Define unsupervised/unsafe self-managed abortion.
actions taken to end a pregnancy without any medical supervision
What is the epidemiology?
In 2017, 18% of nonhospital facilities in the US treated women following self-managed abortion.
Describe the initial management.
Stabilize patients with life-threatening complications, e.g., initiate:
Immediate hemodynamic support
Sepsis management
Management of trauma patients, including FAST
Urgent surgical consults (e.g., general surgery, gynecology)
Pelvic examination to assess for products of conception, injuries, signs of infection (e.g., purulent drainage)
Obtain diagnostic studies if clinically indicated, e.g.:
CBC with differential, type and screen
CMP
hCG (urine or blood)
Cultures: blood, cervical, aspiration of endometrium
Consider imaging to evaluate for complications.
US pelvis: internal bleeding, incomplete abortion, retained products of conception, ectopic pregnancy
CT abdomen/pelvis: pelvic abscess, bowel injury, hematoma
What are potential complications that should be treated?
Organ dysfunction (e.g., renal failure, liver damage)
Uterine perforation or bleeding
Abdominal or pelvic organ injury
Infection
If no complications, provide expectant management with pregnancy test 4 weeks after abortion
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