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Abortion is any pregnancy that terminates before the fetus is viable.

General complications of abortions including complications resulting from management of abortion. Retained products of conception this is is common in incomplete abortion. Endometritis: This is an infection of the uterine lining. It is associated with incomplete abortion. Hemorrhage: This is one of the commonest complications. This may be due to incomplete abortion or failure of the uterus to contract. Acute Hematometra: This occurs due to accumulation of blood and blood clots in the uterine cavity due to retained tissue. Disseminated intravascular coagulation Gastrointestinal disturbances such as nausea, vomiting and diarrhea which is due to prostaglandin administration. Another complication of abortion is perforation and lacerations of the uterine cavity and uterine atony. Bowel and bladder injury may also occur. Uterine rupture: This may occur due use of oxytocin during induction of abortion. Anesthesia reactions is another complication. Pelvic inflammatory disease due to a clot, fat globule or air blocking an artery can lead to embolism. Psychological problems such as feelings of guilt, regret and feeling emotional vulnerable Mortality is also a complication as an abortion could lead to death. Infertility this is a long complication (AbortioninCanada.ca, 2011). Explain the pathophysiology of shock in abortion. Shock is a life threatening condition characterized by failure of the circulatory system to maintain adequate blood flow to vital organs, depriving them of oxygen. Shock in abortion occurs usually in incomplete abortion because there are retained products of conception leading to hemorrhage since the uterus can not contract to close off blood vessels. This leads to hypovolemia which reduces venous return thus cardiac output. Therefore, the tissues inadequately perfused and this can lead to irreversible damage due to lack of oxygen and nutrients. Further more, sepsis (septic shock) from gram negative organisms as they can access the dilated veins and sinuses in the uterine cavity. These bring about generalized vasoconstriction and impaired tissue perfusion this being possibly due to the release of biogenic amines and kinins (Fox and Well, 2003). Describe the management of shock related to abortion. When the patient comes to the ward and they are unstable due to abortion, admit the patient. If alone on the ward call for more help. As help is coming, make sure the airway of the patient is open,

administer oxygen therapy to the patient to improve uptake. Turn the patient onto the side to minimize aspiration if they vomit. Elevate the legs of the patient to improve return of blood to her heart. Put up an intravenous line so that intravenous fluids make be administered later. Do not give fluids orally rather administer intravenous fluids for example normal saline to increase on circulating volume, then monitor vital signs. The patient may be feeling pain thus administer analgesics. If the patient is kind of stable take a full history of how this came to happen, when it started. Carry out a physical examination of the patient by assessing the patient so as to find out the cause of shock. Carry out investigations, that is to say, take off blood for cultures, grouping and cross matching and to also check for hemoglobin and hematocrit. While waiting for cultures administer broad spectrum intravenous or intramuscular antibiotics. If the abortion was incomplete, remove visible products of conception which may help the uterus to contract thus control bleeding. If bleeding continues, find out the cause of bleeding and stop it after which replace the lost fluid by administering blood products like fresh whole blood or fresh frozen plasma if the patient has disseminated intravascular coagulation. Administer any other intravenous fluids to increase circulating volume in the body thus preventing irreversible damage caused by shock (USAID, 2011). Discuss the prevention of abortion There are various causes of habitual abortion for example, incompetent cervix, rhesus incompatibility, infections, anatomical disorders and so on. Abortion can be prevented by managing the causes: Incompetent cervix can be managed by placing cervical suture that is nonabsorbent, at the level of the internal os. This can be best placed in the first trimester once alive fetus has been demonstrated on the ultrasound (Hacker and Moore, 1998). Carry out rhesus(Rh) compatibility test for the mother and the father and if he is rhesus positive and she is rhesus negative, there is a possibility they would have a rhesus positive baby. Thus Rh-d immune globulin, should be administered to the mother which prevents the antibodies from forming at various times during each pregnancy (APA, 2011). Educate couples to avoid domestic violence. Carry out investigations to rule out systemic disorders that is diabetes mellitus and thyroid disease. Further more, paternal and maternal chromosomes should be evaluated and hysteroscopy should be done to evaluate the uterine anatomy. Further investigations should be done to rule out infections like treponema, toxoplasma and others. Counsel youths and couples about abortion. For those who have lost a pregnancy, counsel, answer any questions asked and reassure them about reproductive success in the future. Treat febrile illness during pregnancy like malaria. Educate individuals to abstain so as avoid unwanted pregnancies and to regularly go for antenatal check ups when pregnant.

References AbortioninCanada.ca., 2011., Physical Health Effects of Abortion. http://www.abortionincanada.ca/health/physical_effects.html American Pregnancy Association (APA), 2011., Rhesus Factor. http://www.americanpregnancy.org/prenataltesting/rhfactor.html Fox H, Wells M, 2003., Haines and Taylor: Obstetrical and Gynecological Pathology. 5th Ed. Volume 2. Churchill Livingstone. Spain. Pg 1562. Hacker N F, Moore J G, 1998., Essentials of Obstetrics and Gynecology. 3rd Ed. W B Saunders Company. Philadelphia. USA. Pg. 477 478. USAID, 2011., Emergency Treatment: Post-abortion complications and management. Module 2, Session 6.