ABORTION

Definition of abortion
• DEFN. This refers to interruption of the product
of conception before 28weeks of gestation. It is
the common cause of bleeding in early
pregnancy.
• It occurs 10-20% of pregnancies
CLASSIFICATION
It is classified into two types:

• Spontaneous Abortion (starts on its own)

• Induced Abortion (brought mechanically)

 CAUSES

These are grouped as follows;

• Maternal causes

• Local condition of the uterus

• Fetal causes

• Drugs
 Maternal causes

• Diseases like Malaria, diabetes mellitus,

pneumonia, cardiac disease cause ill health
leading to placental insufficiency resulting into
Abortion.
• High fevers in cases of Malaria and pneumonia
cause high temperatures in the uterus which
leads to frequent fetal movements resulting
into uterine contractions.
 Maternal causes

• Infections like syphilis acute gonorrhea leading to

placental insufficiency resulting into Abortion.
• ABO incompatibility between the mother and
embryo may result into abortions.
• Hormonal imbalance
• Malnutrition
• Accidents
 LOCAL CONDITON OF THE BIRTH CANAL

• Uterine fibroids reduces the space within the

uterus which may lead to abortions
• Retroverted uterus this type of uterus cannot
ascend beyond the pelvic cavity hence causing
abortions.(at what developmental this occur)
• Cervical incompetence due to previous tears
 FETAL CAUSES

• Hormonal imbalance
• Abnormal spermatozoa or ovum
• Wrong implantation of the fetus
DRUGS
• The drugs containing ergot and drugs with
phosphates cause necrosis of the placenta
resulting into abortions.
 VARIETIES OF ABORTION

• Threatened abortion; It can be saved with

treatment
• Inevitable abortion; It cannot be saved with
treatment
• Complete abortion; All products of conception are
expelled
• Incomplete abortion; Some products of conception
retained in the uterus
• Habitual abortion ; More than three concective
abortions
• Missed abortion; Fetus dies and remains in the
CLASSIFICATION OF ABORTION

ABORTION

INDUCED SPONTANOUS
ABORTION ABORTION
SPONTANOUS ABORTION
THREATENED
ABORTION

PROGRESS TO COMPLETE INCOMPLETE

FULL TERM ABORTION ABORTION

SEPTIC
ABORTION
 THREATENED ABORTION

• This when there is slight interruption of the products

of conception and it is possible for the pregnancy to
go up to term, if it responds to the treatment.
• SIGNS
• Mothers may give a history of amenorrhea of less
than 12 weeks
• Mothers complains of slight abdominal pain which is
like that of dysmenorrheal and headache
• On inspection of the vulva there is slight vaginal
bleeding
• On vaginal examination the cervical os is closed
 CAUSES OF THREATENED ABORTION

• Maternal causes
• Medical conditions such as diabetes mellitus &
hypertension
• High fever in cases like malaria
• Over work and violet exercises
• Accidents
• Fetal causes: lower implantation
• Drugs: local medicine containing ergot
 MANAGEMENT IN MATERNITY CENTRE

• The is admitted in warm clean bed

• Put on complete bed rest to increase blood
supply to the placental site and prevent father
separation
• Reassure the patient and relatives
• Take history to find out when the bleeding
started and estimate the amount of blood loss
• Give clean pad
 NURSING CARE IN A MATERNITY CENTRE
OBSERVATIONS
• Take blood pressure, Temperature, pulse and
respiration and observe the amount of blood
loss frequently
DIET
• A good nourishing diet should be rich in
proteins, iron and vitamins plus plenty of
fluids to bring down the temperature and to
avoid dehydration.
 NURSING CARE cont.
HYGIENE
• Bed bath should be given daily, vulva swabbing
three times a day and changing of pads
whenever necessary.
BLADDER
• This should be emptied more frequently to avoid
discomfort to the mother
BOWELS
• Prevent constipation by encouraging the mother
to take in lot of fluids
 NURSING CARE cont.

TREATMENT
• This is going to depend on the cause

MANAGEMENT IN THE HOSPITAL

• Nursing care is the same as in the maternity
centre
 ADVICE ON DISCHARGE

• Avoid sexual intercourse for at least a month

• Should eat a well balanced diet
• Observe personal and communal hygiene to
prevent infections
• Avoid carrying out heavy work lifting heavy
things
• Prevent malaria by sleeping under a treated
mosquito net
• To come back for ANC after two weeks or as soon
as bleeding starts again
 INERVITABLE ABORTION

• Defn: This is when the pregnancy cannot be

saved as the bigger part of the placenta has
been detached from the uterine wall so the
products of conception are expelled from the
uterus either completely or incompletely.
TYPES OF INERVITABLE ABORTION
• There are two types: Complete Abortion
• Incomplete Abortion
 COMPLETE ABORTION

• This is when then the products of conception are

expelled completely usually occurring before the
8th week of pregnancy because by this period the
placenta is not yet embedded deep in the
deciduas.
• Signs
• On abdominal examination the uterus is well
contracted
• On vaginal examination the cervix is found
closing
• Mother feels less pain and less vaginal bleeding
 MANAGEMENT IN THE MATERNITY

