PROGRAM

: BSN 1st YEAR

PLACE TOPIC GROUP TEACHING METHODS NAME OF THE STUDENT NAME OF THE FACULTY DATE AND TIME

: MY CAMPUS : ABORTION : BSN 1st YEAR STUDENTS : LECTURE : LAIBY JOHN : DR. NASIRA SATHARKHAN : DECEMBER 2007

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Post mature sperm or ova.. and toxo plasmosis. Cause frequently unknown. 2 . Psychological factors such as stress and anxiety cause the alteration in the level of pituitary hormones which affects uterine activity and lead to abortion . History of diabetis . 6. 11. Imperfect sperm or ova. 4. Immunologic factor by which the mother and father are gene`tically similar major antigens. or lupus erythematosus. This 500gms of fetal development is attained approximately 22 wks of gestation. Luteal phase defect. 9. but 50% are due to chromosomal anomalies. 10. The expelled embryo or fetus is called abortus. or specific bacterial microorganisms that put the pregnany at risk. retroverted uterus and developmental defects such as bicornuate uterus and myomas can cause abortion. Smoking or drug abuse or both.ABORTION DEFENITION Abortion is the expulsion or extraction from its mother of an embryo or fetus weighing 500gms or less when it is not capable of independent survival.Exposure or contact with teratogenic agents. Structural defect in the maternal reproductive system like incompetent cervix. Maternal illness with virus such as rubella. Page 2 of 10 . Induced abortions PATHOPHYSIOLOGY AND ETIOLOGY 1 .that cause the maternal immune system to reject the embryo. thyroid disease. Spontaneous abortions B . Abortions are mainly classified in to two A . ABO incompatibility between mother and embryo may result in abortion. Poor maternal nutritional status. active herpes. 8. 14. anticardiolipin antibodies. 7. Large doses of any drug consumption. cytomegalovirus. 13. 12. 3. 5.

2. 3. Vaginal bleeding usually begins as dark spotting . Uterine cramping . BEYOND 14th WEEK-The process of expulsion is similar to that of a “mini labour”. death of the ovum occurs first . presence of dilation or tissue evaluated. followed by its expulsion. Beta –hCG levels may be elevated for as long as 2 weeks after the loss of embryo.Expulsion of the fetus commonly occurs leaving behind the placenta and the membranes. Some times the external os fails to dilate so that the entire mass is accommodated in the dilated cervical canal and is called cervical abortion. Page 3 of 10 . Cervix closed or slightly dilated. maternal environmental factors are involved leading to expulsion of fetus which may have signs of life but is too small to survive. MECHANISM OF ABORTION Inearly weeks . BEFORE 8 WEEKS-The ovum surrounded by the villi with the desidual covering . CLINICAL MANIFESTATION Vaginal bleeding or spotting. mild cramps . TYPES OF SPONTANEOUS ABORTION 1.then progress to frank bleeding as the embryo separates from the uterus.CLINICAL MANIFESTATION 1. 2. Ultrasonic evaluation of the gestational sac or embryo.tenderness over uterus. The fetus is expelled first followed by expulsion of the placenta after a varying interval. A part of it may be partially separated with brisk haemorrhage or remains totally attached to the uterine wall.THREATENED ABORTION It is a clinically entity where the process of abortion has started but has not progressed to a state from which recovery is impossible. 8-14WEEKS. symptoms subside or develop into an inevitable abortion. low back pain. Visualisation of the cervix. In later weeks . simulates mild labour or persistent low back ache with feeling of pelvic pressure. DIAGNOSTIC EVALUATION 1. is expelled out intact.

