Ectopic pregnancy incomplete abortion and failed abortion

a. Early detection of ectopic pregnancy, incomplete abortion, or failed abortion is possible with examination of the specimen immediately after the abortion. The patient may have an ectopic pregnancy if no chorionic villi are found. To detect an incomplete abortion that might result in continued pregnancy, the actual gestational sac must be identified.

b. Determination of the b-hCG level and frozen section of the aspirated tissue and vaginal ultrasonography may be useful. If the b-hCG level is greater than 1,500-2,000 mIU, chori-onic villi are not identified on frozen section, or retained tissue is identified by ultrasonography, immediate laparoscopy should be considered. Other patients may be followed closely with serial b-hCG assays until the problem is resolved. With later (>13 weeks) gestations, all of the fetal parts must be identified by the surgeon to prevent incomplete abortion.

c. Heavy bleeding or fever after abortion suggests retained tissue. If the postabortal uterus is larger than 12-week size, preopera-tive ultrasonography should be performed to determine the amount of remaining tissue. When fever is present, high-dose intravenous antibiotic therapy with two or three agents should be initiated, and curettage should be performed shortly thereafter.

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