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Obstetric and Gynecology Department Faculty of Medicine Sriwijaya University Mohammad Husein Hospital
THERAPEUTIC ABORTION
Indications : 1. persistent cardiac decompensation 2. pulmonary hypertension 3. advanced hypentensive vascular disorder 4. malignancy 5. rape or incest 6. to prevent birth of a fetus with a significant anatomical, metabolic, or mental deformity
When no more tissues is aspirated, a gentle sharp curettage should follow to remove any remaining placental or fetal fragments Manipulations should be carried out with the thumb and forefinger only
Intravenous oxytocin Given as a single agent in high dose Given by mixing the oxytocin in an isotonic solution such as normal saline
Prostaglandin E2 Suppositories of 20 mg prostaglandin E2 placed in the posterior vaginal fornix Side effects: nausea, vomiting, fever, and diarrhea
Prostaglandin E1 Misoprostol can be used easily and inexpensively as a single agent for second trimester pregnancy termination Administered 600 g vaginally followed by 400 g every 4 hours
STERILIZATION (TUBAL LIGATION/ TUBECTOMY) Time: During the menstrual cycle (make sure that the patient is not pregnant) Day 6 13 from menstrual cycle (proliferation phase) After the labour - Minilaparotomy: within 2 day or atfer 6 weeks and 12 weeks - Laparoscopy: not indicated
STERILIZATION (TUBAL LIGATION/ TUBECTOMY) Time: After abortion - First trimester: within 7 days as long there is no sign of pelvic infection (minilaparotomy and laparoscopy) - Second trimester: within 7 days as long there is no sign of pelvic infection (minilaparotomy)
Complications: Wound infection Fever after the surgery (> 38 C) Laceration in the vesica urinaria, and intestine (rarely happened) Hematome (sub cutis) Air embolies cause by laparoscopy (very rarely happened) Pain at the incision Superficial bleeding