Ectopic Pregnancy, Incomplete Abortion, and Failed Abortion

Early detection of ectopic pregnancy, incomplete abortion, or failed abortion is possible if the physician performing the
operation carefully examines the specimen immediately after the abortion. The patient may have an ectopic pregnancy
if no chorionic villi are found. To detect an incomplete abortion that might result in continued pregnancy, the actual
gestational sac must be identified. The history and physical examination should be reviewed. Determination of the b-hCG
level and frozen section of the aspirated tissue and vaginal probe ultrasonography may be useful. If the b-hCG
level is greater than 1,500-2,000 mIU, chorionic villi are not identified on frozen section, or retained tissue is identified
by ultrasonography, immediate laparoscopy should be considered. Other patients may be followed closely with serial
b-hCG assays until the problem is resolved. With later (>13 weeks) gestations, all of the fetal parts must be identified
by the surgeon to prevent incomplete abortion. It is not sufficient to send the tissue to the pathologist.
Heavy bleeding or fever after abortion suggests retained tissue. If the postabortal uterus is larger than 12-week size,
it is wise to perform preoperative ultrasonography to determine the amount of remaining tissue. When fever is present,
high-dose intravenous antibiotic therapy should be initiated, and curettage should be performed shortly thereafter.
Because of the need to cover a broad spectrum of possible pathogens, a combination of two or three agents is
suggested. If there is hemolysis or failure of the patient to improve within 12-24 hours after uterine evacuation,
hysterectomy may be indicated and can be lifesaving.
Cancer treatment
Complications and Fragmented Care

Patients who have recently had an abortion and are experiencing complications often seek care at a local hospital
emergency department. A physician managing such a patient should make every effort to communicate with the
abortion provider to learn the details of the procedure, any suspected complications, results of screening tests, results
of the fresh examination of the aborted tissue, and whether D immune globulin was given if the patient is D negative.

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