Postabortion Care: A Reference Manual for Improving Quality of Care

Maternal & Neonatal Health

Postabortion Care:
A Reference Manual for Improving Quality of Care

The table of contents below outlines the topics covered in the Postabortion Care Consortium's reference manual Postabortion Care: A Reference Manual for Improving Quality of Care.

Order Postabortion Care: A Reference Manual for Improving Quality of Care

For more information about JHPIEGO's Postabortion Care projects, contact:

Ricky Lu, MD
E-mail: rlu@jhpiego.net

	PREFACE

ONE	POSTABORTION CARE
	Background Scope of the Problem Elements of Postabortion Care Emergency Treatment Services Postabortion Family Planning Links to Other Reproductive Health Services Rationale for the Use of MVA

TWO	TALKING WITH PATIENTS
	Background Patient Rights Consent for Treatment Establishing the Patient-Provider Relationship Confidentiality Privacy

THREE	INITIAL ASSESSMENT
	Background Signs and Symptoms Screening for Serious Complications Shock Other Serious Complications Severe Vaginal Bleeding Infection/Sepsis Intra-Abdominal Injury Medical Evaluation Medical History Physical Examination Abdominal Examination Pelvic Examination Speculum Examination Bimanual Examination Laboratory Tests Summary Stage of Abortion Management of Postabortion Complications

FOUR	INFECTION PREVENTION
	Background Definitions Protective Barriers Handwashing Glove Use Antisepsis No-Touch Technique Processing MVA Equipment and Other Items Handling Needles and Syringes Waste Disposal Disposal of Products of Conception (POC) Disposal of Hypodermic Syringes (and Needles)

FIVE	PAIN MANAGEMENT
	Background Goal of Pain Management Types of Pain Pain Management Techniques Local Anesthesia Complications of Local Anesthesia How to Administer Paracervical Block

SIX	TREATMENT OF INCOMPLETE ABORTION
	Background Manual Vacuum Aspiration MVA Instrument Kits Choice of Equipment Precautions Prior to Performing MVA Preparation for MVA Procedure Minimizing the Risk of Infection Preparing MVA Instruments Pain Management Pelvic Examination Patient Preparation Steps for Performing MVA Treatment of Second-Trimester Incomplete Abortions Postoperative Care Monitor Patient's Recovery Postoperative Information Postabortion Family Planning

SEVEN	MANAGEMENT OF PROBLEMS AND COMPLICATIONS DURING MVA
	Background Technical Problems Syringe Full Cannula Withdrawn Prematurely Cannula Clogged Syringe Does Not Hold Vacuum Procedural Problems Less Than Expected Tissue Incomplete Evacuation All POC Passed Before the MVA Other Problems Vaginal Bleeding Not Due to Pregnancy Ectopic Pregnancy Postabortal Syndrome (Acute Hematometra) Fainting (Vagal Reaction or Neurogenic Shock) Complications Uterine Perforation Cervical Perforation Shock, Severe Vaginal Bleeding and Post-MVA Infection Air Embolism

EIGHT	PROCESSING MVA EQUIPMENT AND OTHER ITEMS
	Background Processing MVA Equipment Decontamination Making Dilute Chlorine Solutions Cleaning MVA Syringes Sterilization or High-Level Disinfection Sterilization Handling Sterile Items High-Level Disinfection Boiling Steaming Products that Should Not Be Used as Disinfectants Storage and Reassembly Sterile Instruments High-Level Disinfected Instruments MVA Syringes

NINE	POSTABORTION FAMILY PLANNING
	Background Factors Limiting Access to Postabortion Family Planning Postabortion Family Planning Counseling Family Planning Information Counseling Process The Counseling Session Postabortion Contraception Contraception after Postabortion Complications Service Delivery Capabilities

TEN	ORGANIZING AND MANAGING SERVICES
	Background Facilities for Emergency Postabortion Care Referral Systems Transportation Issues Outpatient and Emergency Room Care Caseload Considerations Patient Flow Coordination Within Facilities Equipment and Drugs for Emergency Postabortion Care Current Status of Existing Resources for Postabortion Care Type of Equipment and Supplies Needed Quantity of Equipment and Supplies Needed Inventory Control and Maintenance Policies and Procedures Regarding Equipment and Supplies

APPENDICES

A	ASSESSMENT AND TREATMENT OF COMPLICATIONS
	Background Shock Initial Treatment Definitive Treatment Severe Vaginal Bleeding Initial Treatment Definitive Treatment Continuing Treatment Infection/Sepsis Initial Treatment Definitive Treatment Continuing Treatment Intra-Abdominal Injury Initial Treatment Definitive Treatment Continuing Treatment Uterine Perforation

B	GENERAL PRINCIPLES OF EMERGENCY POSTABORTION CARE
	Background Stabilization and Referral Intravenous (IV) Fluid Replacement Blood Transfusion Administration of Medicines Intravenous (IV) Intramuscular (IM) By mouth (oral) Antibiotics Pain Management Tetanus Diuretics

C	SAMPLE REFERRAL FORM: POSTABORTION COMPLICATIONS

D	PROCESSING SURGICAL GLOVES
	How to Decontaminate and Clean Surgical Gloves Before Sterilization or High-Level Disinfection How to Sterilize Surgical Gloves How to High-Level Disinfect Surgical Gloves by Steaming How to High-Level Disinfect Surgical Gloves by Boiling Accidental Contamination of Sterile or High-Level Disinfected Gloves Regloving After Contamination

E	USE OF MEDICATIONS FOR PAIN
	Types of Medication Analgesia Complications of Analgesia Sedatives Complications of Sedatives

F	EQUIPMENT AND SUPPLIES NEEDED FOR MVA
	Furniture and Equipment For High-Level Disinfection or Sterilization of Instruments For Emergency Resuscitation

G	ESSENTIAL DRUGS FOR EMERGENCY POSTABORTION CARE

H	PRECAUTIONS FOR PERFORMING MVA

I	PREPARING INSTRUMENTS FOR MVA

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