LECTURE ON

‘ABORTION’
BY –RAVINDER KAUR BHULLAR
NURSING TUTOR
MSC NURSING (OBG)
 INTRODUCTION
Any bleeding in pregnancy is abnormal.
Vaginal blood loss in early pregnancy should
be through of as threatened miscarriage until
shown otherwise. The term miscarriage and
spontaneous abortion are synonymous.
 DEFITION
Abortion is process of partial or complete
separation of the products of conception from
the uterine wall with or without partial or
complete expulsion from the uterine cavity
before the age of viability.
The age of viability is 28 weeks in India.
 CLASSIFICTION
ABORTION

SPONTANEOUS INDUCED
 CLASSIFICATION
SPONTANEOUS ABORTION
* THREATENED ABORTION
* INEVITABLE ABORTION
* COMPLETE ABORTION
* INCOMPLETE ABORTION
* MISSED ABORTION
* SEPTIC ABORTION (LESS COMMON)
 CLASSIFICATION
INDUCED

* LEGAL ABORTION (MTP)

* ILLEGAL ABORTION (CRIMINAL)

SEPTIC (COMMON)
 CAUSES
In most cases its unknown
chromosomal abnormalities.
Genetic
Maternal cause such as retroversion of uterus,
bicornuate uterus, fibroids .
Infections like rubella and Chlamydia
Medical conditions- diabetes, renal disease, thyroid
dysfunction.
 THREATENED ABORTION
Vaginal bleeding with or without recognizable
uterine contractions. The blood loss may be
scanty with or without accompanying backache
and cramp like pain. Pain resemble to
dysmenorrhea. The cervix remains closed and
soft uterus no tenderness on palpation.
Outcome could be either stop bleeding and
continue pregnancy to term or expel the
products of conception.
 MANAGEMENT
General and systematic examination
Investigations
Admit and complete bed rest
Treat as per cause found
If pregnancy continues watch for
IUGR
Treat as high risk pregnancy because
more chances of preterm labor
 INEVITABLE ABORTION
Bleeding often heavy, with clots or products
of conception, blood loss may be heavy and
the mother in shocked state. Cervix dilated
on examination, products may seen in the
vagina. Uterus feels smaller than expected.
MANAGEMENT-
* Control bleeding- ergometrine IV/IM
* Analgesics
 INCOMPLETE ABRTION
In this parts of placenta remains within the
uterine cavity, contributing to heavy and
perfuse bleeding

MANAGEMENT-
Ergometrine IV/IM
D&E under general anesthesia
 COMPLETE ABORTION
The conception products, placenta
and membranes are expelled
completely from the uterus. The pain
stops.

No further medical intervention is

required
 MISSED ABORTION
The embryo dies despite the presence of a viable
placenta and the sac is retained. Death of the
embryo occurs before 8 weeks of gestation but
the mothers body fails to recognized the demise.
 brown discharge is suspected
Failure to weight gain
Uterus is smaller than expected and soft
MANGEMENT- D&E under general anesthesia
 HABITUAL ABORTION
Spontaneous abortion in three or more
successive pregnancies may occur, usually
abortion occurs at the same gestational age,
mostly after 16 weeks.
Cause may be genetic or immunological
Management- complete bed rest at the time
of occurrence
Special treatment if cause is identified
 INDUCED ABORTION
MTP (medical termination of pregnancy)
(legal abortion) Act 1971 ( revised in 1975)
Legal abortion is the deliberate induction of
abortion prior to 20 weeks of gestation by a
register medical practitioner in the interest
of mothers health and life
 PROVISION FOR MTP UNDER THE MTP ACT.
The continuation of pregnancy would involve serious
risk of life or grave injury to the physical or mental
health of the pregnant women.
There is substantial risk of the child being born with
serious physical and mental abnormalities so as to be
handicapped in life
The pregnancy is the result of rape
The pregnancy is the result of failure of contraceptives
Foreseeable environment (social or economical)
 INDICATIONS FOR MTP
THERAPEUTIC-
Deteriorating health due to pulmonary TB
Cardiac disease
Chronic glomerulonephritis
Malignant hypertension
 intractable hyperemesis gravidarum
Cervical or breast malignancy
Diabetes mellitus with retinopathy
Psychiatric illness
 SOCIAL
Parous women having unplanned
pregnancy with low socioeconomic status
Pregnancy caused by rape
Pregnancy due to failure of contraceptives
 EUGENIC
Risk of baby born with various physical and mental
abnormalities like-
Chromosomal and gene disorders
Exposure to drugs or radiation
Rubella infection in first trimester
One or both parents are mentally ill
Congenital malformation in siblings
CONDITIONS TO BE MET PRIOR TO THE
PROCEDURE
Register medical practitioner is required for MTP to
save the mother
The procedure can only be performed in hospital
Written consent is necessary of pregnant women
If minor is pregnant consent from parents is required
for legal purpose
Procedure has to be reported to the directorate of
Health Services of state
 METHODS OF MTP
Suction evacuation and curettage
Dilation and evacuation
Pharmacological method
Histerotomy
SUCTION EVACUATION AND CURETTAGE
In this method the product of conception is
sucked out from the uterus with the help of
cannula attached with the suction apparatus.
Cervix dilated with metal dilators and then
cannula introduced into uterine cavity and
with a small flushing curettage uterine cavity
curetted and suction out the remaining portion
of the conception. A dose of Methergine is
administered IV to control bleeding
 DILATION AND EVACUATION

