Negative effects of abortion

1. ABORTIONS
BY
SALIMA F

2. BROAD OBJECTIVE
Define Abortion
List the classifications of Abortion
Explain the assessment of a woman with
abortion
Explain the management of a woman with
abortion
Explain the prevention of abortion

3. ABORTION
• “… wherever there are men and women there
will be pregnancy– and wherever there is
unwanted pregnancy there will be abortion…”
Khama Rogo- World Bank

4. Definition
Is the termination of pregnancy by any means,
resulting in expulsion of an immature,
nonviable fetus of less than 28 weeks.
Abortion can be early or late depending on
gestation e.g. early up to 12 weeks gestation.
Late between 13-28 weeks gestation.

5. Classifications of Abortion
Abortion can be classified as spontaneous or
induced

6. Spontaneous Abortion
Spontaneous abortion (SAB) is defined as the
termination of pregnancy from natural causes
before the fetus is viable.
Viability is defined as 20 to 24 weeks’
gestation or a fetal weight of more than 500 g.
SABs are a common occurrence in human
reproduction, occurring in approximately 15%
to 22% of all pregnancies.

7. Spontaneous Abortion Ctd’
There are five types of SABs, classified according
to symptoms:
1. threatened
2. Inevitable
3. incomplete
4. complete
5. missed.

8. 1. Threatened abortion
Occurs when there is slight bleeding and
cramping very early in the pregnancy
About 50% of women in this category abort
The bleeding is not severe, backache may be
present and rarely lower abdominal pains are
present
Pregnancy may either go to term or not.

9. 2. Inevitable abortion
Occurs when the membranes rupture, the
cervix dilates, and bleeding increases.
The products of conception can no longer be
contained in the uterus making it impossible
for the pregnancy to continue.

10. 3.Incomplete Abortion
An incomplete abortion occurs when the
uterus retains parts of the products of
conception and the placenta.
Sometimes, the fetus and placenta are
expelled, but part of the placenta may adhere
to the wall of the uterus and lead to continued
bleeding.

11. 3.Incomplete Abortion Ctd’
Signs and Symptoms of incomplete Abortion:
Bleeding continues and may be profuse
Severe lower abdominal pain
Involution does not take place

12. 4. Complete Abortion
Occurs when all the products of conception
are passed through the cervix.

13. 5. Missed Abortion
A missed abortion occurs when the products
of conception are retained for 2 months or
more after the death of the fetus.

14. B. INDUCED ABORTION
Induced abortion can either be therapeutic or
criminal

15. (a) Therapeutic
This is termination of pregnancy mostly due to
medical reasons. The reasons include:
Psychiatric illness of the mother
Risk to life of a pregnant woman such as
cardiac, liver, kidney diseases
Disease affecting the foetus such as rubella,
rhesus- incompatibility, heamolytic diseases,
hereditary diseases as downs syndrome.

16. (b) Criminal
This is an abortion which is illegally procured.
It may be performed by an unqualified person
possibly under unhygienic conditions utilizing
a variety of devices and it is usually a hurried
procedure.
Risks include: sepsis, uterine perforation,
cervical laceration, hemorrhage, acute renal
failure, shock and death.

17. Septic Abortion
Septic Abortion or post abortal sepsis usually
follows any incomplete abortion where the
uterus has not been evacuated in a timely
manner.
However this condition is often associated
with criminal abortion.

18. Septic Abortion Ctd’
The patient usually is very ill and presents with the
following signs and symptoms:
Anaemia
Pyrexia
Tachycardia
Headache
Offensive and profuse liquor
Uterus is bulky and tender on palpation
Jaundice may be present

19. Complications of Septic Abortion
Hemorrhage
Septicaemia
Bacteraemic shock with rigors, nausea and
vomiting, diarrhoea, origuria, hypertension,
confusion, delirium and coma
Renal failure
Secondary infertility
death

20. Diagnostic Test
Test: Human chorionic gonadotropin (hCG)
Normal Result: Negative
Explanation: HCG normally is not present in
nonpregnant women

21. Diagnostic Test Ctd’
Test: Ultrasound (transvaginal,
transabdominal)
Normal Result: Positive fetal heart beat;
growth within normal limits
Abnormality with Condition: Heart beat
absent; gestational sac appears shriveled, or
shrinking
Explanation: Used to diagnose a missed
abortion

22. ASSESSMENT
HISTORY:
Obtain a complete obstetric history.
Determine the date of the last menstrual
period to calculate the fetus’s gestational age.
Question the patient as to the onset and
amount of bleeding.
Ask the patient to describe the duration,
location, and intensity of her pain.

