abortion or miscarriage is the condition which causes the end of pregnancy before the child can survive extrauterine area this ppt include abortion and its management and this ppt help nurses to know this condition well and apply this condition in their clinical practice

1. ABORTION
DEPARTMENT
OF
MEDICAL SURGICAL NURSING
Smt. Radhikabai Meghe Memorial College of
Nursing

2. Learning Objectives
At the end of this lecture, students should be able
to:
• Define the term abortion
• Explain the Etiology of abortion
• Enlist the types of abortion
• Describe the Clinical features and diagnostic
evaluation of abortion
• Describe the Complication of abortion
• Explain the Management of abortion

3. Definition
It is expulsion or extraction of products
of conception before fetal viability i.e.
before 24 weeks of gestation.

4. Etiology
A. First trimester abortion :
• Fetal chromosomal abnormalities - An
embryonic pregnancy - Blighted ovum
• Multiple pregnancy

5. Etiology
A. First trimester abortion :
• Infections: genital tract infection , systemic
infection with pyrexia & TORCH syndrome
• Endocrine disorders : Diabetes, thyroid disorders ,
& corpus luteum insufficiency
• Uterine disorders: Uterine anomalies , submucus
fibroid & Asherman’s syndrome

6. Etiology
A. First trimester abortion :
• Thrombophilia: Congenital deficiency of
protein C & S, & anti-thrombin III
• Immunological disorders : Anticardiolipin
syndrome and SLE
• Psychological disorders

7. Etiology
B. Second trimester abortion :
• Multiple pregnancy
• Cervical incompetence (congenital &
acquired )
• Uterine anomalies and Submucous fibroid
• Genital tract infection and PROM

8. Types
• Threatened abortion
• Inevitable abortion
• Incomplete abortion
• Complete abortion
• Missed abortion
• Septic abortion
• Recurrent abortion

9. Threatened abortion
• History
• Examination
• U/S which is essential for the diagnosis

10. Threatened abortion
(Management)
• Reassurance
• Advice:
• Hormones i.e. Progesterone & HCG Which are
used in the first trimester to support pregnancy
• Anti- D: An adequate dose of anti-D should be
given to all Rh -
• ANC as high risk patients

11. Inevitable and incomplete abortions
History
Heavy vaginal bleeding.
 with no passage of products conception
(inevitable)
 with the passage of products of
conception (incomplete abortion)

12. Inevitable and incomplete abortions
Examinations
• Poor general condition.
• The cervix is dilating and products of
conception may be passing trough the os
• The uterus may be the correct size for date
U/S :

13. Inevitable and incomplete abortions
(management)
• CBC , blood grouping , XM 2 units of blood
• Resuscitation  large IV line, fluids & blood
transfusion
• Oxytoxic drugs  Ergometrine 0.5 mg IM +
Oxytocin infusion (20-40 units in 500 cc saline)
• Evacuation & curettage.
• Post-abortion management.

14. Complete abortion
• History
• Heavy vaginal bleeding which has been
stopped.
• lower abdominal pain which follows the
bleeding which has been stopped.
• Examination The cervix is closed
• U/S showed empty uterine cavity or PROP

15. Complete abortion
(Management)
• Evacuation & curettage in the presence of
RPOC.
• Post-abortion management.

16. Missed abortion
• Most of missed abortions are diagnosed
accidentally during routine U/S in early
pregnancy .

17. • In some cases there may be a history of :
• Episodes of mild vaginal bleeding
• Regression of early symptoms of
pregnancy .
• Stop of fetal movements after 20 wks
gestation.

18. Missed abortion
• U/S : diagnosed if two ultrasound ( T/V or
T/A) at least 7days apart showed an embryo of
> 7 weeks gestation ( CRL > 6mm in diameter
and gestational sac > 20 mm in diameter )
with no evidence of heart activity .

19. • Options of treatment
• Conservative treatment:
• Surgical evacuation of the uterus; by D & C:
• Medical termination of pregnancy: by
Misoprostol (PGE1)
• Cytotec: Indicated in 1st & 2nd trimesters missed
abortions.
• Post-abortion management.
Missed abortion
(Management)

20. • Definition :
• It is an incomplete abortion which
complicated by infection of the uterine
contents .
Septic abortion

21. • Bacteriology : Mixed infection
• Types :
• Mild
• Moderate
• Severe
Septic abortion

22. Management :
Antibiotics :
Surgical evacuation of uterus  usually 12 hrs
after antibiotic therapy
Post-abortion management.
Septic abortion

23. • Haemorrhage .
• Complication related to surgical evacuation ie
E&C and D&C.
• Rh- iso immunisation  if the anti –D is not
given or if the dose is inadequate .
• Psychological trauma .
Complications of abortion

24. Summary
So far we have discussed about definition,
etiology,types,sign and symptoms, diagnostic
evaluation, treatment and nursing
management of abortion.

25. Bibliography
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical Nursing,
Saunders publication.
• Brunner and Siddhartha, Medical Surgical
Nursing, Lippincott Williams and Wilkins.
• D.C. Dutta , text book of obstetrics and
gynecology

26. Thank you