This document discusses abortion, also known as miscarriage. Abortion is defined as the termination of a pregnancy by removing the fetus or embryo before it can survive outside the uterus. The document covers the incidence, classification, etiology, signs and symptoms, investigations, and management of different types of miscarriages such as threatened, inevitable, incomplete, missed, septic, and recurrent miscarriages. Nursing management involves close monitoring of symptoms and vital signs and notifying the healthcare provider immediately if bleeding is noticed.

2. • *Abortion is also called as
miscarriage.
•
* Abortion is ending of
pregnancy by removing a foetus
or embryo before it can survive
outside the uterus.

3. DEFINITION:
* Abortion is the expulsion or
extraction from its mother of
an embryo or foetus weghing
500gm
or less when it is not capable
of independent survival (Acc.
WHO)

4. INCIDENCE :
* The incidence of abortion is
difficult to work out but probably
10-20% of all clinical pregnancies
end in miscarriage and another
optmistic figure of 10% are
induced or deliberate About 75%
miscarriages occur before the
16th week of pregnancy.

5. CLASSIFICATION :


6. ETIOLOGY:
The etiology of miscarriage if
often complex and obscure. The
following factors are important:
 Genetic
Anatomic
Immunological
Infection
Endocrinal

7. THREATENED MISCARRIAGE :
It is a clinical entity where the
process of miscarriage has
started but has not progressed to
a state from which recovery is
possible
C/M : painless vaginal bleeding
without vaginal contraction, mild
abdominal pain.

9. INVESTIGATIONS:
Blood:- for hemoglobin
hematocrit ABO and RH grouping
Urine :For immunological test of
pregnancy
Ultrasonography:- Anembryonic
sac is diagnosed
T/T :- Analgesic ,hcg

10. INEVITABLE MISCARRIAGE:
Definition:- it is the clinical type
of abortion where the changes
have progressed to a state from
where continuation of pregnancy
is impossible
Clinical Features :- Increased
vaginal bleeding ,aggravation of
colicky pain , dilated internal os

12. TREATEMENT:-
 Before 12 Weeks:- Dilation and
Evacuation followed by cruttage of
uterine cavity
 After 12 Weeks :- The uterine
contraction is accelerated by
oxytocin drip 40-60 drops per minute
if the foteus is explled and placenta
is retained then D&E is done under
general anesthesia

13. COMPLETE MISCARRIAGE
A complete miscarriage is
defined as a cessation of
vaginal bleeding with no
evidence of retained products of
conception or a gestation sac in
a woman who previously had
an ultrasound confirmed
intrauterine pregnancy

15. Clinical Features:- Abdominal
Pain, vaginal bleeding, uterus
is smaller than period of
amenorrhea , USG shows that
uterine cavity is empty

16. INCOMPLETE MISCARRIAGE
 A miscarriage is labeled "incomplete"
if bleeding has begun and the cervix
is dilated, but tissue from the
pregnancy still remains in the uterus.

17. Clinical Features:- Continuation
of pain in lower abdomen ,
vaginal bleeding, patulous
cervical often admiting tip of the
finger , usg shows echogenic
material within cavity
Management :- D&E , tablet
misoprostol 200mg is used
vaginally evey 4 hrs

18. MISSED MISCARRIAGE
 When the foetus is dead and retained
inside the uterus for a variable period
it is called missed miscarriage or
early fetal demise
 Clinical Features:- Persistence of
vaginal brownish discharge,
Subsidence of pregnancy symptoms
,nonaudibility of FHS even with
doppler ultrasound ,USG shows an
sac with absence of any fetal
movements or cardiac motion

20. MANAGEMENT:-
 When uterus is less than 12 weeks
many women expel the product
spontaneously
 Prostaglandin E1 800mg vaginally
for expulsion
 S&E ,D&E is done either as definitive
treatment
 When uterus more than 12 weeks:-
10-20 units of oxytocin in 500ml of
NS at 30 drops/min Many pt. needs

21. SEPTIC ABORTION
 Definition:- Any abortion associated
with clinical evidences of infection of
the uterus and its content is called
septic abortion
 Mode of Infection :- Through
microorganisms which are anaerobic
bacteriodes, streptococci,colstridium
welchii , pseudomonas escheria coli
mrthicillin resistant stayphylococcus
aureus

22. PATHOLOGY:-
 In the majority the organisms are
endogenous origin and the infection
is localised to the conceptus without
any myometrial involvement in about
15% the infection either produces
localized endometritis surrounded by
a protective leukocytic barrier or
spreads to the parametrium
tubes,ovaries in about 5% there is
generalized peritonitis or endotoxic

23. CLINICAL FEATURES
 The women looks sick and anxious
 Chills and rigors
 Hypothermia
 Abdominal pain
 Renal angle tenderness
 Offensive purulent vaginal
 discharge

24. INVESTIGATIONS
 Routine investigations include:- swab
culuture to find out the dominant
microorganisms,senstivity of
microorganisms to antibiotics and smear
for gram stain
 Urine Analysis including culture
 Blood for HB and count of WBCs
 Plain X-RAY :- To suspect bowel injury
 USG:- To detect the any products in cavity,
fluid accumulation in pouch of Douglas

25. MANAGEMENT
 Hospitalization is essential for cases
of septic abortion
 To take high vaginal or cervical swab
for culture
 Vaginal examination is done to note
the state of the abortion proces and
extension of infection
 Antibiotics and Analgesics
 Evacuation of uterus
 Posterior Colpotomy

26. RECURRENT MISCARRIAGE
Definition:- It is defined as the
sequence of two or more
spontaneous abortion as
documented by sonography
before 20 weeks of gestation
Etiology:- Genetic factors
,endocrine and metabolic
,infections inherited
thrombophillia, immune factors

27. NURSING MANAGEMENT
 The presenting symptom of an abortion is
always vaginal spotting, and once this is
noticed by the pregnant woman, she
should immediately notify her healthcare
provider
 Ask of the pregnant woman’s actions
before the spotting or bleeding occurred
and identifies the measures she did when
she first noticed the bleeding.
 Inquire of the duration and intensity of the
bleeding or pain felt. Lastly, identify the
client’s blood type for cases of Rh
incompatibility.