abortion its types and management

1. CLASS TEACHING ON
ABORTION (COMPLETE,
INCOMPLETE,MISSED ABORTION)

2. SUBJECT: Obstetrics and gynecological nursing.
UNIT:
TOPIC: Abortion (complete,incomplete,missed).
DATE AND TIME:
NAME OF THE EVALUATOR: Prof. Shanta V. Laxami
NAME OF THE STUDENNT: Ms.Mandeep Kaur
METHOD OF TEACHING: Lecture cum discussion.
LEVEL OF STUDENT: B.Sc. Nursing IV year.
AV AIDS: Roller board: Definition of abortion.
Chart: Classification of abortion.
Pamphlet: Symptoms of abortion

3. Black board: Management of complete, incomplete. Missed abortion.
Power point: Abortion (complete, incomplete, missed).
CENTRAL OBJECTIVE:
Helps the students to acquire knowledge and understand about abortion complete, incomplete and
missed and to develop desirable attitude and skills in applying this knowledge in day to day practice.
SPECIFIC OBJECTIVES:

4. INTRODUCTION :
Good morning mam and students. before going to my topic. I would like to give a small introduction; you will be
knowing that the birth of the baby is the rebirth of women as a mother there are certain condition in the pregnancy
is deviated from the normal .It is known as abnormal pregnancy when you are posted in antenatal OPD a antenatal
mother complaints of abdominal cramps, bleeding per vagina, severe back pain what will you suspect for .yes it is
abortion so today we will see about Complete ,incomplete and missed abortion.

5. s.no TIME SPECIFIC
OBJECTIVE
CONTENT TEACHERS
ACTIVITY
STUDENT
ACTIVITY

6. 1.
2.
3min
5min
Define
Abortion
Review the
ABORTION
DEFINITION:
Abortion is the expulsion or extraction from its mother
of an embryo or fetus weighing 500 g or less when it is
not capable of independent survival (WHO).
This 500 g of fetal development
is attained approximately at 22 weeks (154 days) of
gestation. The expelled embryo or fetus is called
abortion. The word miscarriage is the recommended
terminology for spontaneous abortion,
TYPES OF ABORTION:
ABORTION
Explaining
With roller
board
Listening

7. 3. 3min
types of
abortion
definition of
Spontaneous Induced
Isolated Recurrent Legal Illegal
Threatened Inevitable Complete Incomplete Missed
Septic.
Definition of complete abortion
Complete abortion is a completed miscarriage.
Explaining
Listening
and taking
notes

8. complete
abortion
Typically, a history of vaginal bleeding, abdominal
pain, and passage of tissue exists. After the tissue
passes, the patient notes that the pain subsides and the
vaginal bleeding significantly diminishes. The
examination reveals some blood in the vaginal vault; a
closed cervical os; and no tenderness of the cervix,
uterus, adnexa, or abdomen. The ultrasound
demonstrates an empty uterus.
When the products of conception are expelled en missed
, it is called complete miscarriage.
CAUSES OF COMPLETE ABORTION ;
 Congenital Structural Defect: This
Asking
question
Answering

9. 4. 3min structural defect may be due to chromosomal
aberration or a serious physical defect.
 Low Progesterone: Progesterone maintains
the decidua basalis. If the corpus luteum fails
to produce enough progesterone, it would risk
the life of the fetus inside the uterus.
 Rh Incompatibility:The fetus could get
rejected from a mother’s body if they have an
incompatible Rh.
 Under nutrition: Lack of nutrients would
cause undernourishment to both the mother
and the fetus, leading to abortion.
 Drug:There are drugs which are
contraindicated for pregnant women.
Ingestion might compromise the fetus and
lead to abortion.
 Infection:In infection, the fetus would fail to
Explaining Listening
and taking
notes.

10. 5. 3min
grow and estrogen and progesterone
production would fall. This would lead to
endometrial sloughing, then prostaglandins
would be released leading to uterine
contractions and cervical dilatation along
with expulsion of the products of pregnancy.
SYMPTOMS OF COMPLETE ABORTION;
 Vaginal spotting. Vaginal spotting appearsas
small brownish to reddish spots
of blood coming out of the woman’s vaginal
opening. This usually occurs when the cervix
slightly dilates because the woman may have
tried to lift heavy objects or mild trauma to
the abdomen occurred.
 Vaginal bleeding. Bleeding is a serious
occurrence during pregnancy because it
might indicate that the cervix has opened and
Asking
question
Answering

11. 6. 10
min
products of conception might be expelled.
 Pain: Cramping/sharp/dull pain in the
symphysis pubis. This could occur on both
sides and could be caused by trauma or
premature contractions that might cause
cervical dilation.
 Uterine contractions felt by the
mother. Uterine contractions can be false or
true, but either of the two could be alarming
during the early stages of pregnancy because
it could expel the contents of the uterus
thereby leading to abortion.
MANAGEMENT OF COMPLETE ABORTION:
Transvaginal sonagraphy is useful to see that uterine
cavity is empty otherwise evacuation of uterine
curettage should be done.
Explaining
Explaining
Listening
And taking
notes
Listening
And taking

12. Administration of intravenous fluids: Such as
Lactated Ringer’s, IV therapy should be anticipated by
the nurse as well as administration of oxygen regulated
at 6-10L/minute by a face mask to replace intravascular
fluid loss and provide adequate fetal oxygenation.
Avoid vaginal examinations: The physician would
also avoid further vaginal examinations to avoid
disturbing the products of conception or triggering
cervical dilatation.
Dilatation and evacuation:This is to make sure that all
products of conception would be removed from the
uterus. However, before undergoing this intervention,
the physician must be sure that no fetal heart sounds
could be heard anymore and the ultrasound must show
an empty uterus.
Explaining
notes
Listening