• Mother is put in clean warm bed and re-

assured.
• History is taken and the mother is kept for
three days and managed as a normal
puerperium mother.
• If no improvement she is transferred to the
hospital
• If she has improved she is discharged
• Advice the mother to come for review
 MANAGEMENT IN THE HOSPITAL

• Mother is admitted in a warm clean bed

• History is taken and observations
• Dr is informed and may order for
investigations like HB, BS, grouping and
crossing matching
• Patient is kept on the ward for 24hours
and discharged if she has improved
 ADVICE ON DISCHARGE
• Advice about personal hygiene to prevent
infections
• To take well nourishing diet to improve on the
HB
• In case of another pregnancy she is advised to
report to ANC as soon as possible to avoid
another abortion
• To take the given treatment
• To come back on the given date
 INCOMPLETE ABORTION

• This is when the fetus is expelled and

some of the products are remained such
as placenta and membranes.
• It’s common after the 12th week of
pregnancy because the placenta is firmly
embedded in the uterine wall and the
cord thin and can easily break
 SIGNS OF INCOMPLETE ABORTION
• Strong uterine contractions can be felt like
labour pain
• On vaginal examination the os(s )is open
• Products of conception may be felt
protruding in the vagina
• Bleeding continues and may be profuse
with clots because of the detachment of
placenta
 MANAGEMENT IN MATERNITY CENTRE

• Admit the mother in a clean warm bed and

reassure her and relative
• Take quick history ie when the bleeding
started and history of Amenorrhea from or
her relatives if she is in shock
• Take observation of temperature pulse
respiration and blood pressure
• If the patient is in shock put up an intravenous
line and elevate the foot of the foot of the bed
 MANAGEMENT IN MATERNITY CENTRE…….

• Carry out abdominal examination to know

the height of fundus
• Perform vaginal examination to know the
state of the cervix, if dilated and products
of conception protruding remove them.
• Arrange for transport immediately to the
hospital
• Give oxytocin 10 IU after removal of the
products of conception
 MANAGEMENT IN MATERNITY
CENTRE…….
• If transport is delayed the dose can be
repeated and in case of severe bleeding within
10-20 mins
• In case of severe pain and the blood pressure
is above 80/40mmhg give a strong analgesic
like morphin 15mgs IM
• Estimate the blood loss by inspecting all the
soiled linen and record
 MANAGEMENT IN MATERNITY
CENTRE…….
• Send the mother and relatives to hospital with
a written document stating;
• Time of admission
• Treatment given
• Condition when leaving the maternity centre
 MANAGEMENT IN THE HOSPITAL

• Admit the patient in a clean warm bed in

maternity ward and re-assure her and her
relatives
• Take full history from her or her relatives
• Take observations of temperature pulse
respiration and blood pressure
• Remove off blood for Hb, Bs, Grouping
and cross matching and VDRL
 MANAGEMENT IN THE HOSPITAL …
• Carry out abdominal examination to know the
height of fundus
• If the patient is in shock put up an intravenous
line and elevate the foot of the foot of the be
• Inform doctor mean while ;
• Mother is prepared for theatre
• Evacuation is carried out by the doctor under
general anesthesia
• She is nursed as a normal puerperium mother
• Nursing care after theatre should be considered
 ADVICE ON DISCHARGE

• Advice about personal hygiene to prevent

infections
• To take well nourishing diet to improve on the
HB
• In case of another pregnancy she is advised to
report to ANC as soon as possible to avoid
another abortion
• To take the given treatment
• To come back on the given date
• To report early in case of other pregnancy for
medical check up to avoid other abortion
 HABITUAL OR RECURRENT ABORTIONS

• Defn: This is when a mother has had

three or more concective abortions
• Causes: The real cause is not known but it is
associated with the following factors
• Cervical incompetence
• Diseases in the mother like diabetes
mellitus , chronic nephritis
 HABITUAL OR RECURRENT ABORTIONS

• Infection like chronic malaria

• Conditions within the uterus for example
Uterine fibroids
• Hormonal insufficiency
• Congenital fetal abnormalities
 CHARACTERISTICS OF HABITUAL ABORTION DUE TO CERVICAL
INCOMPITENCE

• It occurs in the 2nd trimester usually between

22nd -24th week
• There is no previous warning like vaginal
bleeding
• Membrane rupture suddenly followed by
products of conception
 MANAGEMENT IN THE CENTRE
• Carry out good ANC by:
• Care full history taking
• Care full general examination
• Any mother who gives a history of
abortions of unknown cause refer her to
the hospital for investigation
 IN THE HOSPITAL

• Admit the mother in an ante natal ward

• Investigations are carried out for example blood for;
• HB estimation
• MPS
• VDRL
• Urine Specimen for the of sugar to rule out diabetes mellitus
• Vaginal examination is carried out to rule out ;
• Cervical incompetence
• Fibroids
• Retroverted uterus
• Bicornuate uterus
 TREATMENT

• It is given according to cause

SHIRODKAR STICTCH
• This is inserted in case of incompetent cervix.
This is where by a merseline tape or any non
absorbable suture material is stitched around
the cervix at the level of the internal os.
• This is done at the period of 14th -16th weeks of
gestation