Emergency care for problems after miscarriage or abortion
If you do not have a speculum but you do know how to do a bimanual exam
(see page 384), wash your hands well and put on sterile plastic
gloves. Put 2 fingers into the woman’s vagina to feel her womb.
Move your fingers across the opening of the cervix. If you feel tissue
coming from inside the cervix, gently try to remove it. If it is too
slippery to hold, wrap two fingers with sterile gauze or a thin piece
of sterilized cloth and try again to remove the tissue. This might be
painful for the woman, so be very gentle. This method is rarely
helpful, but it is better than doing nothing.
WARNING! If you are not able to remove the tissue from
an incomplete abortion, you must get medical help
immediately so the tissue can be removed. On the way to the
medical center, treat the woman for infection with the medicines
listed on page 410, and watch for shock (page 414).
After you remove the tissue:
• F eel the womb from the outside to see
if it is soft. Rub the womb every few
hours to keep it hard (see page 224).
• W atch for signs of infection
A woman with an infection in the womb is in serious danger. The infection can
cause injury to the womb, and can spread into the blood (sepsis). Sepsis is very
dangerous and can cause shock or death. Women mainly get infections after
abortions when unsterile tools were used, or after miscarriages and abortions that
were not complete, but even an abortion that was done safely can sometimes cause
Wa r nin g s ig n s
• High temperature, above 38°C
• Fast pulse, over 100 beats a minute.
• Feeling chills and shivering.
• Swollen, hard, or painful belly.
• Bad-smelling fluid coming
from the vagina.
• Feeling ill or weak.
A Book for Midwives (2010)