INEVITABLE ABORTION It is the clinical type of abortion where the changes have progressed to a state from where the continuation of pregnancy is impossible. Excessive bleeding should be promptly controlled by administering methergin 0. Painful uterine contractions. CLINICAL MANIFESTATION Bleeding more profuse. Pad count. Page 4 of 10 . Vaginal examination . Drugs for sedation and relief of pain to be given. If bleeding is profuse with the cervix closed evacuation of the uterus may have to be done by abdominal hysterectomy. serum projesterone level.INVESTIGATIONS Blood test.2mg if the cervix is dilated and the uterine size is less than 12 weeks. AFTER 12 WEEKThe uterine contraction is accelerated by oxitocin drip.Hb. haematocrit. Dilated cervix.followed by dilatation and curettage. it is removed by ovum forceps. If placenta is not separated digital separation followed by its evacuation is to be done under general anaesthesia. Serum HCG level. Observation of the vital signs. Membranes rupture. HABITUAL ABORTION It is defined as a sequence of three or more consecutive spontaneous abortion before 20 weeks. MANAGEMENT Bed rest till the bleeding stops.if lying separated. ABO RH. MANAGEMENT BEFORE 12 WEEKS-.If the fetus is expelled and placenta is retained . Embryo delivered . 2.The shock is corrected by IV fluid therapy and blood transfusion.

placenta and intact membranes. tumors.Vaginal bleeding becomes trace or absent. if any . COMPLETE ABORTION A complete abortion is likely to occur prior to 8th week of pregnancy and constitutes the expulsion of the embryo . MANAGEMENT D&C Page 5 of 10 . incompetent cervix. d)Examination of the expelled fleshy mass is found intact. INCOMPLETE ABORTION When the entire products of conception are not expelled . Internal examination reveals a)Uterus is smaller than the period of amnorrhoea and a little firmer. b)Cervical os is closed. If there is any doubt about complete expulsion of the product uterine curettage should be done. CLINICAL MANIFESTATION Subsidence of abdominal pain. CLINICAL MANIFESTATION Fetus usually expelled. instead a part of it is left inside uterine cavity . Surgical suturing of the cervix if incompetent cervix is a causative factor. Hysterogram to rule out uterine abnormalities or infections. abnormal uterus. placenta and membranes retained. thyroid dysfunction. should be assessed and treated. c)Bleeding is trace. it is called incomplete abortion.MANAGEMENT D&C Treatment of possible causes : Hormonal imbalance. MANAGEMENT The effect of blood loss . With treatment 70-80% carry a pregnancy successfully.

MANAGEMENT First trimester can be managed by D&C. investigation protocols to be done. Voluntary abortion is the termination of a pregnancy before fetal viability as a choice of the woman. To asses the response of treatment. fetal monitoring to determine if fetus is dead. oxitocin induction may be used. over all assessment . No symptoms of abortion. Second trimester by prostaglandin induction.MISSED ABORTION When the fetus is dead and retained inside the uterus for a variable period it is called missed abortion. drug sensitivity test and gram stain . Grade 3 Generalised peritonitis and / endotoxic shock or jaundice or acute renal failure. and if second trimester . To give supportive therapy to bring back the normal homeostatic and cellular metabolism. but symptoms of pregnancy regress. is called septic abortion. MANAGEMENT Hospitalisation and isolation. Fibrinogen concentration should be measured weekly. to take high vaginal or cervical swab for culture . Page 6 of 10 . Offensive or purulent vaginal discharge . CLINICAL MANIFESTATION Fetus dies in utero and is retained. Late second trimester by using intra amniotic saline induction. CLINICAL GRADING Grade 1: The infection is localized in the uterus. Maceration. remove the source of infection. MANAGEMENT Real time ultrasound.If fetus is not passed after diagnosis. SEPTIC ABORTION Any abortion associated with clinical evidences of infection of the uterus and its contents . vaginal examination . Other evidences of pelvic infection such as lower abdominal pain and tenderness. Control sepsis. CLINICAL MANIFESTATION Rise of temperature of at least 38C for 24 hrs or more. Retained dead fetus may lead to development of disseminated intra vascular coagulation or infection. Grade2 : The infection spreads beyond the uterus to the parametrium . tubes and ovaries or pelvic peritoneum. THERAPEUTIC OR VOLANTARY ABORTION Therapeutic abortion is the termination of pregnancy before fetal viability for the purpose of safeguarding the womans health . or hysterectomy. hysterotomy.

