Incomplete Abortion

Subject: Midwifery I (Theory)

Overview

Incomplete abortion is the form of abortion in which the entire result of conception is not evacuated, but rather a portion of it remains inside the uterine cavity; this is known as incomplete abortion. Heavy bleeding, dilated cervix, and a big uterus are signs and symptoms. Management of partial abortion includes total bed rest, vital sign monitoring, oxygen administration, blood tests, and transfusion.

Incomplete abortion occurs when parts of the entire product of conception are retained and not discharged from the uterus. This signifies that the fetus has been evacuated, but the placenta and membranes have been kept in the uterus in whole or in part. It normally happens during the 12th week of pregnancy.

Signs and Symptoms

A varied period of amenorrhea's history.
History of the vaginal evacuation of a meaty mass
Lower abdominal pain as a result of uterine contraction
Due to excessive vaginal bleeding, pallor and shock symptoms may be observed.
Recurrent vaginal bleeding, which can be profuse, and vaginal product passing
The uterus is smaller than the amenorrheal period.
The sensation of a bloated uterus
The internal organs are open, and the uterus is soft, although an older example may have closed internal organs and a hard uterine.
There is no involution and no products of conception may be felt in the cervical canal or vaginal.

Investigation

History
Blood test for hemoglobin, blood grouping, and cross-matching
Blood CBC
Differential and Total count
Ultrasonography

Management

Maintain full bed rest.
Monitor and record vital indicators.
To treat shock, resuscitate the patient with intravenous fluid.
Grouping, hemoglobin, and cross-match blood tests
Blood transfusion based on the patient's condition
Keep all pads and rags for observing and measuring blood loss.
If the pain is severe, an analgesic injection of morphine15mg IM is given.
Oxygen administration is based on the patient's condition and requirements.
Plan for uterine contents evacuation if the pregnancy is fewer than 16 weeks.

If evacuation is not possible right away.

Give ergometry 0.2mg IM or misoprostol 400mcg orally (repeat once every 4 hours as needed).
Make arrangements for uterine evacuation as soon as feasible.
If the pregnancy is more than 16 weeks long
Wait for spontaneous ejection of conception products before evacuating the uterus to remove any residual conception products.
To achieve expulsion of the products of conception, inject oxytocin 40 units in 1 liter IV fluids (normal saline or ringer's lactate) at 40 drops per minute if necessary.
Advise the woman to return for a check-up after therapy.
Other steps were implemented:
- Tetanus toxoid
- Prophylactic antibiotics
- Examination and histopathology of the products to ascertain any recognizable pathology.
If the bleeding is light to moderate and the pregnancy is fewer than 16 weeks, remove the products of conception from the uterus with your fingers and forceps.
Manual evacuation is conducted in cases of pregnancy less than 16 weeks, however, if manual evacuation is not possible, sharp curettage is performed.
If evacuation is not achieved, ergometrine 0.2mg IM should be administered (repeat after 15 minutes as per needs).
If the pregnancy is more than 16 weeks old, administer oxytocin 40 units in 1 liter of IV fluids, either normal saline or ringer lactate, at a rate of 40 drops per minute until the result of conception is not ejected.
Evacuate any residual uterine products.

References

ToWomenHealth. http://www.2womenshealth.com/incomplete-abortion.htm
SlideShare. https://www.slideshare.net/crisbertc/types-of-abortion
Prezi. 17 February 2011. https://prezi.com/7avru5nzs1en/types-of-abortion-management-nurses-perspective/
Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhnadar (Publisher and Distributor), Bhotahity, Kathmandu
NCBI. 22 June 1930. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC381898/?page=3
NYTimes. 14. March 2017. http://www.nytimes.com/health/guides/disease/abortion-threatened/overview.html
The Free Dictionary. http://medical-dictionary.thefreedictionary.com/incomplete+abortion

Things to remember

Incomplete abortion occurs when parts of the entire product of conception are retained and not discharged from the uterus.
Give ergometry 0.2mg IM or misoprostol 400mcg orally (repeat once every 4 hours as needed).
To achieve expulsion of the products of conception, inject oxytocin 40 units in 1 liter IV fluids (normal saline or ringer's lactate) at 40 drops per minute if necessary.
If evacuation is not achieved, ergometrine 0.2mg IM should be administered (repeat after 15 minutes as per needs).
If the pregnancy is more than 16 weeks old, administer oxytocin 40 units in 1 liter of IV fluids, either normal saline or ringer lactate, at a rate of 40 drops per minute until the result of conception is not ejected.

Questions and Answers

Define incomplete abortion.

Incomplete abortion is defined as an abortion in which some or all of the fetus's components are retained and not expelled from the uterus. This indicates that the placenta and membranes have either been completely or partially retained in the uterus while the fetus has been expelled. Usually, it happens 12 weeks into the pregnancy.

Define incomplete abortion. Explain its causes, symptoms and management

Incomplete Abortion

Signs and Symptoms

History of an irregular amenorrheic period.
History of a fleshy mass passing through the vagina
contraction of the uterus causing lower abdominal discomfort
As a result of heavy vaginal bleeding, pallor indications of shock could be observed.
repeatedly heavy vaginal bleeding as well as the transit of items via the vagina.
The uterus is smaller than an amenorrheic woman's menstruation.
The uterus feels large.
The uterus is soft and the internal OS is open, but in older cases, the internal OS may be closed and the uterus may be firm.
The results of conception may be felt in the vaginal or cervical canal with no involution.

Investigation

History,
Blood test for hemoglobin, blood grouping, and cross matching,
Blood CBC,
Differential and Total count,
Ultrasonography.

Management

Maintain total bed rest,
Keep track of the vital indicators.
Use intravenous fluid to revive the patient and treat shock.
Blood test for hemoglobin, cross-match, and grouping,
depending to the patient's conditions, blood transfusion,
To examine and gauge the blood loss, save all pads and rags.
If there is severe pain, morphine 15 mg IM is administered as an analgesic.
according to the condition and needs of the patient, administer oxygen.
Plan for uterine contents evacuation if the pregnancy is less than 16 weeks pregnant.

If evacuation is not immediately possible.

Give ergometry 0.2 mg intramuscularly or 400 mcg of misoprostol orally, repeating as required every four hours.
Make arrangements for uterine evacuation as soon as feasible.
When a pregnancy is more than 16 weeks old
Wait for the natural evacuation of the results of conception, and then drain the uterus to eliminate any leftovers.
To achieve the expulsion of the products of conception, oxytocin 40 units may be infused in 1 liter of IV fluids (normal saline or ringer's lactate) at a rate of 40 drops per minute, if necessary.
Encourage the woman to follow up after the procedure
Other actions were taken, including:
- Tetanus toxoid
- Prophylactic antibiotics
- Examination and histopathology of the products to ascertain any recognizable pathology.
Use your fingers and forceps to remove the results of conception from the uterus if the bleeding is mild to moderate and the pregnancy is less than 16 weeks old.
Manual evacuation is carried out when the pregnancy is less than 16 weeks along, but sharp curettage has to be done in the absence of manual evacuation.
If evacuation is not possible, administer ergometrine 0.2 mg intramuscularly.
Give oxytocin 40 units in 1 liter of IV fluids, either normal saline or ringer lactate, at a rate of 40 drops per minute if the pregnancy is more than 16 weeks along, in order to prevent the expulsion of the fetus.
Remove the uterus' remaining byproducts.