Vaginal Bleeding in Early Pregnancy/ Abortion - antibiotic prophylaxis

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Incomplete abortion

Uterine contents not completely passed out

Bleeding sometimes with clots from the vagina (may be severe) or

Severe lower abdominal cramps

Cervix open

Products of conception (POC) may be felt in the cervical canal

If evacuation of uterus is not immediately possible

  • Give oral misoprostol 600 microgram sublingual stat (repeat once after 4 hours if necessary)
  • If at HC2, refer to HC3 after misoprostol
  • Use fingers to remove POC protruding through the cervix
  • Evacuate the uterus by Manual Vacuum Aspiration (if pregnancy <16 weeks) or Dilation and Curettage
  • Ensure follow up

If signs of infection (fever, foul smelling blood)

  • Give a stat dose of IV Ceftriaxone 2 g and IV metronidazole 500 mg
  • Amoxicillin 500 mg orally every 6 hours for 7 days
  • Plus metronidazole 400 mg orally every 8 hours for 7 days
Septic abortion

Incomplete abortion with infection (may follow induced abortion)
Fever
Offensive vaginal discharge
Lower abdominal pain
Tenderness on palpating the abdomen
  • Give 7-day course of antibiotics as in incomplete abortion (above)
  • Evacuate the uterus
Post-abortal Sepsis

Patient has signs and symptoms of sepsis following an abortion, but there are no products of conception in the uterus
  • Give IV antibiotics ceftriaxone 2 g + metronidazole 500 mg IV 8 hourly for 48 hours, until fever has disappeared, then switch to oral treatment as for septic abortion