Abortion

2nd Group : Esmy Maulidya Nurlailatul Khairiyyah

Abortion is the termination of

pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability.

Abortion classification
Spontaneous Abortion Provokatus abortion (abortion that deliberately)

Spontaneous Abortion
Abortion Imminens Abortion insipiens Incomplete abortion Complete Abortion

Handling imminen abortion

- Take a rest - Progesterone therapy by IM - Ultrasound examination

Abortion insipiens handling

If less than 16 weeks gestational age, evaluate the uterine manual vacuum aspiration. If the evaluation is not possible, then immediately do: a. Give ergomefiin 0.2 mg intramuscularly (can be repeated after 15 minutes if necessary) or 400 mcg of misoprostol orally (can be repeated after 4 hours if necessary). b. Immediately do preparation for spending the products of conception from the uterus. If the gestational age over 16 weeks: Wait for spontaneous expulsion of products of conception and evaluation of the remnants of the products of conception. If necessary, infusion of 20 units of oxytocin in 500 ml of intravenous fluids (normal saline or Ringer's lactate solution at a rate of 40 drops per minute to help the expulsion of the products of conception. Be sure to keep track of the condition of women after treatment

Handling of incomplete abortion

If the bleeding is not how much or less 16 weeks gestation, the evaluation can be done digitally or with ovum forceps to remove products of conception exit through the cervix. If the bleeding stops, give ergometrin 0.2 mg intramuscularly or 400 mcg of misoprostol orally. If the bleeding continues and more or less than 16 weeks gestational age, the evaluation of the products of conception: a. manual vacuum aspiration is an evaluation method selected. Evacuation with sharp curettage should only be done if the manual vacuum aspiration is not available. b. If evacuation can not be performed immediately make ergometrin 0.2 mg intramuscularly (repeated after 15 minutes if necessary) or 400 mcg of misoprostol orally (can be repeated after 4 hours if necessary). If the pregnancies over 16 weeks: a. Provide an infusion of oxytocin 20 units in 500 ml of intravenous fluids (normal saline or Ringer's lactate) at 40 drops per minute until the expulsion of the products of conception occurs b. If necessary given misoprostol 200 mcg vaginally every 4 hours until the expulsion of the products of conception occurs (maximum 800 mcg) c. Evaluation of residual products of conception in the uterus. d. Make sure to keep track of the condition of women after treatment.

Complete Abortion
Clients with abortion kompletus not require special treatment, only if the patient needs to be given tablets sulfas anemia ferrosus 600 mg per day or if the anemia is severe then it should be given a blood transfusion.

Provokatus abortion
Abortion provokatus is event stop pregnancy before the fetus can live outside the mother's body

Etiologi
Fetal Factors Mothers factor The use of drugs and environmental factors Immunological Factors

Pathophysiology
Pathophysiology of abortion starts bleeding in the decidua that cause necrosis of the surrounding tissue. Then part / whole fetus will detach from the uterine wall. This situation is a foreign body to the uterus, thereby stimulating uterine contractions to occur eksplusi fatus often invisible and is called "Bligrted Ovum".

Gynecological examination
inspection Vulva Inspekulo vaginal plug

Complication
1. Bleeding (haemorrhage) 2. perforation 3. Infection and tetanus 4. acute renal failure 5. Shock, shock caused by hemoreagrie (bleeding a lot) and septic shock or endoseptik (severe infection or septic) 6. In the missed abortion with retention of long products of conception can occur clotting disorders

Management of Abortion
1. surgical technique a. Kuretose / dilation b. Menstrual aspiration c. Laparotomy 2. medical techniques

Nursing Diagnosis
1. The risk of fluid volume deficit related to hemorrhage 2. Activity intolerance related to weakness. 3. Pain related to intrauterine tissue damage. 4. The risk of infection is related to bleeding, the vulva moist conditions.

Thanks for Nurse

Billahi Fii Sabilil Haq Fastabiqul Khairat