There are two methods of D&E that is two stage

method (slow method) and one stage method (rapid
method)
(1) In slow method cervix is dilated by introducing
laminaria tent into the cervical canal and women kept
12 hours in bed during which time tent swell up and
dilate the cervix. (2) After 12 hours with dilators cervix
further dilated and with ovum forceps conception
products are removed, curette can also done,
antibiotics and methergine are administered.
 PHARMACOLOGICAL METHOD

Mifepristne – used to termination of

pregnancy up to 9 weeks, a single dose of
600 mg is given orally and abortion is likely
to occurs in about 36 hours. If fails
prostaglandin E1 methyl ester pessary (1mg)
is introduced virginally to complete the
abortion, abortion occurs within 4 hours
 METHOTREXATE
Termination with methotrexate has
been used effectively up to 8 weeks of
pregnancy. A single dose is give IM with
misoprostol vaginally, abortion occurs
within 3-4 hours.
 HYSTEROTOMY
It is used as a method of termination of
midtrimester pregnancy where other
methods of termination have failed or are
contraindicated. The products of conception
are expelled out of the uterus by cutting
through the anterior wall of the uterus.
 SEPTIC ABORTION
This abortion is characterized by infection of he
products of the conception and the uterus. This
condition is most commonly complication of
induced or incomplete abortion. Illegal abortion
carried out in non sterile conditions are often leads
to septic abortion.
Causes-
Criminal abortion- inexpert attempts
Abortion with infection
MTP with infection
 CLINICAL MANIFESTATION
Pyrexia
Headache
Nausea
Foul smelling vaginal discharge
Tenderness in lower abdomen
Septicemia
Peritonitis
Shock
TREATMENT
IV antibiotics
Hospitalization
 NURSING PROCESS IN ABORTION
ASSESSMENT
* Vaginal bleeding , spotting and clot
* Low abdominal cramps
* Passing of tissue through vagina
* Increased pulse rate
* Women may verbalize fear, disappointment or feelings
of guilt
 NURSING DIAGNOSIS
Risk for fetal injuries
Risk for infection
Ineffective airway clearance
Actual risk for aspiration
Anxiety
Grieving
Altered family processes
Health seeking behaviour
 PLANNING
Provide information regarding treatment plan
Provide support regarding nursing care
Promote maternal physical well-being
Provide opportunity for counseling and support
Provide teaching regarding self care
 IMPLEMENTATION
Observe for vaginal bleeding and cramping
Save excelled tissue and clots for examination
 Observe vital signs carefully
Maintain women on bed rest
Observe for signs for shock
Prepare for D&C if appropriate
Provide support but avoid offering false assurance
 EVALUATION
Ensure that the women -
Is free from anemia and infection
Is free from vaginal bleeding
Return to normal physiological status following the
abortion
Understand self care measures
ANY QUESTION?
 SUMMERY
Today we have discussed topic abortion
* Introduction
* Definition
* Classification (spontaneous and induced abortion
* MTP (medical termination of pregnancy)
* Nursing process
 RECAPTULIZATION:-

Define abortion
What is the classification of abortion
Explain missed abortion
What are the indications of MTP
 ASSIGNMENT
Tomorrow will be your oral test
of abortion
 BIBLIOGRAPHY
Jacob A, a comprehensive textbook of midwifery &
gynecological nursing, 5th edi, Jaypee publication, 2019
Dutta DC, A text book of Obstetrics (Hiralal Koner)
8th edi. New Delhi. Jaypee publications 2016
Raynor Maureen, Marshall Jayne. Myles text book for
Midwives, 7th international edi. London. Elsever
publications 2014
Thank You