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post abortion care PDF

185 Pages·2010·2.78 MB·English
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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

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