Abortion

abortion or miscarriage is the condition which causes the end of pregnancy before the child can survive extrauterine area this ppt include abortion and its management and this ppt help nurses to know this condition well and apply this condition in their clinical practice

1. ABORTION DEPARTMENT OF MEDICAL SURGICAL NURSING Smt . Radhikabai Meghe Memorial College of Nursing

2. Learning Objectives At the end of this lecture, students should be able to: Define the term abortion Explain the Etiology of abortion Enlist the types of abortion Describe the Clinical features and diagnostic evaluation of abortion Describe the Complication of abortion Explain the Management of abortion

3. Definition It is expulsion or extraction of products of conception before fetal viability i.e. before 24 weeks of gestation.

4. Etiology First trimester abortion :   Fetal chromosomal abnormalities - An embryonic pregnancy - Blighted ovum Multiple pregnancy

5. Etiology First trimester abortion : Infections: genital tract infection , systemic infection with pyrexia & TORCH syndrome Endocrine disorders : Diabetes, thyroid disorders , & corpus luteum insufficiency Uterine disorders: Uterine anomalies , submucus fibroid & Asherman’s syndrome

6. Etiology First trimester abortion : Thrombophilia : Congenital deficiency of protein C & S, & anti-thrombin III Immunological disorders : Anticardiolipin syndrome and SLE Psychological disorders

7. Etiology Second trimester abortion : Multiple pregnancy Cervical incompetence (congenital & acquired ) Uterine anomalies and Submucous fibroid Genital tract infection and PROM

8. Types Threatened abortion Inevitable abortion Incomplete abortion Complete abortion Missed abortion Septic abortion Recurrent abortion

9. Threatened abortion History Examination U/S which is essential for the diagnosis

10. Threatened abortion (Management) Reassurance Advice : Hormones i.e. Progesterone & HCG Which are used in the first trimester to support pregnancy Anti- D: An adequate dose of anti-D should be given to all Rh - ANC as high risk patients

11. Inevitable and incomplete abortions History Heavy vaginal bleeding. with no passage of products conception (inevitable) with the passage of products of conception (incomplete abortion )

12. Inevitable and incomplete abortions Examinations Poor general condition. The cervix is dilating and products of conception may be passing trough the os The uterus may be the correct size for date U/S :

13. Inevitable and incomplete abortions (management) CBC , blood grouping , XM 2 units of blood Resuscitation  large IV line, fluids & blood transfusion Oxytoxic drugs  Ergometrine 0.5 mg IM + Oxytocin infusion (20-40 units in 500 cc saline) Evacuation & curettage. Post-abortion management .

14. Complete abortion History Heavy vaginal bleeding which has been stopped . lower abdominal pain which follows the bleeding which has been stopped . Examination T he cervix is closed U/S showed empty uterine cavity or PROP

15. Complete abortion (Management) Evacuation & curettage in the presence of RPOC. Post-abortion management.

16. Missed abortion Most of missed abortions are diagnosed accidentally during routine U/S in early pregnancy .

17. In some cases there may be a history of : Episodes of mild vaginal bleeding Regression of early symptoms of pregnancy . Stop of fetal movements after 20 wks gestation.

18. Missed abortion U/S : diagnosed if two ultrasound ( T/V or T/A) at least 7days apart showed an embryo of > 7 weeks gestation ( CRL > 6mm in diameter and gestational sac > 20 mm in diameter ) with no evidence of heart activity .

19. Options of treatment Conservative treatment: Surgical evacuation of the uterus; by D & C: Medical termination of pregnancy: by Misoprostol (PGE1) Cytotec : Indicated in 1 st & 2 nd trimesters missed abortions. Post-abortion management. Missed abortion (Management)

20. Definition : It is an incomplete abortion which complicated by infection of the uterine contents . Septic abortion

21. Bacteriology : Mixed infection Types : Mild Moderate Severe Septic abortion

22. Management : Antibiotics : Surgical evacuation of uterus  usually 12 hrs after antibiotic therapy Post-abortion management. Septic abortion

23. Haemorrhage . Complication related to surgical evacuation ie E&C and D&C.   Rh - iso immunisation  if the anti –D is not given or if the dose is inadequate . Psychological trauma .   Complications of abortion

24. Summary So far we have discussed about definition, etiology,types,sign and symptoms, diagnostic evaluation, treatment and nursing management of abortion.

25. Bibliography Lewis et al, Medical Surgical Nursing, Mosby Elsevier,7 th edition. Joyce.M.Black et al, Medical Surgical Nursing, Saunders publication. Brunner and Siddhartha, Medical Surgical Nursing, Lippincott Williams and Wilkins . D.C. Dutta , text book of obstetrics and gynecology

26. Thank you