Terminology, definitions, etiology, clinical features, management, and complications of abortion are discussed in detail in the document. Abortion is defined as the expulsion of an embryo or fetus weighing 500 grams or less. Etiology includes both maternal and fetal factors. Clinical features, management, and nursing care are described for different types of abortion including threatened, inevitable, incomplete, missed, septic, and recurrent abortion. Complications of abortion and medical termination of pregnancy are also outlined.

2. Terminology:-
Trisomy
Monosomy
Polyploidy
Intrauterine Adhesion
Suction evacuation
DIC( Disseminated intravascular coagulation)

3. DEFINITION
Abortion is the expulsion or extraction of
an embryo or fetus weighing 500 g or less
from its mother when it is not capable of
independent survival (i.e. before the
period of viability)

4. Incidence
•75% abortions occur before the 16th week

6. Etiology
•Maternal factor
•Fetal factor

7. Fetal Factors:-
Genetic factor
Multiple Pregnancy
 Degeneration of villi

8. Maternal Factor
• Endocrine & Metabolic Factor (10–15%):
– Luteal Phase Defect
– Thyroid abnormalities
• Anatomical abnormalities
Cervicouterine factors
• Infection

9. • Immunological Factor:-(5–10%)— –
• • Autoimmune disease
• • Alloimmune disease
• Environmental Factors
• – Cigarette smoking
• – Alcohol consumption

10. •Maternal medical illness :
•– Cyanotic heart disease
•Unexplained (40-60%) – In majority, the
exact cause is not known.

11. Threatened Abortion:-
• Condition in which miscarriage has
started but has not progressed to a state
from which recovery is impossible

12. Clinical Feature
•Slight bleeding per vaginam
•The uterus and cervix feel soft.
•• Differential diagnosis includes :-
•– cervical ectopy
• – polyps or carcinoma

13. Management & Prognosis:-
•Rest: Patient should be in bed for few days until
bleeding stops
• • Relief of pain: Diazepam 5 mg BD
•If pregnancy continues, there is increased
frequency of preterm labor, placenta previa &
IUGR

14. Inevitable Abortion:-
•It is the clinical type of abortion
where the changes have progressed
to a state from where continuation
of pregnancy is impossible.

15. CLINICAL FEATURES:
•vaginal bleeding
• Aggravation of colicky pain in the lower
abdomen
•Internal examination reveals dilated internal os
through which the products of conception are felt

16. Management :-
Management is aimed:
• – To accelerate the process of expulsion
• – To maintain strict asepsis
•• If pregnancy < 12 weeks, suction evacuation is
done

17. Incomplete abortion :-
•The process of abortion has already
taken place, but the entire products of
conception are not expelled & a part of it
is left inside the uterine cavity

18. Clinical features:
History of expulsion of a fleshy mass per vaginam;
• – Continuation of pain in lower abdomen
• • Internal examination reveals:-
• – uterus smaller than the period of amenorrhea
• – Open internal os
• – varying amount of bleeding

19. MANAGEMENT:
• Early abortion:
• Dilatation and evacuation under analgesia or general
anaesthesia is to be done.
• Late abortion:
• Uterus is evacuated under general anaesthesia and the
products are removed by ovum forceps or by blunt curette. In
late cases, D&C is to be done to remove the bits of tissues left
behind

20. Complete Abortion :-
•When the products of conception
are completely expelled from the
uterus, it is called complete
miscarriage.

21. Clinical features:-
• There is history of expulsion of a fleshy mass per vaginam followed
by
• – Subsidence of abdominal pain
• – Vaginal bleeding becomes trace or absent
• Internal examination reveals:
• – Uterus smaller than the period of amenorrhea
• – Cervical os is closed

22. Missed Abortion :-
• The fetus is dead and retained passively
inside the uterus for a variable period. It is
diagnosed when there is a fetus with a crown
rump length of 5mm without a fetal heart.

23. CLINICAL FEATURES:
The patient usually presents with features of threatened miscarriage
followed by: –
Subsidence of pregnancy symptoms
 Uterus becomes smaller in size
 Cervix feels firm with closed internal os
 No audibility of the fetal heart sound even with Doppler
ultrasound

24. Complications:-
 Retaining the products for long time can lead
to sepsis
 • DIC [Disseminated Intravascular
Coagulation] – (very rare) in gestations
exceeding 16 weeks

25. Management :-
•Uterus is less than 12 weeks:
• Prostaglandin E1 (Misoprostol) 800 mg is given
vaginally and repeated after 24 hours if needed.
Expulsion usually occurs within 48 hours
• Suction evacuation is done when the medical method
fails

26. •Uterus more than 12 weeks
• 6th or 12th hourly misoprostol tablets
given vaginally • If this fails, extra
amniotic instillation of ethacridine lactate
is used
• Antibiotics are given

27. Septic Abortion :-
•Any abortion associated with clinical
evidences of infection of the uterus and
its contents
• Most common cause – Attempt at
induced abortion by an untrained person
without the use of aseptic precautions

28. Clinical Grading:
•Grade 1
•Grade 2
•Grade 3
•Grade 1 is most common

29. Clinical Features:-
• Fever, abdominal pain and vomiting or diarrhoea
• Internal examination reveals:
• – offensive purulent vaginal discharge
• – tender uterus usually with patulous os or a boggy
feel

30. Investigations:-
• CBC , Serum urea, creatinine, electrolytes
• Pelvic USG to detect retained products of
conception
• • X-ray abdomen in suspected bowel injury
•• X-ray chest if there is difficulty in respiration