D. 2. If the fetus is aborted intact . Maintaining fluid volume Report any tachycardia . Anticipatory grieving related to loss of pregnancy . Maintain IVline for fluid replacement and possible BT. Draw blood for type and screen for possible blood transfusion. 4. Determine if a positive PT obtained before and the date of LMP. Encourage perineal care following each urination and defecation to prevent contamination. Encourage the patient and father to discuss their feelings about the loss of the baby . Provide the time alone for the couple to discuss their feelings. 3. Pain related to uterine cramping and possible procedures. Preventing infection Evaluate temperature every 4 hrs if normal. NURSING ASSESMENT Evaluate the amount and color of blood. which may indicate infection. NURSING DIAGNOSIS 1. 2. 5. 1. Risk for infection related to dilated cervix and open uterine vessels. Risk for fluid volume deficit related to maternal bleeding. C. cause of the abortion. Page 7 of 10 . the time of bleeding started and the precipitating factor. disseminated intravascular coagulation in a missed abortion. and every 2hrs if elevated. 3. provide an opportunity for viewing if parents desire. Instruct and encourage the use of relaxation techniques to augment analgesics. septicemia. Check vaginal drainage for increased amount and odor. 4. Promoting comfort Instruct patient on cause pain to decrease anxiety. 2. 4. Inspect all tissue passed for completeness. future child bearing. Assess the reaction of the patient and support person. 3. Discuss the prognosis of the future pregnancies. infection. Providing support through the grieving process. Evaluate any blood or clot tissue for retained products. hypotension. Administer pain medications as needed and as prescribed. 3. B. 1. uterine infection. diaphoresis or pallor indicating hemorrhage and shock. Monitor vital signs for the indication of complications such as hemorrhage. NURSING INTERVENTIONS A. 1.COMPLICATIONS OF ABORTION Haemorrhage. 1. 2. 3. 2.

every 4 hrly.Explain the cause of pain to reduce anxiety. Checked temp. Temp.NURSING CARE PLAN ASSESMENT 1. related to dilated cervix and open uterine vessels. PLANNING 1. 2. every 4 hrly if normal and 2hrly if elevated. 3.Explained the cause of pain to reduce anxiety. 3. which may indicate infection. 2. 1. 2. Releaved pain. Page 8 of 10 . Normal discharge. related to uterine cramping and possible procedures.Pain Altred To relieve comfort pain. 2. and slept well.Instruct and encourage relaxation technique. Check temp.Encourage perineal care.2°C No signs of infection. IMPLIMENTATION EVALUATION 1.Infection NURSING GOAL DIAGNOSIS Risk for To avoid infection infection.Checked vaginal drainage. Perineal care given.Check vaginal drainage for increased amount and odor . 3. 3. 2. no signs of infection.Give analgesics as needed and as ordered. 37.Analgesics given as needed and as ordered. 1.Instructed and encouraged relaxation technique.

3.Blood grouping and cross matching done. 3.Do blood grouping and cross matching for possible BT.Maintain I/V line with large bore catheter for BT and large quantity fluid replaceme nt. 2.Observed closely signs of to find out any signs shock. 2. 3. 1. Protected the patient from the possibility for hypovolemea.Hypovolemea Risk for fluid To avoid volume hypovole deficit related mea. of shock.Report any 1. Maintained I/V line with large bore catheter for BT and large quantity fluid replacement. Page 9 of 10 . to maternal bleeding.

Edinburgh UK.Text book of obstretics. 3. and to get medical care immediately. send specimen according to policy. D. Culcutta.1026-1028.2008.The lippincott manual of nursing practice. EVALUATION A. C. Sandra M. Vital signs remain normal. normal.LippincottWilliams& Wilkins. performs perineal care. BIBLIOGRAPHY 1. Page 10 of 10 . pg no.New central book agency. minimal blood loss. Nettina. 2.6th edition. ELBS. pg no. Teach the woman to observe for the signs of infection. Verbalizes relief of pain. Ruth Bennett& Linda k. Expresses feelings regarding the loss of pregnancy. 6th edition.pg no-1647-1650. V. and explain the need to wait at least 3-6 months for another pregnancy.1996.Philadelphia. Lippincott.pg no.Brunner& Suddarth’s text book of medical surgical nursing. 11th edition . Smelter. Provide information regarding the genetic testing of the product of conception if indicated. 1993. 2. temp. C. 3. brown.PATIENT EDUCATION 1.-159178.Myles Text Book for midwives.-272-279. 4. Dutta. Discuss the methods of contraception to be used. D. No signs of infection . B.etal.12th edition. 2004. Philadelphia. Suzanne C.

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