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How to Treat Gestation?


Things to note:
  • Counselling.
  • Outpatient procedure by nursing staff with specific training.
  • Manual vacuum aspiration of the uterus.

Medical Treatment:
Manual vacuum aspiration:
  • Misoprostol, PV, 400 mcg 3 hours before routine vacuum aspiration of the uterus.
Routine analgesia for vacuum aspiration
  • Pethidine, IM, 100 mg 30 minutes before aspiration procedure.
OR
  • Morphine, IM, 10 mg 30 minutes before aspiration procedure.
Do not give intravenous benzodiazepines and parenteral opioid analgesics concurrently.
  • Alternatively, consider paracervical block.
Oral analgesia as required for 48 hours.
  • Paracetamol, oral, 1 g 6 hourly.
AND
  • Ibuprofen, oral, 800 mg 8 hourly.
Women who decline MVA:
An alternative is medical TOP with:
  • Mifepristone, oral, immediately as a single dose.
    • Up to 9 weeks gestation: 100-200 mg.
    • 9- 13 weeks gestation:200 mg.
Followed 24-48 hours later by:
  • Misoprostol, PV, 800 mcg.
    • If expulsion has not occurred 4 hours after misoprostol administration, a second dose of misoprostol 400 mcg oral/PV may be given.
    • Review with ultrasound on day 7.
Note:
  • Bleeding may persist for up to 1 week.
After administration of mifepristone, start:
  • Paracetamol, oral, 1 g 6 hourly.
ADD
After expulsion is complete:
  • Ibuprofen, oral, 800 mg 8 hourly.