emDOCs Podcast – Episode 58: Post Abortion Complications Part II

Today on the emDOCs cast with Brit Long, MD (@long_brit), we cover the second in a series on post abortion complications. Today’s podcast looks at incomplete abortion and retained products of conception, complications of medical abortion, trauma and perforation, drug toxicity, and amniotic air embolism.

Episode 58: Post Abortion Complications Part II

References:

1. World Health Organization. Available at https://www.who.int/news-room/fact-sheets/detail/abortion. Accessed May 20, 2022.
2. Fawcus SR. Maternal mortality and unsafe abortion. Best Pract Res Clin Obstet Gynaecol. 2008 Jun;22(3):533-48
3. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33.
4. World Health Organization, Department of Reproductive Health and Research. Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2008, 6, WHO, Geneva 2011.
5. World Health Organization. Abortion Care Guideline (2022). https://apps.who.int/iris/bitstream/handle/10665/349316/9789240039483-eng.pdf?sequence=1&isAllowed=y (Accessed on April 08, 2022).
6. Clinical policy guidelines for abortion care. National Abortion Federation 2020. Available at: https://prochoice.org/store/clinical-policy-guidelines/ (Accessed on July 23, 2021).
7. Robson SC, Kelly T, Howel D, et al. Randomised preference trial of medical versus surgical termination of pregnancy less than 14 weeks’ gestation (TOPS). Health Technol Assess. 2009 Nov;13(53):1-124, iii-iv.
8. Grossman D, Grindlay K, Buchacker T, et al. Effectiveness and acceptability of medical abortion provided through telemedicine. Obstet Gynecol. 2011 Aug;118(2 Pt 1):296-303.
9. Upadhyay U, Johns N, Barron R, et al. Abortion-related emergency department visits: analysis of a national emergency department sample. BMC Med. 2018;16:88.
10. Cleland K, Creinin M, Nucatola D, et al. Significant adverse events and outcomes after medical abortion. Obstet Gynecol. 2013;121:166-171.
11. Adler AJ, Filippi V, Thomas SL, Ronsmans C. Quantifying the global burden of morbidity due to unsafe abortion: magnitude in hospital-based studies and methodological issues. Int J Gynaecol Obstet. 2012 Sep;118 Suppl 2:S65-77.
12. Orlowski MH, Soares WE, Kerrigan KA, Zerden ML. Management of Postabortion Complications for the Emergency Medicine Clinician. Ann Emerg Med. 2021 Feb;77(2):221-232.
13. Medical management of first-trimester abortion. Contraception. 2014 Mar;89(3):148-61.
14. Davis A, Westhoff C, De Nonno L. Bleeding patterns after early abortion with mifepristone and misoprostol or manual vacuum aspiration. J Am Med Womens Assoc (1972). 2000;55(3 Suppl):141-4.
15. Christin-Maitre S, Bouchard P, Spitz IM. Medical termination of pregnancy. N Engl J Med. 2000 Mar 30;342(13):946-56.
16. Trinder J, Brocklehurst P, Porter R, et al. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ. 2006 May 27;332(7552):1235-40.
17. Davis AR, Hendlish SK, Westhoff C, et al; National Institute of Child Health and Human Development Management of Early Pregnancy Failure Trial. Bleeding patterns after misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial. Am J Obstet Gynecol. 2007 Jan;196(1):31.e1-7.
18. Wolman I, Altman E, Faith G, et al. Combined clinical and ultrasonographic work-up for the diagnosis of retained products of conception. Fertil Steril. 2009 Sep;92(3):1162-1164.
19. Rooks JB, Cates W Jr. Abortion methods: morbidity, costs and emotional impact. 3. Emotional impact of D&E vs. instillation. Fam Plann Perspect. 1977 Nov-Dec;9(6):276-7.
20. Ben-Ami I, Schneider D, Maymon R, et al. Sonographic versus clinical evaluation as predictors of residual trophoblastic tissue. Hum Reprod. 2005 Apr;20(4):1107-11
21. Abbasi S, Jamal A, Eslamian L, Marsousi V. Role of clinical and ultrasound findings in the diagnosis of retained products of conception. Ultrasound Obstet Gynecol. 2008 Oct;32(5):704-7.
22. Sawyer E, Ofuasia E, Ofili-Yebovi D, et al. The value of measuring endometrial thickness and volume on transvaginal ultrasound scan for the diagnosis of incomplete miscarriage. Ultrasound Obstet Gynecol. 2007 Feb;29(2):205-9.
