Professional Documents
Culture Documents
ON
ABORTION
Presented By:
Mandeep Kaur
M.Sc. (N) Final Year
INTRODUCTION:
Threatened abortion
Legal abortion
Inevitable abortion
Illegal abortion
Complete abortion
Incomplete abortion
Missed abortion
Septic abortion
Spontaneous Abortion:
Spontaneous abortion is defined as the involuntary
loss of products of conception prior to 28 weeks of
gestation, when the fetus weights approximately
1000gm or less.
Spontaneous abortions occur in every 15
pregnancies.
In India it has been computed that about 6 million
pregnancy loss.
Maternal causes are:
Ultrasonography.
Treatment:
Rest
Drugs: For Relief of pain.
Inevitable Abortion:
The women presents with bleeding,
often heavy, with clots or products of
conception. Blood loss may be heavy
and the mother in a shocked state.
The cervix is dilated and on
examination, products may be seen in
the vagina or protruding trough the os.
The uterus if palpable may be smaller
than expected.
Management:
Management is aimed:
a) to accelerate the process of expulsion.
b) to maintain strict asepsis.
General measures: Excessive bleeding should
be promptly controlled by administering
methergin 0.2mg if the cervix is dilated and the
size of the uterus is less than 12 weeks.
The blood loss is corrected by intravenous fluid
complete
Management:
Transvaginal ultra sonography is usefull to
see that uterine cavity is empty, otherwise
evacuation of uterine curettage should be
done.
Incomplete Abortion
When the entire
products of
conception are not
expelled, instead a
part of it is left inside
the uterine cavity it is
called incomplete
miscarriage or
abortion.
Clinical features
History of expulsion of a fleshy mass per vagina
followed by:
Continuation of pain lower abdomen.
Sepsis
Placental polyp
Management:
In recent cases: Evacuation of the retained
products of conception (ERCP) is done.
Medical management of incomplete abortion
smaller in size.
Non audibility of the fetal heart sound even with
negative.
Real time ultrasonography reveals an
empty sac early in the pregnancy or the
absence of fetal motion or fetal cardiac
movements.
Management:
Uterus is less than 12 weeks:
Expectant management: many women expel the
conceptus spontaneously.
Medical management: prostaglandin E1
(Misoprostal) 800mg vaginally in the posterior
fornix is given and repeated after 24 hours if
needed. Expulsion usually occurs within 48 hours.
Suction evacuation or dilatation and evacuation is
treatment.
Dilatation and evacuation is done once the cervix becomes
more.
Offensive or purulent vaginal discharge.
infection.
Clinical features:
Depending upon the severity and the extent of infection,
the clinical picture varies widely.
Pyrexia associated with chills and rigor suggest of blood
stream spread of infection.
Pain abdomen
A rising pulse rate of 100-120/min or more is a significant
finding then even pyrexia. It indicates spread of infection
beyond the uterus.
Internal examination reveals offensive purulent discharge
or a tender uterus usually with patulous os or a boggy feel
of the uterus.
Clinical grading:
particularly gut.
Spread of infection leads to generalised peritonitis, endotoxic shock,
Remote complications:
Chronic pelvic pain and backache
Dyspareunia
Ectopic pregnancy
Secondary infertility
Emotional depression
Management of septic abortion:
Hospitalization is essential for all cases of septic abortion. The patient is
kept in isolation.
To take high vaginal or cervical swab for culture, drug sensitivity test
and gram stain.
Vaginal examination is done to note the state of abortion.
Overall assessment and patient is levelled in accordance with clinical
grading.
Investigation protocols.
Drugs: Antibiotics, analgesics and sedatives.
Pelvic abscess if present will be drained.
Evacuation of the uterus.
Laparotomy : Removal of the uterus should be done irrespective of
parity.
Induced abortion:
This is deliberate interruption of an intact
pregnancy. Induced abortions are
performed legally in India since the
Medical termination pregnancy (MTP) Act
of 1971 (revised in 1975).
MTP ACT
PROVISIONS:-
The continuation of pregnancy would involve serious
THERAPEUTIC OR MEDICAL
TERMINATION:
Cardiac disease
Chronic glomerulonephritis.
Cervical or breast malignancy
Diabetes mellitus
Psychiatric illness
Cont…
SOCIAL INDICATIONS:
GYNAECOLOGICAL COMPLICATIONS:
Menstrual disturbances
Chronic pelvic inflammation
OBSTETRICAL COMPLICATIONS:
Preterm labour
Dysmaturity
Rupture uterus
Role of nurse
Assessment: Assess for the following manifestations:
Vaginal bleeding, spotting, clots.
feelings of guilt.
Nursing diagnosis:
Risk for fetal injury.
Risk for infection related abortion.
Fluid volume deficit related to vaginal bleeding as
evidenced by cool and clamy skin, dry mucosa.
Anticipatory grieving related to loss of pregnancy.
Anxiety related to outcomes of abortion and its effect on
future pregnancies.
Altered family processes related to abortion.
Knowledge deficit related to abortion and its complications.
Planning:
Provide information regarding treatment plan.
Provide support and reassurance regarding
nursing care.
Promote maternal physical well-being.
support.
Provide teaching related to self care.
Implementation:
Observe for vaginal bleeding and cramping.
Save expelled tissue and clot for examination.
Monitor vital signs every 5 minutes to 4 hours
depending on maternal status.
Maintain women on bed rest.
Observe for signs of shock and institute treatment
measures.
Prepare for dilatation and curettage if appropriate.
Provide support, but avoid offering false assurance.
Summarization:
Definition of abortion.
Incidence of abortion.
Aetiology of abortion.
Classification of abortion.
MTP act.