MARKING KEY – ABORTION

Abortion is the interruption of pregnancy before the 26th week, after which the fetus is
said to be viable. 5%

Abortion

Spontaneous Induced

Threatened Termination
Of pregnancy criminal

Invitable Septic

Missed

Blood Incomplete Complete

Mole
Habitual

Carneous
Mole

Delivery of
Viable infant

Possible Links

Possible
Outcome

Abortion can be classified as spontaneous or induced.

Abortion can be classified as spontaneous or induced.

1
Spontaneous abortion can be divided into:-

• Threatened abortion
• Missed
• Blood mole and carneous mole
• Inevitable abortion, which can be complete or incomplete
• Habitual or recurrent abortion

1. Threatened abortion is diagnosed when a pregnant woman presents with

slight bleeding through indilated cervix
2. Missed abortion occurs when the fetus dies and is retained in utero, together
with the placenta and membranes. There is no pain, the uterus does not
grow, the breasts soften, the signs of pregnancy disappear and there is a
brownish vaginal discharge.
3. Bloodmore arises in cases of missed abortion. The ovum dies in utero and
the deciduas capsuslaris remains intact. The zygote is surrounded by layers
of blood due to bleeding between the gestational sac and the uterine wall.
4. Blood mole usually occurs before the 12th week of gestation. The signs of
pregnancy disappear and a brownish discharge is usually present.
5. Carneous mole – When fluid drains from blood mole, the fleshly, firm, hard
mass which is left is known as the carneous mole.
6. Inevitable abortion is when the pregnancy can no longer continue. An
inevitable abortion may be complete or incomplete.
(i) Complete abortion is when all the products of conception
are expelled.
(ii) Incomplete abortion is one in which part of the products of
conception (usually fetus) is passed and placenta and membranes are
retained.
7. Habitual or recurrent abortion is when the patient experiences 3 or more
consecutive spontaneous abortions, usually after 14 weeks gestation.
8. Induced abortion can be terminated of pregnancy as treatment
(therapeutic) or can be criminal
9. Therapeutic abortion is an abortion in which the uterus is evacuated by
a qualified, trained medical for a valid reason
10. Criminal abortion is an abortion which is illegally procured. It may
be performed by an unqualified person, possibly under
unhygienic condition, utilizing a variety of methods, people and places.
11. Septic abortion can follow any incomplete abortion, but is more
often associated with a criminal abortion.

Management of inevitable abortion:

In this case the pregnancy can not be saved because a good proportion of the
placenta has been detached and the cervical os is dilating. The vaginal bleeding is
severe and some clots may even be passed.

2
The accompanying backache and intermittent lower abdominal pain are intense.
Where the uterus is palpable, strong uterine contractions may be felt abdominally.
Membranes may rupture and part of the products of conception may protrude
through the dilating cervical os.

This needs an emergency treatment.

Objectives:
1. Assess condition and confirm postabortion complications and medical evaluation
2. Educate the woman regarding her medical condition and treatment plan
3. Stabilize the emergency condition and treat any complications
4. Evacuate the uterus to remove the retained products of conception to prevent
infection.

The inevitable abortion may be complete or incomplete

1. Complete abortion – the whole product of conception is expelled. After expulsion

of the conceptus, pain and abdominal pain decrease. The cervix if inspected is
found to be closed or reforming and the uterus becomes smaller in size.
2. Incomplete abortion – In this variety of abortion part of the product of
conception, usually the foetus is passed and placenta and membranes are
retained. The placenta is embedded and the slender cord breaks. The bleeding
continues and may become profuse because the presence of retained products
does not allow the efficient contraction and retraction of the uterus and therefore
control bleeding. There is pain as well as backache.

Initial assessment: 5%

- Mrs Tipile is assessed quickly to confirm the diagnosis and initiate any
emergency treatment.
- The severe bleeding is controlled by giving oxytocin 0.5
- If there are any signs of shock are treated without delay in order to
save the patients life and to keep her condition from worsening.
- Intravenous fluid replacement is given. Normal saline or ringer’s
lactate to provide the salt required to restore fluid balance.
- When there is need to transfuse blood it is done with care – grouping
and cross matching and observing the infusion
- Observations of pulse, blood pressure and temperature are done to
monitor the patient’s condition.
- It is important to maintain a clear airway, respiration and circulation.
- Manage pain by choosing the analgesic carefully not give a drug that
will mastic symptoms or deeply sedate the patient
- Medical evaluation is done – thorough reproductive history, careful
physical and pelvic examination and obtaining appropriate laboratory
tests.

3
Talking with the patient: 10%

- The condition is explained to the patient as she has the right to

information about her condition.
- The content of information is based on the woman’s condition and her
immediate physical needs.
- The information is also give to the family where it is appropriate
- The patient is allowed to ask questions.
- The patient has the right to privacy when receiving counseling or
undergoing physical examination
- The patient has the right to decide freely whether or not to receive
treatment. A written consent may be required for all operative
procedures.
- Determine if the woman is capable of listening to and under standing
medical explanations
- Explain in detail in non threatening manner and in language the
woman can understand the procedures to be performed.
- Ask the woman or representative where necessary to give consent for
treatment.
- Establish patient provider relationship.

Uterine evacuation: 10%

- Evacuation of the placenta tissue if retained is done to make the

uterus contract and stays the bleeding.
- Manual vacuum Aspiration (MUA) can be done
- During the MUA procedure give supportive attention to reduce pain
and anxiety.
- Talking to the patient in a calm relaxed manner help focus attendance
away from the procedure.
- Monitor the patient condition to be sure she is not experience undue
discomfort or pain.
- After the procedure the patient is reassured that everything is
satisfactory.
- Ergometrine 0.5 may be repeated after evacuation Counseling for
family planning and provision of temporary contraceptive methods
may be initiated prior to discharge.

Infection Prevention: 10%

- With MUA as with any invasive procedure, there is risk to patients,

providers and other staff from contact with blood and other body
fluids that may carry blood diseases e.g. hepatitis B & AIDs.
- Observe the standard precautions at all times:- hand washing use of
protective barriers, processing tissue samples, handling equipment
and proper disposal of waste. “These measures will prevent infection.
- If infection is present, antibiotics are given as prescribed.
Temperature is taken 4 hourly to monitor the condition of the patient.

4
 50%
d. Five points to discuss with the couple on discharge:

1. The couple is given information to understand that Mrs Tipilire

can become pregnant again before the next menses.

- That there are safe methods to prevent or delay pregnancy

- Tell them where they can obtain family planning services

2. They should avoid sexually transmitted infectious and when infected they
should both get treatment.

3. They may need to undergo thorough investigations to treat the cause of

the cause of the abortion.

4. If any problem develops when they go home, they should not hesitate to
come back and seek medical advise or come for review.

5. They have been given any treatment they should comply. 20%
1.

5
6