DEFINITION:

Abortion is the expulsion or extraction from its mother of an

embryo or foetus weighing 500 gm or less when it is not
capable of independent survival.

Or

It is process of partial or complete separation of the products of

conception from the uterine wall with or without partial or
complete expulsion from the uterine cavity before the age of
viability.

TYPES:

ETIOLOGY:

The causes of abortion in most instances remain unknown, but

may include the following

A.Genetic factors: Majority (50%) of early miscarriages are

due to chromosomal abnormality in the conceptus.Autosomal
trisomy is the commonest (50%) cytogenetic abnormality.

Foetal causes: Where a cause is determined.50% of abortion

are due to chromosomal abnormalities of the conceptus.
Genetic and structural abnormalities are also said to cause
pregnancy loss.

Maternal causes: Spontaneous early pregnancy loss has been

attributed to the following maternal influences:
Maternal age- the risk increases with
advancing maternal age.
B.Infection– these include rubella, listeria, and Chlamydia and
the accepted causes of late as well as early abortions.Infections
could be

1) Viral: Rubella, vaccinia.

2) Parasitic: Toxoplasma, malaria

3) Bacterial: Ureaplasma, Chlamydia etc.

C.Endocrine and metabolic factors:

Maternal diseases-management and control of medical

conditions such as diabetes, renal disease and thyroid
dysfunction have reduced the risk of abortion in affected
women . Luteal phase
defect results in early in early miscarriage as implantation and
placentation are not supported adequately. Deficient
progesterone secretion from corpus luteum or poor endometrial
response to progesterone is the cause.
Thyroid abnormalities: overt
hypothyroidism or hyperthyroidism is associated with increased
foetal loss. Diabetes mellitus when poorly controlled causes
increased miscarriage.

D.Immunological factors: Both autoimmune and alloimune

factors can cause miscarriage.

Autoimmune disease- can cause miscarriage usually in the

second trimester. These patient form antibodies against their
own tissue and placenta. These antibodies ultimately cause
rejection of early pregnancy.

Alloimmune disease-Paternal antigens which are foreign to the

mother invoke a protective blocking antibody response. These
blocking antibodies prevent maternal immune cells from
recognising the foetus as a foreign entity.Therfore the foetal
allograft containing foreign paternal antigens are not rejected
by the mother.

E. Anatomic factors: Structural abnormalities of the genital

tract- these include retroversion of uterus, bicornuate uterus
and fibroids.

Cervico- uterine factors: These are related mostly to the second

trimester abortions.

a) Cervical incompetence either congenital or acquired is one of

the commonest causes of midtrimester and recurrent abortion.

b) Congenital malformation of the uterus in the form of

bicornuate or septate uterus may be responsible for
midtrimester recurrent abortion

Others: Premature rupture of the membranes inevitably leads

to abortion.

Paternal factors: sperm chromosomal anomaly can cause

abortion.

Environmental factors- excessive consumption of alcohol

and coffee along with cigarette smoking including passive
exposure to cigarette smoke have been found to increase the
risk of abortion.

THREATENED ABORTION:

It is clinical entity where the process of abortion has started

but has not progressed to a state from which recovery is
impossible

Clinical features:
 • The blood loss may be scanty with or without
accompanying backache and cramp like pain. Cramping
and spotting which can be severe.
• Blood clots or tissue may be expelled.
• Abdominal and suprapubic pain are common and may
radiate to the lower back buttocks and perineum.
• The pain may be resembled dysmenorrhoea or periods
pains .The cervix remains closed and the uterus soft with
no tenderness when palpated.

Investigation:

Routine investigational include 1) blood –for haemoglobin,

haematocrit, ABO and Rh grouping. Blood transfusion may be
required if abortion becomes inevitable and anti-D gamma
globulin has to be given in Rh negative non- immunized women

Treatment:

Vaginal rest is needed and bed rest is advice. The woman is

instructed to report bleeding heavier than a normal menstrual
period, cramping, or fever. If tissue is passed, she is to save it
for examination by the physician.

INEVITABLE ABORTION:

It is an abortion characterized by cramping and spotting or

vaginal bleeding with cervical dilation. And may leak with
amniotic fluid

Clinical features:

• Increased vaginal bleeding

• Aggravation of pain in the lower abdomen which may be
colicky in nature.
• Internal examination reveals dilated internal os of the
cervix through which the products of conception are felt.

Management
The principles in the management are

➢ To take appropriate measures to look after the general

condition
➢ To accelerate the process of expulsion
➢ To maintain strict asepsis as outlined in conduction of
labour.

Treatment:

Surgical removal of the pregnancy is the treatment of choice.