23. ASSESSMENT
HISTORY:
With a missed abortion, early signs of
pregnancy cease; thus, inquire about nausea,
vomiting, breast tenderness, urinary
frequency, and leukorrhea (white or yellow
mucous discharge from the vagina).

24. Assessment
PHYSICAL EXAMINATION.
Temperature is elevated if a maternal
infection is present.
Pallor, cool and clammy skin and changes in
the level of consciousness are symptoms of
shock.
 Examine the patient’s peripad for blood loss,
and determine if any tissue has been expelled.

25. Assessment
PHYSICAL EXAMINATION
Assess the patient’s emotional status, as well
as that of the baby’s father and other family
members.

26. Management of a woman with
abortion
General management of abortion:
The woman must be admitted to
gynecological ward for close observation and
treatment
History taking to obtain possible aetiological
factors together with details of bleeding, pain
and products of conception expelled
Physical examination: check mucous
membranes for anemia

27. Management of a woman with
abortion ctd’
Check and record vital signs i.e. temperature,
pulse, respiration and blood pressure
Encourage bed rest
Provide pads to observe severity of blood loss
Put up intravenous fluids if the woman is
bleeding severely i.e. normal saline, ringers
lactate and add pitocin 20-40 in the litre
Encourage vulva and personal hygiene

28. Management of a woman with
abortion ctd’
Check Hb, grouping and cross matching and
arrange for blood donor if necessary
counseling
Keep the woman warm
Prepare the woman for surgical intervention
i.e. evacuation or manual vacuum aspiration

29. Specific Management
(a) Threatening Abortion
Follow the general management except no
pitocin
Strict bed rest
Treat cause

30. Specific Management ctd’
(b) Inevitable Abortion
No pitocin
No anti-biotics
Follow general management
(c) Incomplete Abortion
The general management
Evacuate the uterus by either manual vacuum
aspiration or curettage under anesthesia

31. Specific Management ctd’
(d) Complete Abortion
General management
Ergometrine iv stat
(e) Missed Abortion
General management but no pitocin
Refer ultra sound screening

32. Specific Management ctd’
(f) Septic Abortion
General management plus IV antibiotics and
assess when to do evacuation or manual
vacuum aspiration which may be performed in
the ward.

33. Prevention of Abortions
Ensure that family planning services are
accessible to all women of child bearing age
Provide IEC to the public on danger of criminal
abortions and how to prevent unwanted or
unintended pregnancies through family
planning
Health personnel should get accurate history
in order to identify women at risk

34. Prevention of Abortions Ctd’
Encourage women at risk to go to health
facility for treatment
Thorough physical examination in antenatal
clinics to identify risk factors such as diabetes,
anaemia, hypertension, infections (sexually
transmitted), malaria which can predispose a
woman to having abortions.

35. Prevention of Abortions Ctd’
Carry out laboratory investigations to rule out
the above mentioned conditions i.e. anaemia
STIs
• Hb (hemodlobin level)
• Grouping
• VDRL
• Urine full report, sugar, microscopy
• Fasting blood sugar

36. Prevention of Abortions Ctd’
Treat all infections antenatally
Give prophylactic treatment for malaria and
anemia antenatally
Counseling should be done to those mothers
with HIV infection to prevent them from
getting other pregnancies
Educate women on signs of abortion, and
encourage them to come to the hospital when
they experience such signs

37. Prevention of Abortions Ctd’
Educate mothers on good nutritious diets to
prevent anaemia
Counsel mothers with history of habitual
abortion to report to hospital as soon as they
realise they are pregnant for possible insertion
of shrodkar suture
Counsel all postabortal women and provide
Family Planning services

38. Required Competences
History taking
Physical examination
Manual Vacuum Aspiration
Counseling skills

39. References
Mackay B (1986). Obstetrics and the
Newborn; An illustrated Textbook, Butler and
Tanner Ltd, London
Myles M (1981) Textbook for Midwives, C & C
Joint printing company Ltd; Hong Kong
Sellers P.M (1993). Midwifery- A textbook and
Reference book for Midwives in Southern
Africa; Creda Press, Cape Town