pre-abortion counseling, abortion procedures, post-abortion care, Obstetrics and Gynecology, Obstetrics and Gynecology PowerPoint presentation

Published on : Jun 20, 2023 | Views : 1634 | Downloads : 5

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COMPREHENSIVE ABORTION CARE Dr. Diomede NTASUMBUMUYANGE Senior Lecturer UR/CMHS
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Session Objectives Define abortion Explain magnitude of abortion Discuss legality of abortion for safe abortion in Rwanda Identify causes/risk factor Classify abortion Identify differential diagnosis of abortion Manage abortion based on its classification Identify uterine evacuation methods Provide post abortal care
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Definitions • Abortion (Miscarriage) is termination of pregnancy before viability In USA, abortion sometimes defined as termination of pregnancy at GA of less than 20 weeks or a birth weight of less than 500gm In most Developing Countries abortion is defined as termination of pregnancy before GA 28 weeks or birth weight of less than1000gm In Rwanda?
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WHO Definition • Abortion is referred as termination of pregnancy before or at GA of 22 weeks or weight less than 500gm (WHO, 2003) • Viability depends on various factors in each country (WHO, 2012)
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Magnitude Globally, 213 million pregnancy annually (>40% unplanned: 85 Million) Currently, an estimated 55.9 million abortions occur each year—49.3 million in developing regions and 6.6 million in developed regions ( Singh, Remez, Sedgh Kwok &Onda, 2017)
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Abortion rate
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Abortion rate
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Abortion rate
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Legality of Abortion in Rwanda Abortion in Rwanda is governed by organic Law 01/2012/OL of 02/05/2012 Exemptions from criminal liability for abortion were specified in articles 162 through 167 of the Penal Code: Rape Incest Forced marriage Risk to the health of the woman or the fetus
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Classification of Abortion WHO classification Safe abortion Unsafe abortion “Less safe” “Least safe” Based on gestational age First trimester abortion Second trimester abortion
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Classification (con’d) Based on occurrence Spontaneous Induced Based on clinical stages Threatened Inevitable Incomplete Complete Missed Anembryonic pregnancy Septic Recurrent
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Spontaneous Abortion Definition: Abortion occurring without any medical or surgical means to empty the uterus Incidence: At least 15% of clinically evident pregnancies end up in spontaneous abortion 80% of spontaneous abortion occur before 12 weeks
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Etiology/Risk factor of spontaneous abortion Fetal factors: Chromosomal abnormalities (60%) Aneuploidy(Monosomy X ) Autosomal Trisomies (T-16 ) Polyploidy Defective implantation Defects in the placenta or embryo Accidental injuries to the fetus Aging of the gametes Failure of hormonal mechanisms Exposure of the embryo to various viruses, chemicals or irradiation
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Etiologies (con’d) Maternal factors: Infections (Bacterial, Viral, protozoal ) Endocrine disorders (Hypothyroidism, DM) Cardiovascular disorders (HTN, Renal disease) Malnutrition
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Etiologies (con’d) Drugs Tobacco Alcohol Caffeine Radiation Paternal factors? Environmental toxins Immunologic factors Thrombophilias Maternal surgery Trauma Uterine defects
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Mechanism of Abortion Hemorrhage occurs in the decidua basalis leading to local necrosis and inflammation. The POC, partly or wholly detached, acts as a foreign body and initiates uterine contractions. The cervix begins to dilate. Expulsion complete. The decidua is shed during the next few days in the lochial flow.
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Differential Diagnosis Ectopic pregnancy Molar pregnancy Local lesions Polyps
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Management Threatened abortion Medical treatment usually not necessary. Advise woman to avoid strenuous activity and sexual intercourse; bed rest not necessary. If bleeding stops, follow up in antenatal clinic. Reassess if bleeding recurs. If bleeding persists, assess for fetal viability (pregnancy test/ultrasound) or ectopic pregnancy (ultrasound). Persistent bleeding, esp. in the presence of uterus larger than expected may indicate twins or molar pregnancy. Treat if anaemia or in hypovolemic shock.
