This document discusses different types of bleeding that can occur during pregnancy and classifications of abortions. It defines abortion and lists some potential causes such as abnormal fetal formation or infection. Abortions are classified as spontaneous or induced, isolated or recurrent, legal or illegal. Different categories of abortions including threatened, inevitable, complete, incomplete, missed and septic abortions are defined. Each category lists typical clinical features, investigations, and treatment approaches. Nursing diagnoses related to abortions include pain, fear, knowledge deficit, anxiety, low self-esteem, and risks for issues like fluid deficit, infection, and maternal injury.

1. MRS.V.ELIZEBETH RANI,
READER,
MACCON

2. INTRODUCTION
Bleeding can occur during
pregnancy. spotting or fresh
bleeding is accompanied by
abdominal pain or cramping in early
pregnancy requires immediate
attention.

3. REASONS FOR SLIGHT BLEEDING WHICH ARE NOT
HAVING DANGEROUS IMPACT
 Fertilized egg implants in uterus, there
can be a day (or)two of light bleeding.
 When the placenta embeds in uterine
lining.
 Bleeding at around the time pregnant
women would usually have had a
period. It is usually due to background
variation in hormonal level.

4. ABORTION DEFINITION
An abortion is the premature
expulsion of products of conception
from uterus.
It can be either spontaneous (or)
induced & is defined as termination
of pregnancy before the period of
viability which is usually 28 weeks .

5. ABORTION CAUSES
Abnormal fetal
formation
Infection
Fetus
fails to
grow
crosses
placenta
Immunologic
al factor
Rejection of embryo
through
immunological
response
Deficient
progestero
ne
Poor
endometrial
response
Miscarriag
e
Endometri
al
sloughing

6. CLASSIFICATION
Abortion
spontaneous Induced
Isolated recurrent legal illegal
threatened inevitable complete incomplete missed septic

7. CATEGORIES &
DEFINITION
CLINICAL
FEATURES
INVESTIGATIONS TREATMENT
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 impossible.
Vaginal
Bleeding : slight
, brownish
(or)bright red in
colour.
Pain : painless
but mild back
ache (or) dull
pain in lower
abdomen.
No cervical
dilatation
Closed cervical
os
No passage of
Pelvic
examination :
a) Speculum
examination
b) Digital
examination
Routine
investigation
ultrasonography
Bed rest
Nutritious
diet &
adequate
hydration
Drugs : pain
relief
diazepam 5mg
twice daily.

8. CATEGORIES &
DEFINITION
CLINICAL
FEATURES
INVESTIGATIONS TREATMENT
Inevitable
miscarriage
It is the clinical
type of abortion
where the changes
have progressed to a
state from where
continuation of
pregnancy is
impossible.
Increased vaginal
bleeding.
Colicky pain
Cervical
dilatation
Possible passage
of products of
conception
2nd trimester,
rupture of
membranes
Intermittent lower
abdominal pain.
Ultrasound
HCG levels to
indicate pregnancy
loss.
IV fluids & blood
transfusion
Admin.
Inj.methergin
0.2mg
Before 12
weeks: D & C
under GA.
After 12 weeks :
Uterine contraction
is accelerated by
oxytocin drip 10
units in 500ml of
NS 40- 60 drops /
mt.

9. CATEGORIES
&
DEFINITION
CLINICAL
FEATURES
INVESTIGATIONS TREATMENT
Complete
miscarrage
when the
products of
conception are
expelled , it is
called
complete
miscarrage.
H/o expulsion or a
fleshy mass per vaginum
followed by :
Subsidence of
abdominal pain
Vaginal bleeding
becomes trace (or)
absent.
Internal examination
reveals :
a) Uterus is smaller
than the period of
amenorrhoea & a
little firmer.
b) Cervical os is closed.
c) Bleeding is trace.
Examination of the
expelled fleshy mass
is found complete.
Ultrasound : shows
empty uterus.
Evacuation of uterine
curettage if needed.
Rh- negative
women:
Early miscarrage
Anti-d gamma
globulin –
50microgram (or )
100 microgram / IM
with in 72 hours.
Anti-D may not
required
complete
miscarrage before 12
weeks of gestation
where no instrument
has been done.

10. CATEGORIES &
DEFINITION
CLINICAL FEATURES INVESTIGATIONS TREATMENT
Incomplete
miscarrage
when the
entire products of
conception are not
expelled , instead a
part of it is left
inside the uterine
cavity, it is called
incomplete
misscarriage.
H/o expulsion or a
fleshy mass per vaginum
followed by :
1. Continuation of pain
lower abdomen
2. Persistence of vaginal
bleeding
3. Internal examination
reveals :
a) Uterus smaller than
the period of
amenorrhoea
b) Patulous cervical os
after admitting tip of
the finger
c) Varying amount of
bleeding
d) On examination, the
expelled mass is
found incomplete.
Ultrasound :
confirmation that
products of conception
still in uterus.
Complication
Profuse bleeding
Sepsis
Placental polyp
Early Abortion
D & E under
analgesia (or)
general anaesthesia
is to be done.
Late Abortion
uterus is
evacuated under GA
& the products are
removed by ovum
forceps (or) by blunt
curette.
Medical
management
Tab.Misoprostal
200ug is used
vaginally every 4
hours.

