Analgesia Pain Management in First Trimester
Abortions occur at a rate of ~11.8 per 1,000 women in the United States. Patients undergoing abortions require management in the same way those having any other medical procedure would. An essential part of care and management is pain relief both during and after the procedure. Regardless of whether the patient has a medical or surgical abortion, there are risks including incomplete abortion, heavy & prolonged bleeding, infection and fever that impact the individual undergoing the procedure. Equally important, is the management of the pain following the procedure and understanding the expected symptoms following the procedure.
During my OBGYN rotation, I encountered a patient in the ED complaining of bleeding and pain following dilation & curettage. In this experience, the patient was not well informed as to the expected side effects of the procedure prompting her to come the ED for evaluation. The evaluation in the ED showed an empty uterus but significant blood in the vaginal vault. The patient received antibiotics prophylactically and there was no concern of infection following the examination allowing the provider to confidently decide this patient was experiencing expected side effects after the D&C.
The article selected discusses pain management in first trimester surgical abortion and discusses the various factors that affect a patient. The authors highlight the conclusion that pain management is a ‘critical aspect of patient care’ and discuss the different types of pain medications available to treat patients experiencing pain after a surgical abortion. Interestingly the article delves into the various components of abortion pain and the parasympathetic and sympathetic fibers affected as a result of the procedure. The research notes the importance of discussing pain as the ‘fifth vital sign’ to allow for better optimization of pain and tailoring of medication to yield relief.
Outside of the physiology of pain, the authors highlight the factors associated with increased pain including patient characteristics and history, preparations and counseling, procedure time, provider, atmosphere where the procedure occurs and gestational age. Furthermore the research discusses the different medications and anesthesia used and non-pharmacologic pain management as well. Ultimately, the authors state adequate pain management during abortion ‘improves the patient experience and may reduce the risk of complications’ and discusses the variety of factors that inform management and the need to individualize the patients need for pain care.
In this particular experience, the patient was not informed about the side effects and pain that occur as a result of dilation and curettage and therefore did not know what to expect. Her visit to the ED would likely had been avoided if pain management was discussed and she was given the proper counseling on what medications she could take to manage the symptoms she was experiencing. With the proper counseling, the patients’ nerves were eased and she felt comfortable being discharged from the hospital. The patient was informed of the side effects that should prompt her to return to the ED but also given counseling on pain management and offered the appropriate care as an individual.
https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm
https://www.mayoclinic.org/tests-procedures/medical-abortion/about/pac-20394687
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