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Mild to sever vaginal bleeding with no expulsion of products of conception Crampy abdominal pain Effacement & dilatation of cx Rupture of membrane Management of Inevitable Abortion
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Management of Inevitable Abortion If pregnancy is less than 12 weeks, plan for evacuation of uterine contents. If evacuation not immediately possible: misoprostol 400 mcg by mouth (repeated once after 4 hours if necessary); Arrange for evacuation as soon as possible. Ensure follow-up after treatment.
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Management of Inevitable Abortion If pregnancy is greater than 12 weeks: Await spontaneous expulsion of products of conception and then evacuate uterus to remove any remaining products of conception If necessary, infuse oxytocin 40 units in 1 L IV fluids at 40 drops/min to help expulsion of products of conception
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Incomplete Abortion The expulsion of some but not all of the products of conception. Symptoms & sign Placental tissue is in uterine cavity Cervix is open & visible or palpable RPC Pain with profuse vaginal bleeding
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Management of Incomplete Abortion Less than 12 weeks: If bleeding light to moderate, use fingers or ring (or sponge) forceps to remove products of conception protruding through cervix. If bleeding heavy, evacuate uterus: Manual vacuum aspiration (MVA) is preferred method. EVA should only be done if MVA not available Ensure follow-up of the woman after treatment.
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Management of Incomplete Abortion Greater than 12 weeks: Infuse oxytocin 40 units in 1 L IV fluids at 40 drops/min. until expulsion of POC occurs Evacuate any remaining products of conception from uterus by evacuation and curettage If necessary, give misoprostol 200 mcg vaginally every 4 hours until expulsion, but do not administer more than 800 mcg. Antibiotic therapy. Ensure follow-up of the woman after treatment.
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Mifepristone Misoprostol Protocol
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Complete Abortion Definition: The whole products of conception is expelled. Symptoms & Sign: The uterus is small and well contracted, Closed cervix, Scant vaginal bleeding, and only mild cramping
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Management of Complete Abortion Evacuation of the uterus usually not necessary Observe for heavy bleeding Ensure follow-up of woman after treatment
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Missed Abortion Definition: Retention of dead products of conception in utero for several weeks Signs and symptoms: Regression of symptoms and signs of pregnancy Persistent amenorrhea, brownish vaginal discharge Uterine size regress & cervix is closed Management: Counseling for uterine evacuation Clotting profile Post abortion care
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Septic Abortion Definition: any of the types of abortion complicated by pelvic infection. Etiology: Polymicrobial Symptoms & Sign Fever, shivering Restlessness Abdominal pain Malodorous vaginal discharge Low BP Tachypnea & tachycardia Guarding & rebound tenderness Cervical motion tenderness Peritonitis
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Management of Septic Abortion Fluid resuscitation Broad spectrum Antibiotics Consider uterine evacuation Follow up of treatment
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Which Method Is Best? Use of a certain method depends on: Safety, efficacy and cost Staff skills Equipment, supplies, drugs available Woman’s clinical condition Woman’s personal preference
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Methods of uterine evacuation 34 Electric vacuum aspiration Foot pump Medication methods MVA
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Distribution of abortion safety categories worldwide and by region
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Unsafe Abortion consequences Every year, 68 000 women die ,about eight per hour Unsafe abortions when performed under least safe conditions can lead to: Incomplete abortion Heavy bleeding Infection uterine perforation Damage to the genital tract and internal organs. Death
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Effective CAC Counselling Explores feelings, coping, decisions Identifies special needs Improves woman-provider relationships Facilitates less painful procedure Creates greater satisfaction
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Decision to Terminate Confidentiality of care Length of pregnancy Abortion methods available Pain medications available Any other tests that may be done If applicable, fetal anomalies or other medical indications detected Permission to treat a complication if necessary
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Procedure Choice Explain differences between methods What will be done during and after the procedure What she is likely to experience How long it will take Side-effects, risks and potential complications Aftercare and follow-up
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SUMMARY: Post Abortion Care
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Summary (cont’d)
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Thank You