Complications. Anesthesia. Cervical Shock

Complications

The most common postabortal complication is a triad of pain, bleeding, and low-grade fever. Often, this complication
can be managed initially by administration of oral antibiotics and ergot preparations. However, most cases are caused
by retained gestational tissue or a clot in the uterine cavity. These symptoms are best managed by a repeat uterine
evacuation, performed under local anesthesia in an ambulatory setting.

Anesthesia

Local anesthesia is preferred because general anesthesia increases the risk of uterine perforation, visceral injury,
hemorrhage, and death. However, when local anesthesia is used, complications include convulsions, syncope, and
fever. The addition of epinephrine to the local anesthetic is contraindicated. Rarely, fatal anaphylaxis as a result of the
metabisulfite preservative in epinephrine solutions has occurred in women with asthma.

Cervical Shock

Vasovagal syncope produced by stimulation of the cervical canal can be seen after paracervical block. Brief tonic-clonic
activity rarely may be observed and is often confused with seizure. It is distinguished by the presence of a very slow
pulse, rapid patient recovery, and the absence of a postictal state. The routine use of atropine with paracervical anesthe-
sia or the use of conscious sedation prevents cervical shock.

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