Ongoing pregnancy[6]: Ongoing pregnancy after medication abortion is uncommon and can be treated with another dose of MISO or with procedural abortion. Procedural abortion is recommended if cardiac activity is present 14 to 21 days after taking MISO.
Retained products of conception[6]: In the absence of ongoing pregnancy, retained products of conception can be managed by asking patients to wait for bleeding and cramping, offering them another dose of MISO, or providing them with or referring them for procedural abortion. Urgent procedural abortion is indicated in cases of heavy uncontrolled bleeding or retained products of conception associated with endometritis.
Symptoms of retained products include unexpected heavy/prolonged bleeding or cramping, and failure to have expected bleeding.
Post-abortion infections[6]: Treatment should be individualized and usually consists of broad-spectrum therapy. In mild cases, oral antibiotics can be used, but if infection is severe, patients should be hospitalized for treatment. Once patients start antibiotics, procedural abortion may be necessary to remove significant retained products of contraception.
Symptoms of Post-Abortion Infections
- Abdominal or pelvic pain
- Foul-smelling vaginal or cervical discharge
- Prolonged vaginal bleeding or spotting
- Fever or chills (more than 24 hours after MISO)
- Uterine or adnexal tenderness
- Elevated white blood cell count (upon lab examination)
Toxic shock syndrome[6]: Toxic shock syndrome is associated with clostridium and Group A streptococcus. The majority of these infections are fulminant and rapidly progress to shock. Standard antibiotic therapy is not sufficient; thus, the treatment consists of supportive care, and empiric antibiotic treatment covering clostridial species and other organisms known to cause toxic shock, and surgical debridement, including possible hysterectomy.
Symptoms of Toxic Shock Syndrome
- General malaise with nausea, vomiting, and diarrhea
- Absence of fever (or mild fever)
- Minimal abdominal pain
- Weakness
- Flu-like symptoms
- Tachycardia / hypotension
- Edema
- High white blood cell counts or high hemoglobin level (upon lab examination)