11. CATEGORIES &
DEFINITION
CLINICAL
FEATURES
INVESTIGATIONS TREATMENT
Missed
miscarrage
when the fetus is
dead & retained
inside the uterus
for a period, it is
called missed
miscarrage (or)
early fetal demise.
Persistence of
brownish vaginal
bleeding
Subsidence of
pregnancy symptoms
Retrogression of
breast changes
Cessation of uetrine
growth which in fact
becomes smaller in
size.
Non audibility of
the FHS even with
doppler US
Cervix feels firm
Immunological test
for pregnancy
negative
USG shows empty
sac ,absence of fetal
motion / cardiac
Ultrasound : to
identify products of
conception in uterus.
Complication :
Psychological
upset
Infection
Blood coagulation
disorders are less
likely occur.
Uterus <than 12 wks
Expectant
management :
many women expel
the conceptus
spontaneously.
Medical
management :
protoglandin E1
800 mg vaginally in
posterior fornix &
repeat after 24 hrs if
required . Expulsion
occurs with in 48 hrs.
Suction evacuation
( or ) D&C.
Uterus > than 12 wks
medical induction
of labour.

12. CATEGORIES &
DEFINITION
CLINICAL
FEATURES
INVESTIGATIONS TREATMENT
Septic
Abortion
Any abortion
associated with
clinical evidences
of infection of the
uterus & its
contents ,is called
septic abortion .
Mode of infection:
Anaerobic
Aerobic
Pyrexia
Pain abdomen
Rising pulse rate
Variable systemic
& abdominal
findings
Inrenal
examination reveals
offensive purulent
discharge (or) tender
uterus with patulous
os (or) a boggy feel.
Clinical grading :
Grade I : localised
in the uterus.
Grade II : spreads
beyond the uterus.
Grade III :
generalised
peritonitis /
endotoxic shock/
jaundice/ ARF .
Cervical / high
vaginal swab
Blood for HB
Urine analysis
Special
investigation :
Ultrasonography
Blood : culture ,
serum electrolytes,
coagulation profile
X-Ray :
abdomen, chest.
Grade I :
Antibiotics
Prophylactic anti
gasgangrene serum of
8000u & 3000u of
antitetanus serum/IM
Analgesics &
sedatives
Blood transfusion
Evacuation of uterus
Grade II :
Antibiotics
Evacuation of uterus
Supportive theraphy
Grade III :
Antibiotics
Clinical monitoring
Supportive theraphy

13. NURSING DIAGNOSIS RELATED TO ABORTIONS
1. Pain related to abdominal cramping ith
contractions of uterine muscles.
2. Fear related to potential loss of pregnancy.
3. Knowlwdge defecit related to the cause of
abortion.
4. Anxiety related to pregnancy outcome &
uncertainnity of future outcome.

14. NURSING DIAGNOSIS RELATED TO ABORTIONS
5. Self esteem , situational low related to
feelings of guilt & blame for abortion.
6. Spiritual distress related to couple’s
preference in religious rites is not carried out.
7. Risk for fluid volume defecit related to
haemorrhage , related to retention of tissue &
surgery required to empty uterus.
8. Risk for infection related to incomplete
abortion.
9. Risk for maternal injury related to fetal
autolysis of Rh Iso immunization.

15. REFERENCE
 Bobak, I.M., & Leonard, D. (1995). Text Book Of Maternity & Gynecologic
Care :The Nurse & The Family (4th ed.). Mosby Publication.
 Diane., Fraser., & Margret. (2003). Text Book for Midwives (14th ed.).
Elsevier Publishers.
 Dutta, D.c., & Hiralal Konar. (2013). Text Book of Obstetrics (7th ed.).
Jaypee Brothers Medical Publishers.
 Elizabeth, M (2014). Midwifery for Nurses (2nd ed.). Sathish Kumar Jain
Publishers.
 Jacob, A. (2008). A Comprehensive textbook of Midwifery & Gynecological
Nursing (4th ed.). Newyork: Jaypee Brothers Medical Publishers.
 Kumari Neelam., Sharma Shivani., & Gupta Preethi. (2010). A Text Book of
Midwifery and Gynecological Nursing.
 Ladewig, L. Maternal & Newborn Nursing (3rd ed.). Cumming Publication.
 Nurse Midwifery Helen Varney (2nd ed.).
 Parulekar, V. S. Textbook for Midwives. (2nd ed.). Mumbai: Vora Medical
Publications.
 Raman, A. V. (2014). Maternity nursing (1st ed.). Wolters kluwer publishers.
 Richa S. Snapshort In Obstetrical & Gynaecology. Jaypee Brother’s
Medical Publisher.

16. THANK YOU