Managing Complications in Pregnancy and Childbirth: - IAWG

Vaginal bleeding in early pregnancyS-17- Use vacuum aspiration (page P-65). Manual vacuumaspiration is safer and associated with less blood loss. Therisk of perforation using a metal curette is high;- Have three syringes cocked and ready for use during theevacuation. The uterine contents are copious and it isimportant to evacuate them rapidly.• Infuse oxytocin 20 units in 1 L IV fluids (normal saline or Ringer’slactate) at 60 drops per minute to prevent haemorrhage onceevacuation is under way.SUBSEQUENT MANAGEMENT• Recommend a hormonal family planning method for at least 1 yearto prevent pregnancy (Table S-3, page S-13). Voluntary tuballigation may be offered if the woman has completed her family.• Follow up every 8 weeks for at least 1 year with urine pregnancytests because of the risk of persistent trophoblastic disease orchoriocarcinoma. If the urine pregnancy test is not negative after 8weeks or becomes positive again within the first year, refer thewoman to a tertiary care centre for further follow-up andmanagement.