Abortion

Case Presentation by: Kristianne Ysabel E. Soriano

Physical Assessment
Past and Present History
History of Present Illness
The patient complained of Abdominal spasm and profuse vaginal bleeding with blood clots. For 2 days she had
experienced light spotting that increased in severity that morning. Upon interviewing Mrs. Emz reported no fever, chills,
burning on urination, nausea or vomiting. The patient’s abdomen was slightly distended, and mild tenderness was
present over her lower pelvic area. During pelvic examination, moderate bleeding was noted , with the cervical os open.
Blood clots were noted on the perineal pad. The remainder of the patient’s physical examination was unremarkable.

Obstetric History
Gravida 5, Para 3, Abortion 1.

Past Medical History

The patient was otherwise healthy and had no significant medical problems. Upon review of her history, physical
examination and diagnostic workup, Mrs. Emz was diagnosed with Incomplete Spontaneous Abortion.
Symptoms Manifested
● Abdominal cramping
● Heavy vaginal bleeding with blood clots
● Cervical os opened
Diagnostic Findings
Diagnostic Findings
● Cervical os is open - unstable support for the fetus which can cause miscarriage
● Moderate bleeding and spotting - problems with the cervix, including cervical insufficiency, miscarriage

Transvaginal Ultrasonography
● A type of pelvic ultrasound used by doctors to examine the reproductive organs, which include the uterus, fallopian tubes, ovaries, cervix
and vagina
- Presence of abnormal abdominal sac within the cervical canal is a sign of miscarriage because abdominal sac should be in the uterus.

Hemoglobin Measurement
- the main protein in the red blood cells, is the substance that allows for the transport of oxygen throughout the body.
- Low hemoglobin = anemia, which causes symptoms like fatigue and trouble breathing

Hematocrit Measurement
- the percentage of red blood cells in the total blood volume
- Low hematocrit = anemia, increases the risk of premature birth
Anatomy and Pathophysiology
Anatomy and Pathophysiology
The ovaries (female gonads) are the primary sex organs of the female. Like the testes of the male, the ovaries produce both an exocrine product
(eggs, or ova) and endocrine products (estrogens and progesterone). The accessory structures of the female reproductive system transport, house,
nurture, or otherwise serve the needs of the reproductive cells and/or the developing fetus.

The reproductive structures of the female are generally considered in terms of internal organs and external organs, or external genitals.

The external genitalia consist of the mons pubis, the labia majora and minora, the clitoris, the urethral and vaginal orifices, and greater vestibular
glands. The mons pubis is a rounded fatty area overlying the pubic symphysis. Running inferiorly and posteriorly from the mons pubis are two
elongated, hair-covered skin folds, the labia majora, which are homologous to the scrotum of the male. These enclose two smaller hair-free folds,
the labia minora. (Terms indicating only one of the two folds in each case are labium majus and minus, respectively.) The labia minora, in turn,
enclose a region called the vestibule, which contains the clitoris, most anteriorly, followed by the urethral orifice and the vaginal orifice. The
diamond-shaped region between the anterior end of the labial folds, the ischial tuberosities laterally, and the anus posteriorly is called the perineum.

The small protruding clitoris is homologous to the male penis and likewise is composed of highly sensitive erectile tissue and is hooded by a
prepuce. The urethral orifice, posterior to the clitoris, is the outlet for the urinary system and has no reproductive function in the female. The vaginal
opening is flanked by the pea-sized, mucus-secreting greater vestibular glands. These glands (not illustrated) lubricate the distal end of the vagina
during sexual intercourse.
Anatomy and Pathophysiology
The internal female organs include the vagina, uterus, uterine tubes, ovaries, and the structures that suspend these organs in the
pelvic cavity. The vagina extends for approximately 10 cm (4 inches) from the vestibule to the uterus superiorly. It serves as a
copulatory organ and birth canal and permits the menstrual flow to pass. The pear-shaped uterus, situated between the bladder and
the rectum, is a muscular organ with its narrow end, the cervix, directed inferiorly. The major portion of the uterus is the body; its
superior rounded region above the entrance of the uterine tubes is the fundus. A fertilized egg is implanted in the uterus, which
houses the embryo or fetus during its development.

The uterine, or fallopian, tubes enter the superior part of the uterus and extend for about 10 cm (4 inches) toward the ovaries in the
peritoneal cavity. The distal ends of the tubes are funnel-shaped and have fingerlike projections called fimbriae. Unlike the male duct
system, there is no actual contact between the female gonad and the initial part of the female duct system—the uterine tube.

