Inevitable Abortion

Subject: Midwifery I (Theory)

Overview

Inevitable abortion is a form of abortion in which the process of abortion has begun and progressed to the point where the expulsion of the products of conception appears to be unavoidable. Pregnancy cannot be continued in this condition. We can manage the unavoidable abortion by allowing the patient absolute bed rest, monitoring vital signs, blood tests, and transfusions, administering painkillers for extreme pain, and injecting ergometrine 0.2 mg in severe bleeding.

Abortion characterized by the rupture of the membranes or cervical dilatation in the presence of vaginal bleeding and uterine contraction in a viable pregnancy. The cervix has dilated, but no conception products have been evacuated. The cervix is typically slightly dilated, attesting to the application's inevitability.

Signs and Symptoms

  1. Variable period of amenorrhea history
  2. Vaginal bleeding with the passage of new blood and clots caused by chorionic villi separation.
  3. The vaginal bleeding may be profuse.
  4. Intermittent uterine contractions are excruciatingly painful.
  5. Weakness as a result of excessive blood loss
  6. Cervical enlargement
  7. Membrane ruptures
  8. Pallor, tachycardia, and hypotension may occur.
  9. The cervix is soft.
  10. Blood clots were discovered in the vagina as a result of the fertilization.

Investigation

  1. Making history
  2. Examination of the body
  3. Ultrasonography for grouping, Rh factor, and hemoglobin
  4. Bulky uterus The gestational sac descends into the uterine cavity.
  5. It is possible to discern fetal echoes.
  6. The internal operating system is accessible.
  7. A sonolucent region may be noticed if there are blood clots in the cervical canal.

Treatment

  1. Raise the bed's foot end and keep the patients warm.
  2. Inhalation of oxygen is required.
  3. Pethidine 100mg and diazepam 10mg IM were administered as needed.
  4. Crossmatch IV drip with 5% dextrose begins after a blood test for hemoglobin. A blood transfusion is required.
  5. If the bleeding persists, an IV of oxytocin 5-10 units or ergometrine 0.5mg should be administered.

Management

  1. Finish the bed rest.
  2. Monitor and record vital indicators.
  3. To treat shock, resuscitate the patient with intravenous fluid.
  4. Grouping, hemoglobin, and cross-match blood tests
  5. Blood transfusion based on the patient's condition
  6. Keep all pads and rags for observing and measuring blood loss.
  7. If the pain is severe, an analgesic injection of morphine 15mg IM is given.
  8. Ergometrine 0.2mg injection is indicated if serious bleeding occurs.
  9. Oxygen administration is based on the patient's condition and requirements.
  10. Plan for uterine contents evacuation if the pregnancy is fewer than 16 weeks.

If evacuation is not immediately possible.

  1. Give ergometry 0.2mg IM or misoprostol 400mcg orally (repeat once every 4 hours as needed).
  2. Make arrangements for uterine evacuation as soon as feasible.
  3. If the pregnancy is more than 16 weeks long
  4. Wait for spontaneous ejection of conception products before evacuating the uterus to remove any residual conception products.
  5. 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.
  6. Advise the woman to return for a check-up after therapy.
  7. Other steps were implemented:
  • Tetanus toxoid
  • Prophylactic antibiotics
  • Examination and histopathology of the products to ascertain any recognizable pathology.

 References

  • Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu
  • ToWomenHealth. http://www.2womenshealth.com/Abortion-sign-symptom-cause.htm
  • SlideShare. https://www.slideshare.net/crisbertc/types-of-abortion
  • Prezi. 17 February 2011. https://prezi.com/7avru5nzs1en/types-of-abortion-management-nurses-perspective/
  • NCBI. 22 June 1930. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC381898/?page=
Things to remember
  • Abortion is characterized by the rupture of the membranes or cervical dilatation in the presence of vaginal bleeding and uterine contraction in a viable pregnancy.
  • Vaginal bleeding with the passage of new blood and clots caused by chorionic villi separation.
  • If the bleeding persists, an IV of oxytocin 5-10 units or ergometrine 0.5mg should be administered.
  • If the pain is severe, analgesic injection morphine 15mg IM is given.
  • Ergometrine 0.2mg injection is indicated if serious bleeding occurs.
Questions and Answers

When there is vaginal bleeding and uterine contraction, an abortion is defined as the rupture of the membranes or cervical dilation in a previable pregnancy. Although the cervix has dilated, the fetus has not yet been evacuated. The fact that the cervix is typically just slightly dilated confirms the inevitable nature of the process.

Inevitable Abortion

When there is vaginal bleeding and uterine contraction, an abortion is defined as the rupture of the membranes or cervical dilatation in a previable pregnancy. Although the cervix has dilated, the fetus has not yet been evacuated. The fact that the cervix is frequently only partially dilated confirms the inevitable nature of the process for this kind.

Signs and Symptoms

  • History of variable period of amenorrhea
  • Vaginal bleeding with passage of fresh blood and clots due to the detachment of the chorionic villi.
  • Bleeding per vagina may be profuse.
  • Painful intermittent uterine contraction
  • Weakness due to heavy blood loss
  • Dilatation of the cervix
  • Ruptures of membranes
  • There may be pallor, tachycardia, hypotension
  • Cervix feels soft
  • Blood clots were seen in the vagina
  • Product of the conception felt through the OS.

Investigation

  • History taking,
  • Physical examination,
  • Blood test for grouping, Rh factor and hemoglobin,
  • Ultrasonography,
  • Bulky uterus,
  • Gestational sac lows down in the uterine cavity,
  • Fetal echoes may be seen,
  • Internal OS is open,
  • Blood clots in the cervical canal may be seen as a sonolucent area.

Treatment

  • Raise the foot end of the bed and keep the patients warm
  • Oxygen inhalation must be given
  • As per needed injection pethidine 100mg and diazepam 10mg IM given
  • Blood test for hemoglobin, cross match
  • IV drip with 5% dextrose starting. Blood transfusion should be done.
  • If the bleeding is continuous then IV of oxytocin 5-10 units or ergometrine 0.5mg should be given.

Management

  • Finish the 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 significant pain, morphine 15 mg IM is used as an analgesic.
  • Ergometrine 0.2 mg is injected in cases of severe bleeding.
  • according to the state and needs of the patient, provide 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.

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