Pregnancies less than 14 weeks are usually evacuated by
dilatation and curettage (D&C).

INCOMPLETE ABORTION:

When the entire products of conception are not expelled,

instead a part of it is left inside the uterine. Usually, the foetus
delivers and placenta and membranes are retained.

Clinical features: History of expulsion of a fleshly mass per

vaginam followed by

• Continuation of pain lower abdomen, colicky in nature.

• Persistence of vaginal bleeding of varying magnitude.
• Internal examination reveals a). Uterus smaller than the
period of amenorrhoea. b). varying amount of bleeding.

Treatment: Dilatation and evacuation under general

anaesthesia is to be done.

COMPLETE ABORTION: All of the products of conception are

expelled.

Clinical features:

• Subsidence of abdominal pain.

• Vaginal bleeding becomes trace or absent.
• Internal examination the uterus is smaller than the period
of amenorrhoea and a little firmer and cervical os is
closed.
Treatment:

The women are dismissed home with instructions to monitor for

complications such as heavy or increased bleeding or fever. No
surgical are recommended.

MISSED ABORTION:

The foetus dies, but remains in utero.Signs of pregnancy are

present, but the fundus does not grow as expected in a normal
pregnancy and may regress. No foetal heart tones are present.

Clinical features:

• Persistence of brownish vaginal discharge.

• Subsidence of pregnancy symptoms.
• Retrogression of breast changes
• Cessation of uterine growth which in fact becomes smaller
in size.
• Non audibility of the foetal heart sound even with Doppler
cardioscope if it had been audible before.
• Cervix feels firm.

Complication: The complications of the missed abortion are

those mentioned in intrauterine foetal death .Blood coagulation
disorders are less likely to occur in missed abortion.

Treatment: Ultrasound is used to confirm the diagnosis. If a

dead foetus is carried for longer than 4 weeks, the risk of a
haemorrhagic disorder is high. The uterus is then evacuated by
D&C, or oxytocin is used to induce labour, which results in
passing of the products of conception.

SEPTIC ABORTION:

Any abortion associated with clinical evidences of infection of

the uterus and its contents, is called septic abortion.
Clinical features

ξ Pain abdomen
ξ Fever and chills are associated with sepsis.
ξ A rising pulse rate of 100-120/minute or more.

Management:

• Hospitalization is essential for all cases of septic abortion.

The patient is kept in isolation.
• To take high vaginal or cervical swab for culture, drug
sensitivity test and Gram stain.
• Vaginal examination is done to note the state of the
abortion process and extension of the infection. If the
products are found loosely lying in the cervix, it is
removed by an ovum forceps.

TREATMENT

➢ Attempts are made to determine and treat the cause. It

depends on which type of early pregnancy loss is occurring.
➢ Usually advice the women to bed rest and pelvic rest,
which includes no sexual intercourse, douches or tampons.
➢ The woman is instructed to report heavy bleeding,
cramping or fever.
➢ D&C are the most common methods used to clear the
uterus of the products of conception.
➢ Intravenous oxytocin (Pitocin) or methergine may be
ordered after uterine evacuation to help prevent bleeding.
Ibuprofen may be ordered to control uterine cramping.

NURSING PROCESS
ASSESSMENT For the following manifestations

 Vaginal bleeding, spotting clots

 Low abdominal cramping
 Passing of tissue through the vagina
 Shock decreased blood pressure, increased pulse rate.
 Women may verbalize fear, disappointment or feelings of
guilt.

NURSING DIAGNOSIS

ξ Risk for foetal injury

ξ Risk for infection ineffective airway clearance
ξ Ineffective airway clearance
ξ Actual/ risk for aspiration
ξ Anxiety
ξ Anticipatory grieving
ξ Altered family processes

PLANNING

 Provide information regarding treatment plan.

 Provide support and reassurance regarding nursing care.
 Promote maternal physical well being.
 Provide opportunities for counselling and support.
 Provide teaching related to self care.

IMPLEMENTATION
Observe for vaginal bleeding and cramping.
Save expelled tissue and clot for examination.
Monitor vital signs every 5 minutes to 4 hours depending on maternal
status.
Maintain women on bed rest.
Observe for signs of shock and institute treatment measures.
Prepare for D&C if appropriate
 Provide support, but avoid offering false assurance.

EVALUATION:
• Is free from anaemia and or infection
• Is free from vaginal bleeding
• Returns to normal, physiological status following to abortion

SUBMITTED TO: MS SUBHASHINI G.

HOD OBG NURSING DEPARTMENT

P.I.O.N

SUBMITTED BY: MS DIMSEY.R.MARAK

MSC NURSING 1ST YEAR

P.I.O.N