23. van den Bosch T, Daemen A, Van Schoubroeck D, et al. Occurrence and outcome of residual trophoblastic tissue: a prospective study. J Ultrasound Med. 2008 Mar;27(3):357-61.
24. McEwing RL, Anderson NG, Meates JB, et al. Sonographic appearances of the endometrium after termination of pregnancy in asymptomatic versus symptomatic women. J Ultrasound Med. 2009 May;28(5):579-86.
25. Alcázar JL. Transvaginal ultrasonography combined with color velocity imaging and pulsed Doppler to detect residual trophoblastic tissue. Ultrasound Obstet Gynecol. 1998 Jan;11(1):54-8.
26. Centers for Disease Control (CDC). Ectopic pregnancy–United States, 1988-1989. MMWR Morb Mortal Wkly Rep. 1992 Aug 14;41(32):591-4.
27. Ulmann A, Silvestre L, Chemama L, et al. Medical termination of early pregnancy with mifepristone (RU 486) followed by a prostaglandin analogue. Study in 16,369 women. Acta Obstet Gynecol Scand. 1992 May;71(4):278-83.
28. Edwards J, Carson SA. New technologies permit safe abortion at less than six weeks’ gestation and provide timely detection of ectopic gestation. Am J Obstet Gynecol. 1997 May;176(5):1101-6. D
29. Shannon C, Brothers LP, Philip NM, Winikoff B. Ectopic pregnancy and medical abortion. Obstet Gynecol. 2004 Jul;104(1):161-7.
30. Gentile GP, Siegler AM. Inadvertent intestinal biopsy during laparoscopy and hysteroscopy: a report of two cases. Fertil Steril. 1981 Sep;36(3):402-4.
31. Sullivan B, Kenney P, Seibel M. Hysteroscopic resection of fibroid with thermal injury to sigmoid. Obstet Gynecol. 1992 Sep;80(3 Pt 2):546-7.
32. Aydeniz B, Gruber IV, Schauf B, et al. A multicenter survey of complications associated with 21,676 operative hysteroscopies. Eur J Obstet Gynecol Reprod Biol. 2002 Sep 10;104(2):160-4.
33. Agostini A, Cravello L, Bretelle F, et al. Risk of uterine perforation during hysteroscopic surgery. J Am Assoc Gynecol Laparosc. 2002 Aug;9(3):264-7.
34. Jansen FW, Vredevoogd CB, van Ulzen K, et al. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol. 2000 Aug;96(2):266-70.
35. Kerns J, Steinauer J. Management of postabortion hemorrhage: release date November 2012 SFP Guideline #20131. Contraception. 2013 Mar;87(3):331-42. doi: 10.1016/j.contraception.2012.10.024. Ep
36. Goyal V. Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review. Obstet Gynecol. 2009 May;113(5):1117-1123.
37. Istre O. Managing bleeding, fluid absorption and uterine perforation at hysteroscopy. Best Pract Res Clin Obstet Gynaecol. 2009 Oct;23(5):619-29.
38. Grimes DA, Schulz KF, Cates WJ Jr. Prevention of uterine perforation during curettage abortion. JAMA. 1984 Apr 27;251(16):2108-11.
39. Darney PD, Atkinson E, Hirabayashi K. Uterine perforation during second-trimester abortion by cervical dilation and instrumental extraction: a review of 15 cases. Obstet Gynecol. 1990 Mar;75(3 Pt 1):441-4.
40. Hefler L, Lemach A, Seebacher V, et al. The intraoperative complication rate of nonobstetric dilation and curettage. Obstet Gynecol. 2009 Jun;113(6):1268-1271.
41. Chen CH, Yang CC, Yeh YH. Role of upright chest radiography and ultrasonography in demonstrating free air of perforated peptic ulcers. Hepatogastroenterology. 2001 Jul-Aug;48(40):1082-4.
42. Romero JA, Castaño N. Ultrasonography is superior to plain radiography in the diagnosis of pneumoperitoneum (Br J Surg 2002; 89: 351-4). Br J Surg. 2002 Sep;89(9):1194-5; author reply 1195.
43. Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005 Sep;12(9):844-9.
44. Nazerian P, Tozzetti C, Vanni S, et al. Accuracy of abdominal ultrasound for the diagnosis of pneumoperitoneum in patients with acute abdominal pain: a pilot study. Crit Ultrasound J. 2015 Dec;7(1):15.
45. West AB; NDSG. The pathology of diverticulitis. J Clin Gastroenterol. 2008 Nov-Dec;42(10):1137-8.
46. Del Gaizo AJ, Lall C, Allen BC, Leyendecker JR. From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography. Abdom Imaging. 2014 Aug;39(4):802-23
47. Singh JP, Steward MJ, Booth TC, et al. Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl. 2010 Apr;92(3):182-8.
48. Pouli S, Kozana A, Papakitsou I, et al. Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology. Insights Imaging. 2020 Feb 21;11(1):31.