31. Complications:-
• Injury may to uterus & adjacent structures
• • Spread of infection leads to:
• – Generalized peritonitis
• – Endotoxic shock—mostly due to E. Coli
• – DIC
• Haemorrhage

32. Management:-
• Mild cases:-
• – – Broad spectrum antibiotics started
• – Uterus is evacuated
• Severe Cases :-
• – Vigorous IV infusion with crystalloid
• – Oxygen given by nasal catheter
• – Broad spectrum antibiotics

33. Recurrent Abortion :-
•• Recurrent miscarriage is defined as a
sequence of three or more consecutive
spontaneous abortion
•• Seen in ~ 1% of all women

34. Etiology:-
• First Trimester Abortion:-
• Genetic factors (3–5%):
• Endocrine and Metabolic:
• Infection:
• Immunological cause:
• Second Trimester Abortion
• • Anatomic abnormalities
• Uterine Causes
• Cervical Insufficiency (Incompetence) :-

35. • • Congenital :-
• Acquired (iatrogenic)
• Diagnosis:-
• • History - Repeated mid trimester painless cervical dilatation and escape of liquor
amnii followed by painless expulsion of the products of conception
• • Internal examination: Interconceptual period: – Passage of no. 6–8 Hegar dilator
beyond the internal os without any resistance or pain – Funnelling of internal os seen
in hysterosalpingography

36. Management
•Surgical management
• – Cervical cerclage
• • Usually at 12-14 weeks

37. CONTRAINDICATION
• – Intrauterine infection
• – Ruptured membranes
• – History of vaginal bleeding
• – Severe uterine irritability
• – Cervical dilatation > 4 cm.

38. Methods
•2 main methods – McDonald and
Modified Shirodkar
• Success rates - 80 – 90%

41. Postoperative care: –

42. COMPLICATION
• – Slipping or cutting through the suture
• – Chorioamnionitis
•– Rupture of the membranes
•– Cervical scarring and dystocia requiring cesarean
delivery.

43. Prognosis of
recurrent
miscarriage :-
• • The overall risk of recurrent
miscarriage is about 25–30%
irrespective of the number of
previous spontaneous miscarriage.

44. Post abortion instruction:-
 Activity is restricted for 2 weeks
 Intercourse is avoided for 2 weeks
 Review performed after 4- 6 weeks
 Counselling is provided regarding contraceptive intrauterine device may be inserted or oral
contraceptive initiated 4 weeks after the abortion
 Iron supplement is recommended for 4- 12 weeks
 Emotional support is required for all women after the abortion
 It is essential to reassure the women that she is in no way responsible for causing the
abortion

45. Complication of Abortion:-
 Incomplete evacuation of the uterus
- Hemorrhage
- Abdominal Pain
- Low grade fever
 Injury due to instruments:-
- Cervical trauma
- Uterine perforation
•

46.  Infection
- Septic abortion
- Endometritis, parametritis, peritonitis
- Septicemia /septic shock
•
 Asherman syndrome
- Due to vigorous curettage
• . Secondary curettage
• . Infertility
• . Injury

47. Induction of Abortion:-
•Deliberate termination of pregnancy either
by medical or by surgical method before the
viability of the fetus is called induction of
abortion. The induced abortion may be legal
or illegal (criminal).

48. MEDICAL TERMINATION OF PREGNANCY
(MTP)
The following provisions are laid down:
 The continuation of pregnancy would involve serious risk of to the physical &
mental health of the pregnant women
 There is substantial risk of child being born with serious physical & mental
abnormalities so as to be handicaped in life
 When the pregnancy cause by rape
 Pregnancy cause by failure of contraception

49. The indications for termination under the MTP
Act:
• To save the life of the mother (therapeutic or medical
termination):
• • Social indications:
• Eugenic:-

50. RECOMMENDATIONS

51. METHODS OF TERMINATIONOF PREGNANCY:

52. Complication Of MTP:-
• Immediate :
• (1) Injury to the cervix
• (2) Uterine perforation
• (3) Hemorrhage and shock
• (4) Thrombosis or embolism.
• (5) Postabortal triad of pain

53. Remote:-
• Gynaecological complications include-
• (a) menstrual disturbances
• (b) chronic pelvic inflammation
• (c)infertility due to cornual block
• Obstetrical complications include-
• (a) recurrent mid trimester abortion
• (b) ectopic pregnancy (three-fold increase)
• (c) preterm labor
• (d) dysmaturity

54. Nursing Care for Abortion/ Pregnancy Loss:-
• Pre-operative care for surgical abortion :-
1. For morning appointments:
• NBM, no smoking, after 12:00 am (midnight) the day of the procedure.
1. For afternoon appointments:
• NBM, no smoking, after 8am the day of the procedure.
• No recreational drugs or alcoholic beverages for 48 hours prior to surgery.
• Please dress comfortably; no make-up, jewellery, contact lenses, or high
heel shoes.

55. Nursing responsibilities:
• . Check pt’s name, type of surgery
• 2. Monitor input & output, blood test, bleeding and vaginal secretion (
character, colour & volume)
• 3. Strict aseptic technique
• 4. Strengthen the perineum care & maintain the vulva cleanliness
• 5. Psychological care:

56. Post-operative care:-
Monitor vital signs .
Blood pressure and pulse.
 Assess the client’s conscious level,
 Assess for severity of pain using pain scale

57. Summary:-
• Induced abortion is the termination of a pregnancy by artificial
means. Governments can be permissive or restrictive in their
legislation regulating abortion. Induced abortion is legal in the
United States today, where more than one in five pregnancies end
in induced abortion.