post abortion care

185 Pages·2010·2.78 MB·English

POSTA BORTION CARE
A Reference Manual for
Improving Quality of Care

POSTABORTION CARE

A Reference Manual for Improving Quality of Care
editors
Judith Winkler

Elizabeth Oliveras

Noel McIntosh

POSTABORTION CARE CONSORTIUM

(AVSC International, IPAS, IPPF, JHU/CCP, JHPIEGO, Pathfinder International)
Copyright © 1995, The Postabortion Care Consortium.

The text in this publication can be used or adapted freely by anyone.

Editors: Judith Winkler
Elizabeth Oliveras
Noel McIntosh
ISBN: 0-929817-08-7
Published in the United States of America
To obtain copies of this manual, contact:
POSTABORTION CARE CONSORTIUM

AVSC International

4d1,\_\ INTERNATIONAL
iIlll\ Planned
t~lIlIJ Parenthood
W/// FEDERATION
IIPAS

! I I V ­
(()M/ NI/MI-' IN l( I I ( N /.'
JHPEGO

H, I BGO
CORPORATION
Pathfnder
INTERNATIONAL
POSTABORTION CARE CONSORTIUM

For more information on the member organizations of the Postabortion Care Consortium,
they can be contacted directly at the following addresses:
AVSC International

79 Madison Avenue

New York, NY 10016, USA

212-561-8000

International Planned Parenthood Federation

Regent's College

Inner Circle, Regent's Park

London NW1 4NS

United Kingdom

71-486-0741

IPAS
303 East Main Street

PO Box 100

Carrboro, NC 27510, USA

919-967-7052

Johns Hopkins Center for Communication Programs

111 Market Place, Suite 301

Baltimore, MD 21202-4024, USA

410-659-6300

JHPIEGO Corporation

1615 Thames Street

Baltimore, MD 21231-3447, USA

410-955-8558

Pathfinder International

Nine Galen Street, Suite 217

Watertown, MA 02172-4501, USA

617-924-7200
ACKNOWLEDGMENTS

This manual was developed, in part, to increase awareness of the high rates of maternal
mortality and morbidity caused by incomplete abortion in many areas of the world. It is designed
to provide health care providers with up-to-date information on emergency treatment of
postabortion cornplications together with provision of postabortion family planning counseling and
services.
The manual is adapted primarily from previously reviewed publications. The main sources were:
" Yordy L, Leonard AH and Winkler J. Manual Vacuum Aspiration: Guide for Clinicians. IPAS.
" World Health Organization. Clinical Management of Abortion Complications: A Practical
Guide.
" World Health Organization. Complications of Abortion: Technical and Managerial Guidelines
for Prevention and Treatment.
" IPAS. Advances in Abortion Care (Volumes 2 through 4).
" Tietjen et al. Infection Prevention for Family Planning Service Programs. JHPIEGO.
Throughout this manual, specific reference to these documents is cited within the text or
acknowledged at the end of each chapter. The Postabortion Care Consortium would like to thank
the World Health Organization (WHO) for granting permission to use their documents.
Although preparing these guidelines was the responsibility of Judith Winkler, Elizabeth Oliveras
and Noel McIntosh, several staff members of consortium member organizations contributed many
valuable suggestions. In addition, special thanks go to Drs. Philip Stubblefield, Phillip Darney and
Paul Blumenthal, and Gilberte Vansintejan for their technicai input as external reviewers. Finally,
we wish to acknowledge the contribution made by the staff of the Office of Population, Health
and Nutrition at the Agency for International Development.
Members of the Postabortion Care Consortium who contributed to the development of this
manual are:
• AVSC International

" International Planned Parenthood Federation (IPPF)

* IPAS (International Projects Assistance Services)

" Johns Hopkins Center for Communication Programs

" JHPIEGO Corporation

* Pathfinder International
Funded in part by the United States Agency for International Development (USAID). The views
expressed in this document are not necessarily those of USAID.
REVIEWERS