The internal female organs are all retroperitoneal, except the ovaries. They are supported and suspended somewhat freely by folds of
peritoneum. The peritoneum takes an undulating course. The fold that encloses the uterine tubes and uterus and secures them to the
lateral body walls is the broad ligament. The round ligaments and the uterosacral ligaments also help attach the uterus to the body
wall. The ovaries are supported medially by the ovarian ligament (extending from the uterus to the ovary) and laterally by the
suspensory ligaments.
Concept Mapping
Laboratory Result
Laboratory findings showed WBC’s 10,000/uL, hemoglobin of
10.3 g/dL and hematocrit 30.5 % and urinalysis with the
following result : color pinkish, reaction: acidic, specific
gravity: 1.05, RBC; 10-15 hpf WBC; 10-12hpf, Mrs. Emz blood
type was A-positive. Transvaginal ultrasonography showed
abnormal abdominal sac within the cervical canal.
Impression
Incomplete Spontaneous Abortion
Medical and Surgical Management
Dilation and curettage – a type of procedure used to evacuate or remove tissue from inside
the uterus of the woman. It helps clear the uterine lining after a miscarriage or abortion. D&C
is surgically performed by a doctor whereby the cervix is dilated so that the endometrium
lining is scraped with a curette (a spoon-shaped instrument) to remove the abnormal tissues.

Psychological therapy – the patient may begin to experience extreme sadness or depression
after losing a child, especially if they have planned this pregnancy. Talking to a therapist or
counsellor will help the woman explore her feeling about the abortion, and it will be
explained to her that she is not alone. Therapy can prevent Post-Traumatic Stress and other
psychological symptoms.
Nursing Care Plan
Drug Study
Drug Study
Drug Study
Drug Study
Drug Study
Discharge Plan
Health Teachings

● Educate the importance of rest as the body needs to heal from the procedure
● Help her understand that there might be some pain after the procedure, as well as vaginal bleeding which is
experienced for a few weeks
● Introduce perineum pads, and that they must be change 4-6 hours
● Educate that personal hygiene is crucial to prevent any infections from occurring, therefore, every time the client
changes pads, she must thoroughly wash her perineum with unscented soap and dried with a clean washcloth
● Advise the client to have her next pregnancy at least 6 months to allow her body to recover from the trauma
● Teach the patient that after taking her oral medications, she must not drive a vehicle

Outpatient follow-up (call the doctor if any of the following occurs):

● Severity of the bleeding has been increasing for 2 days

● Fever or chills
● Abdominal cramps that cannot be relieved by Ibuprofen
● Foul-smelling vaginal discharge
Discharge Plan
Lifestyle:

● Abstain from any sexual activity for the time being, until the next follow-up when
the doctor has cleared the client
● Avoid using tampons or inserting anything inside her vagina
● Follow a healthy diet, consisting with a lot of protein to allow the muscles of the
body to heal
● Perform moderate exercises 4 weeks after procedure for a healthy body
● Get enough sleep
● Surround yourself with friends and family
Review of Related Literature
"The Incidence of Abortion Worldwide", by Stanley K. Henshaw, Susheela Singh, Taylor Haas

Context: Accurate measurement of induced abortion levels has proven difficult in many parts of the world. Health care workers and
policymakers need information on the incidence of both legal and illegal induced abortion to provide the needed services and to reduce the
negative impact of unsafe abortion on women's health.

Methods: Numbers and rates of induced abortions were estimated from four sources: official statistics or other national data on legal
abortions in 57 countries; estimates based on population surveys for two countries without official statistics; special studies for 10 countries
where abortion is highly restricted; and worldwide and regional estimates of unsafe abortion from the World Health Organization.

Results: Approximately 26 million legal and 20 million illegal abortions were performed world-wide in 1995, resulting in a worldwide
abortion rate of 35 per 1,000 women aged 15-44. Among the subregions of the world, Eastern Europe had the highest abortion rate (90 per
1,000) and Western Europe the lowest rate (11 per 1,000). Among countries where abortion is legal without restriction as to reason, the
highest abortion rate, 83 per 1,000, was reported for Vietnam and the lowest, seven per 1,000, for Belgium and the Netherlands. Abortion
rates are no lower overall in areas where abortion is generally restricted by law (and where many abortions are performed under unsafe
conditions) than in areas where abortion is legally permitted.

Conclusions: Both developed and developing countries can have low abortion rates. Most countries, however, have moderate to high
abortion rates, reflecting lower prevalence and effectiveness of contraceptive use. Stringent legal restrictions do not guarantee a low
abortion rate.