13. 7.
8.
Dilation and curettage: This is most commonly
performed for both complete and incomplete abortions
to remove the remainder of the products of conception
from the uterus.
INCOMPLETE ABORTION
DEFINITION OF INCOMPLTE ABORTION:
The embryo is dead but some products of conception
are still intact. The cervix is already dilated and there is
severe vaginal bleeding. An incomplete
And taking
notes

14. 9.
abortion involves vaginal bleeding, cramping
(contractions), cervical dilatation,
and incomplete passage of the products of conception.
A woman experiencing incomplete abortion frequently
describes passage of clots or pieces of tissue, and
reports vaginal bleeding.
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.
CAUSES:
Sever high blood pressure:
High blood pressure can cause problems for mother
Asking
questions Answering

15. 10.
and baby during pregnancy, including preeclampsia and
premature birth. High blood pressure usually
doesn't cause signs or symptoms.
FIBROIDS:
 Women with fibroids may experience tummy
(abdominal) pain during pregnancy, and there's a
risk of premature labour. ... In rare cases, fibroids
can cause miscarriage.
 Poor muscle tone in the womb.
 Cervix and uterus problems.
 Un controlled diabetes .
 Acute infection such as german measles and
mycoplasma.
 Kidney disease.
 Autoimmune disease.
 Trauma to the abdomen.
SYMPTOMS OF COMPLETE ABORTION;
Explaining Listening
And asking
douest.

16. 11
Continuation of pain in lower abdomen.
Persistence of vaginal bleeding.
Vaginal spotting or bleeding.
Nausea ,vomiting.
Abdominal cramping.
INTERNAL EXAMINATION REVEALS:
Uterus smaller than the period of amenorrhea.
Patulous cervical OS often admitting tip of the finger.
The expelled mass is found incomplete.
Ultrasonagraphy reveals echogenic material within the
cavity.
MANAGEMENT OF INCOMPLETE ABORTION.
Medical management of incomplete abortion can be
done.
Tablet misoprisol 200ug is used vaginally every 4hours.
Explaining
Listening

17. EARLY ABORTION;
Dilation and evacuation under analgesics or general
anesthesia is to be done.
LATE ABORTION;
 The uterus is evacuated under general anesthesia
and the products are removd by ovum forceps.
 The uterus is evacuated under general anesthesia
and the products are removed by ovum forceps or
by blunt curette.
 In late cases, dilatation and curettage operation is
to be done remove the bits of tissues left behind.
 The removed materials are subjected to a
histological
 examination.
 Medical management of incomplete miscarriage
may be done. Tablet misoprostol 200 μg is used
 vaginally every 4 hours.
Misoprostol may be used to treat women with
Explaining Listening
and taking
notes.

18. an incomplete and missed abortion. Incomplete
abortion usually is diagnosed when a pregnant woman
has an open cervix and has passed some, but not all of
the products of conception .
Misoprostol is an effective treatment for incomplete
abortion. Simple regimens may be as effective as more
complicated ones and a single dose of 600 microg
should be further evaluated in larger trials.
MISSED ABORTION:
Listening
and taking
notes

19. A missed miscarriage is when embryonic death has
occurred but there is not any expulsion of the embryo. It
is not known why this occurs. Signs of this would be a
loss of pregnancy symptoms and the absence of fetal
heart tones found on an ultrasound.
When the fetus is dead and inside the uterus for variable
period it is called missed miscarriage or early fetal
demise
A miscarriage is the spontaneous loss of a fetus before
the 20th week of pregnancy (pregnancy losses after the
20th week are called stillbirths). Miscarriage is a
naturally occurring event, unlike medical or surgical
abortions.
Answering

20. CAUSES OF MISCARRIAGE INCLUDE:
 Drug and alcohol abuse
 Exposure to environmental toxins
 Hormone problems
 Infection
 Overweight
 Physical problems with the mother's reproductive
organs
 Problem with the body's immune response
 Serious body-wide (systemic) diseases in the
mother (such as uncontrolled diabetes)
 Smoking
SYMPTOMES OF MISSED ABORTION;
 vaginal bleeding
Listening
And taking
notes

21.  abdominal cramps or pain
 discharged of fluid or tissue
 lack of pregnancy symptoms.
 Mild to severe back pain (often worse than
normal menstrual cramps)
 Weight loss
 White-pink mucus
 True contractions (very painful happening every
5-20 minutes)
 Brown or bright red bleeding with or without
cramps (20-30% of all pregnancies can
experience some bleeding in early pregnancy,
with about 50% of those resulting in normal
pregnancies)
 Tissue with clot like material passing from the
vagina.
MANAGEMENT OF MISSED ABORTION;
Answering

22.  Uterus evacuated as soon as possible. A
donor should be kept ready.
 If uterine size is less than 12 weeks
ofgestation PGE1 tablets kept in vagina
results in spontaneous expulsion without
the need of surgical intervention.
 If more than 12 weeks, 6th or 12th hourly
PGE1tablets used vaginally results in
spontaneous expulsion or extra amniotic
ethacridine acetate.Anti D and antibiotics.

23. .
Dilatation and
curettage operation
is
to be done to remove
the
bitsbehind.Dilatation
and curettage

24. operation is
to be done to remove
the bits of tissue
left behind.