HABITUAL ABORTION

It is defined as a sequence of three or more consecutive spontaneous abortion before 20 weeks.

MANAGEMENT

D&C
Treatment of possible causes : Hormonal imbalance, tumors, thyroid dysfunction, abnormal
uterus, incompetent cervix.
With treatment 70-80% carry a pregnancy successfully.
Surgical suturing of the cervix if incompetent cervix is a causative factor.
Hysterogram to rule out uterine abnormalities or infections.

COMPLETE ABORTION

A complete abortion is likely to occur prior to 8th week of pregnancy and constitutes the
expulsion of the embryo , placenta and intact membranes.

CLINICAL MANIFESTATION

Subsidence of abdominal pain.Vaginal bleeding becomes trace or absent.

Internal examination reveals
a)Uterus is smaller than the period of amnorrhoea and a little firmer.
b)Cervical os is closed.
c)Bleeding is trace.
d)Examination of the expelled fleshy mass is found intact.

MANAGEMENT

The effect of blood loss , if any , should be assessed and treated.

If there is any doubt about complete expulsion of the product uterine curettage should be done.

INCOMPLETE ABORTION

When the entire products of conception are not expelled , instead a part of it is left inside uterine
cavity , it is called incomplete abortion.

CLINICAL MANIFESTATION
Fetus usually expelled, placenta and membranes retained.

MANAGEMENT

D&C

MISSED ABORTION

When the fetus is dead and retained inside the uterus for a variable period it is called missed
abortion.

CLINICAL MANIFESTATION
Fetus dies in utero and is retained.
Maceration.
No symptoms of abortion, but symptoms of pregnancy regress.

MANAGEMENT
Real time ultrasound, and if second trimester , fetal monitoring to determine if fetus is dead.If
fetus is not passed after diagnosis, oxitocin induction may be used. Retained dead fetus may lead
to development of disseminated intra vascular coagulation or infection.
Fibrinogen concentration should be measured weekly.

SEPTIC ABORTION
Any abortion associated with clinical evidences of infection of the uterus and its contents , is
called septic abortion.

CLINICAL MANIFESTATION
Rise of temperature of at least 38C for 24 hrs or more.
Offensive or purulent vaginal discharge .
Other evidences of pelvic infection such as lower abdominal pain and tenderness.

CLINICAL GRADING
Grade 1: The infection is localized in the uterus.
Grade2 : The infection spreads beyond the uterus to the parametrium , tubes and ovaries or
pelvic peritoneum.
Grade 3 Generalised peritonitis and / endotoxic shock or jaundice or acute renal failure.

MANAGEMENT
Hospitalisation and isolation, to take high vaginal or cervical swab for culture , drug sensitivity
test and gram stain , vaginal examination , over all assessment , investigation protocols to be
done.
Control sepsis, remove the source of infection.
To give supportive therapy to bring back the normal homeostatic and cellular metabolism.
To asses the response of treatment.

THERAPEUTIC OR VOLANTARY ABORTION

Therapeutic abortion is the termination of pregnancy before fetal viability for the purpose of
safeguarding the womans health .
Voluntary abortion is the termination of a pregnancy before fetal viability as a choice of the
woman.

MANAGEMENT
First trimester can be managed by D&C.
Second trimester by prostaglandin induction.
Late second trimester by using intra amniotic saline induction, hysterotomy, or hysterectomy.
COMPLICATIONS OF ABORTION

Haemorrhage, uterine infection, septicemia, disseminated intravascular coagulation in a missed

abortion.

NURSING ASSESMENT

Evaluate the amount and color of blood, the time of bleeding started and the precipitating factor.
Determine if a positive PT obtained before and the date of LMP.
Monitor vital signs for the indication of complications such as hemorrhage, infection.
Evaluate any blood or clot tissue for retained products.

NURSING DIAGNOSIS

1. Risk for fluid volume deficit related to maternal bleeding.

2. Anticipatory grieving related to loss of pregnancy , cause of the abortion, future child
bearing.
3. Risk for infection related to dilated cervix and open uterine vessels.
4. Pain related to uterine cramping and possible procedures.

NURSING INTERVENTIONS

A. Maintaining fluid volume

1. Report any tachycardia , hypotension, diaphoresis or pallor indicating hemorrhage and shock.
2. Draw blood for type and screen for possible blood transfusion.
3. Maintain IVline for fluid replacement and possible BT.
4. Inspect all tissue passed for completeness.
B. Providing support through the grieving process.
1. Assess the reaction of the patient and support person.
2. Encourage the patient and father to discuss their feelings about the loss of the baby .
3. Provide the time alone for the couple to discuss their feelings.
4. Discuss the prognosis of the future pregnancies.
5. If the fetus is aborted intact , provide an opportunity for viewing if parents desire.
C. Preventing infection
1. Evaluate temperature every 4 hrs if normal, and every 2hrs if elevated.
2. Check vaginal drainage for increased amount and odor, which may indicate infection.
3. Encourage perineal care following each urination and defecation to prevent contamination.

D. Promoting comfort
1. Instruct patient on cause pain to decrease anxiety.
2. Instruct and encourage the use of relaxation techniques to augment analgesics.
3. Administer pain medications as needed and as prescribed.