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TEXTBOOK DISCUSSION
a. Definition
An incomplete abortion is the termination of pregnancy in which the products of conception are
not entirely expelled or removed. It also involves the expulsion of the fetus with retention of
placenta. It often causes hemorrhage that may require surgical evacuation by curettage,
oxytocics, and blood replacement. Infection is also a frequent complication of incomplete
abortion.
b. Manifestations
C. Pathophysiology
Abdominal contraction
Abdominal pain
Cervical dilation
Intermittent vaginal
bleeding for 1 day
D. Management
1. Medical management
With missed, incomplete, or inevitable abortion present before 13 weeks' gestation, the standard
therapy has been suction D&C. However, at least 2 randomized controlled trials show that
misoprostol is an effective alternative medical therapy. In one study of incomplete abortion, the
patients were randomized between oral misoprostol (600 mcg) or suction D&C, with success
rates at 96.3% and 91.5%, respectively. The complication rate is low (0.9% for misoprostol).
The other study was a randomized controlled trial with a 3:1 randomization to medical therapy
versus D&C. It included subjects with the following diagnoses: missed abortion (with or without
a fetal pole; no fetal heart motion when the fetal pole was present), incomplete abortion, or
inevitable abortion. In this study, the initial dose of misoprostol was 800 mcg (4 tab 200 mcg
placed vaginally), and the subject was reevaluated on day 3. If the expulsion had not occurred,
then a second dose of 800 mcg of misoprostol was placed vaginally. The study showed that 71%
had completed abortion after the first dose by day 3, and 84% had success with misoprostol by
day 8 (95% confidence interval, 81-87%).
2. Surgical management
Suction dilation and curettage (D&C). Dilation and curettage (D&C) is a procedure to
remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and
treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a
miscarriage or abortion.
In a dilation and curettage — sometimes spelled "dilatation" and curettage — your doctor
uses small instruments or a medication to open (dilate) your cervix — the lower, narrow part of
your uterus. Your doctor then uses a surgical instrument called a curette to remove uterine tissue.
Curettes used in a D&C can be sharp or use suction.
3. Nursing management
Medication
Treatment:
References:
Lowdermilk, Deitra Leonard, and Perry, Shannon E. Maternity and Women’s Health Care
Eighth Edition. Mosby, Inc: Singapore