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UNIT 3 - ABORTION - Coggle Diagram
UNIT 3 - ABORTION
INEVITABLE ABORTIONS
It is the clinical type of abortion where the changes have progressed to a state from where continuation of pregnancy is impossible
CLINICAL FEATURES
- VAGINAL BLEEDING: increased vaginal bleeding or sometimes loss of fluid
- PAIN: subsequent uterine contractions and aggravation of pain in the lower abdomen which may be colicky in nature
MANAGEMENT
- if <12 weeks - vaccum curettage (removal of uterine contents with a vacuum curet)
- if > 12 weeks - dilation and curettage (D&C - stretching the cervical os to permit suctioning or scraping the uterine walls)
NURSING INTERVENTIONS
- provide the psychological support
- listen to pt concerns carefully and observe the behaviour
initiate IV fluids
INCOMPLETE ABORTIONS
The process of abortion has already taken place, but the entire products of conception are not expelled and a part of it is left inside the uterine cavity
CLINICAL FEATURES
- history of expulsion of a fleshy mass per vaginam
- continuation of pain in lower abdomen
- persistance of vaginal bleeding
- internal examination reveals: uterus smaller than the period of amenorrhea, open internal os, varying amount of bleeding
- on examination, the expelled mass is found incomplete
COMPLICATIONSthe retained products may cause:
- bleeding
- sepsis
- placental polyp
MANAGEMENT
- evacuation of retained products of conception
- EARLY ABORTION: dilation and evacuation under GA
- LATE ABORTION: uterus us evacuated under GA and products are removed by ovum forceps or by blunt curette. D&C is done to remove bits of tissue left behind
- prophylactic antibiotics are given
MISSED ABORTIONS
- the fetus is dead and retained passively inside the uterus for variable period
- diagnosed when there is a fetus with a crown rump of 5 mm without a fetal heart
CLINICAL FEATURES
- subsidence of pregnancy symptoms
- uterus becomes smaller in size
- cervix feels firm with closed internal os
- non-audibility of the fetal heart sound even with dopller ultrasound
- immunological test for pregnancy becomes negative
COMPLICATIONS
- retaining the products for long time can lead to sepsis
- DIC (Disseminated Intravascular coagulation)
MANAGEMENT
UTERUS LESS THAN 12 WEEKS:
- prostaglandin E1 800 mg is given vaginally and repeated after 24 hours if needed. expulsion usually occurs within 48 hours
- suction evacuation is done when the medical method fails
UTERUS MORE THAN 12 WEEKS
- 6th or 12th hourly misoprostol tablets given vaginally
- if this fails, extraamniotic intillation of ethacridine lactate is used
- antibiotics are given
RECURRENT ABORTIONS
Defined as a sequence of three or more consecutive spontaneous abortion. risk increases with each successive abortion
CAUSE
PRIMARY CAUSE
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anormalies of the reproductive tract, such as bicornuate uterus or incomplete cervix
OTHER CAUSES
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immunoglobic factors that involve increased sharing of human leukocyte antigens by the sperm of the man and the ovum of the woman who concieved
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COMPLICATIONS
- negative emotions - anger, frustration, confusion, sadness
- affect relationships and results in a loss of intimacy
NURSING INTERVENTIONS
- emphasize that abortions usually occur as the result of factors or abnormalities that cannot be avoided
- must listen carefully to what the woman says and observe how she behaves
SPONTANEOUS ABORTIONS
-
6 SUBGROUPS
- threatened
- inevitable
- incomplete
- complete
- missed
- recurrent incidence
ETIOLOGY
- severe congenital abnormalities
- maternal infections
- maternal endocrine disorders (hypothyroidism)
THREATENED ABORTIONS
condition in which miscarriage has started but has not progressed to a state from which recovery is impossible
CLINICAL FEATURES
- VAGINAL BLEEDING: slight and may be brownish or bright red in color
- PAIN: bleeding is usually painless but there may be mild backache or dull pain in lower abdomen
MANAGEMENT
- Observation: no. of perineal pads used, quantity and color of blood
- ultrasound examination to verify if embryo or fetus is alive
- advice to limit sexual activity until bleeding has ceased
- provide psychological support
- provide accurate information and avoid false hope
- avoid vaginal examination
COMPLETE ABORTIONS
-
CLINICAL FEATURES
- History of expulsion of a fleshy mass per vagina followed by subsidence of abdominal pain, vaginal bleeding becomes trace or absent
- internal examination reveals uterus smaller than the period of amenorrhea, cervical os is closed, bleeding is traced
- transvaginal sosography confrms that the uterus is empty
NURSING MANAGEMENT
- no additional intervention is required unless excessive bleeding or infection
- advise to rest and to watch for further bleeding, pain or fever
- provide psychological support
DEFINITION
It is the loss of pregnancy before the fetus is viable, or capable of living outside the uterus, less than 20 weeks of gestation or when the fetus weighs less than 500g
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TYPES
SPONTANEOUS
- THREATHENED
- INEVITABLE
- INCOMPLETE
- COMPLETE
- MISSED
- RECURRENT SPONTANEOUS
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LEGAL ABORTIONS
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In Maldives:
- illegal
- abortion for permissible cases is available only up to 120 days
- only for married women and husband consent is required
ILLEGAL ABORTIONS
Termination of pregnancy illegally or often performed by unskilled or uneducated individuals out of the legal system, and without satisfying medical standards
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