Conditions in Late Pregnancy
Obstetric and Gynaecological Emergencies 3833 Give rhesus-negative mothers anti-D immunoglobulin 250 units i.m. within
72 hours up to 13 weeks of pregnancy, and 625 units i.m. for multiple
pregnancies or after the first trimester (500 IU i.m. in the UK).
4 Refer patients with a threatened miscarriage to the EPEU (Early Pregnancy
Evaluation Unit) or similar for ongoing management.
5 Admit all other patients under the gynaecology team for surgical (evacua-
tion of retained products of conception – ERPC), medical (misoprostol) or
expectant management of uterine evacuation for an inevitable, incomplete
or silent miscarriage.
Induced septic abortion
DIAGNOSIS AND MANAGEMENT
1 This is the result of ‘backstreet’ abortion or occasionally therapeutic uterine
evacuation.
2 There is rapidly spreading pelvic infection, with salpingitis, peritonitis,
pelvic and pulmonary thrombophlebitis, which can lead to septicaemia,
DIC, shock and death.
3 The patient presents unwell with fever, abdominal pain, foul-smelling
vaginal discharge and bleeding. The patient will develop hypotension, oli-
guria, confusion and coma if untreated.
4 Give the patient high-f low oxygen by face mask.
5 Gain i.v. access, send blood for FBC, coagulation profile, U&Es, liver
function tests (LFTs), blood sugar, two sets of blood cultures and G&S for
rhesus D antibodies. Start rapid normal saline i.v.
6 Commence gentamicin 5 mg/kg i.v., ampicillin 2 g i.v. and metronidazole
500 mg i.v., and refer the patient urgently to the gynaecology team for evacu-
ation of the uterine contents or emergency hysterectomy.
CONDITIONS IN LATE PREGNANCY
Ideally, all patients >18–20 weeks pregnant should be sent straight to the
labour ward. Occasionally, they are too unstable or there is not time to get them
there. Thus the following conditions may be seen, all requiring prompt obstetric
help.
Tip: miscarriage can be associated with significant psychological
sequelae. An empathic approach to medical care, and the provision of
counselling and psychological support are important.✓