Paul Blumenthal JHPIEGO Corporation
Departrient of Obstetrics and Gynecology
Johns Hopkins Bayview Medical Center Terri Dean
Graciela Salvador
Philip Darney Tami Smith
Department of Obstetrics and Gynecolegy Judith Weinstein
and Reproductive Sciences
University of California, San Fr2ncisco Johns Hopkins Center for
Communication Programs
Phillip Stubblefield
Department of Obstetrics and Gynecology Nicolene Hengen
Maine Medical Center Laurie Liskin
Gilberte Vansintejan Pathfinder International
Center for Population and Family Health
Columbia/Presbyterian Medical Center Alfredo Guzmn
Douglas Huber
Agency for International Development
Allen Brimmer
Patricia Coffey
Roy Jacobstein
Bonnie Pedersen
Nancy Stark
Anne Wilson
AVSC International
Karen Beattie
Amy Pollack
Cynthia Steele Verme
International Planned Parenthood
Federation
Carlos Huezo
Pramilla Senanayake
IPAS-International Projects Assistance
Services
Forrest C. Greenslade
Ann H. Leonard
Katie Early McLaurin
TABLE OF CONTENTS

Preface ix

Chapter 1: Postabortion Care
Background 1-1

Scope of the Problem 1-1

Elements of Postabortion Care 1-2

Emergency Treatment Services 1-2

Postabortion Family Planning 1-3

Links to Other Reproductive Health Services 1-6

Rationale for the Use of MVA 1-6

Chapter 2: Talking with Patients
Background 2-1

Patient Rights 2-1

Consent for Treatment 2-2

Establishing the Patient-Provider Relationship 2-3

Confidentiality 2-5

Privacy 2-5

Chapter 3: Initial Assessment
Background 3-1

Signs and Symptoms 3-1

Screening for Serious Complications 3-2

Shock 3-2

Other Serious Complications 3-3

Severe Vaginal Bleeding 3-3

Infection/Sepsis 3-3

Intra-Abdominal Injury 3-4

Medical Evaluation 3-5

Medical History 3-5

Physical Examination 3-6

Abdominal Examination 3-6

Pelvic Examination 3-6

Speculum Examination 3-6

Bimanual Examination 3-7

Laboratory Tests 3-9

Summary 3-9

Stage of Abortion 3-10

Management of Postabortion Complications 3-11

Postabortion Care i
Chapter 4: Infection Prevention
Background 4-1

Definitions 4-1

Protective Barriers 4-2

Handwashing 4-3

Glove Use 4-4

Antisepsis 4-4

No-Touch Technique 4-5

Processing MVA Equipment and Other Items 4-6

Handling Needles and Syringes 4-6

Waste Disposal 4-7

Disposal of Products of Conception (POC) 4-7

Disposal of Hypodermic Syringes (and Needles) 4-7

Chapter 5: Pain Management
Background 5-1

Goal of Pain Management 5-1

Types of Pain 5-2

Pain Management Techniques 5-2

Local Anesthesia 5-4

Complications of Local Anesthesia 5-5

How to Administer Paracervical Block 5-7

Chapter 6: Treatment of Incomplete Abortion
Background 6-1

Manual Vacuum Aspiration 6-1

MVA Instrument Kits 6-2

Choice of Equipment 6-2

Precautions Prior to Performing MVA 6-3

Preparation for MVA Procedure 6-3

Minimizing the Risk of Infection 6-3

Preparing MVA Instruments 6-4

Pain Management 6-5

Pelvic Examination 6-5

Patient Preparation 6-5

Steps for Performing MVA 6-6

Treatment of Second-Trimester Incomplete Abortions 6-12

Postoperative Care 6-13

Monitor Patient's Recovery 6-13

Postoperative Information 6-13

Postabortion Family Planning 6-14

Postabortion Care