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Lesson plan on

ABORTIONS

Submitted by- Ms
Sneha Sehrawat
Tutor

IDENTIFICATION DATA

NAME: Ms. Sneha Sehrawat

CLASS:

SUBJECT: OBG

TOPIC: Abortions

GROUP:
SIZE OF THE GROUP:

DURATION: 1 hour

PLACE:

METHOD OF TEACHING: Lecture cum Discussion

AV AIDS USED: Powerpoint Presentation

DATE:

TIME:

LANGUAGE: English

SUPERVISOR:

PREVIOUS KNOWLEDGE:

GENERAL OBJECTIVES

After the class, students will be able to:


 Acquire knowledge of topic- ABORTIONS.
 Vocalize their learning about the topic .

 Explain various types of abortions.

 Able to critically analyze the existing practices in OBG nursing related to abortion.

 Discuss role of midwife related to abortion.

 Understand the use and assimilate this knowledge in future nursing practices.

Teacher will be able to :-


1. Develop confidence in facing the group.

2. Develop confidence in teaching.

3. Develop skills in classroom management.

4. Develop in-depth knowledge about the Topic.

5. Develop skills in conduction of evaluation .

6. Develop skills in appropriate utilization of A.V. aids.

7. Develop skills in lecture cum discussion method of teaching.

Tim Specific Contents Teaching Learning Evaluatio


e Objectives Activities with n
A.V.aids
INTRODUCTION

1 Abortion is the ending


of pregnancy by
min
removing a fetus or
embryo before it can
survive outside the
uterus. An abortion
which occurs
spontaneously is also
known as a
miscarriage. An
abortion may be
caused purposely and
is then called an
induced abortion, or
less frequently,
"induced
miscarriage". The
word abortion is often
used to mean only
induced abortions. A
similar procedure
after the fetus could
potentially survive
outside the womb is
known as a "late
termination of
pregnancy"
ANNOUNCEMENT
OF THE TOPIC :
1
Today we will be
min.
studying about
Abortions.
The group
will be able
Definition : Expulsion or Teacher defines
to:-
extraction from its mother of an abortion.
2
To define embryo or fetus weighing 500gm
min or less when it is not capable of
abortions
independent (WHO).
Define
abortion.
4 To enlist Type of abortion Teacher enlists
min different different types of
types of  Spontaneous abortion.
abortion.
o Threatened

o Inevitable

o Incomplete

o Complete

o Missed

o Septic
Enlist
 Induced
different
o Legal types of
abortion.
o Illegal (criminal)

10 Ṭo discuss Etiology : Teacher discusses


various types various types of
mins  Genetic factors
of etiological etiological factors
factors  Infection related to abortions. Enlist
related to  Endocrine and metabolic
various
abortions. factors
types of
 Immunological etiological
factors
 Anatomical factors related to
 Others abortions

25 To elaborate Threatened Abortion Teacher discusses


mins about about different
different Definition : It is a clinical entity abortions, causes and
where the process of abortion has
abortions, their management.
causes and started but has not progressed to a
their state from which recovery is
impossible.
management.
Clinical features :

1. Bleeding per vagina : The


bleeding is usually slight and bright
red in colour. On rare occasion, the
bleeding may be brisk and sharp,
specially in the second trimester,
suggestive of low implantation of
placenta. The bleeding usually
stops spontaneously.

2. Pain : Usually painless, may be


mild backache dull pain in lower
abdomen. Pain appears usually
following haemorrhage.

P/V Examination : Usually not


done if necessary should be done as
gently as possible.

P/S Examination : Reveals


bleeding if any escapes through the
external os.

Investigation :

 Blood for Hb%, ABO and


Rh grouping, anti-D gamma
globulin- if Rh negative.
 Urine for Pg test.

 Ultrasonography (TVS/
Abdominal) :

Treatment :

1. Rest : When active bleeding


Define
present. threatened
abortion.
2. Drugs : Sedation and relief of
pain.

3. General measure : Pulse, Blood


Pressure,

4. Temperature, P/V bleeding.

Inevitable Abortion

Definition : In this type of abortion


where the changes have progressed
to a state from where continuation
of pregnancy is impossible.

Clinical Features :
What are
1. Amenorrhoea the signs
and
2. P/V bleeding
symptoms
3. Lower abdominal pain : related to
Aggravation of pain colicky in inevitable
nature. abortion?
4. P/V examination /Bleeding
Present (+)or (++) :

P/S: Dilated internal os of the


cervix through which the products
of conception are felt.
Management :

1. Correction of aneaemia

2. Correction of dehydration

3. To accelerate process of
expulsion

4. To maintain strict asepsis (to


reduce post abortion omplication).

Treatment :

1. Before 12 weeks : Dilatation,


evacuation, curettage Suction
evacuation and curettage Under
G/A.

2. After 12 weeks : Oxytocin drip


Prosterglandin tablet

Complete abortion

Definition : When product of


conception are expelled completely.

Clinical Features :

1. Amenorrhoea

2. History of expulsion of fleshey


mass per vagina.

3. Subsidence abdominal pain.

4. P/V bleeding : Trace or absent

5. P/V examination : Bleeding (+)


or absent.

Bimanual examination :

1. Uterus is smaller than the period


of amenorrhoea and firm.

2. Cervical os closed.

3. Bleeding : Trace or absent.

Management :

1. Correction of anaemia if needed.

2. Anti-D gamma globulin-50


microgram or 100 microgram if
patient Rh negative, within 72
hours of abortion.

Incomplete abortion

Definition : When the entire


products of conception are not
expelled, instead a part of it is left
inside the uterine cavity, it is called
incomplete abortion. Commonest
type of abortion amongst hospital
incidence.

Clinical features :

1. Amenorrhoea History of

2. History of Expulsion of product


of conception per vagina.

3. Continues lower abdominal Define


colicky pain.
incomplet
4. Per vaginal bleeding.(irregular). e
abortion.
5. Internal examination :

a. Uterus smaller than the period of


amenorrhoea.

b. Patulous cervical os often


admitting tip of the finger.
c. Varying amount of bleeding.
(P/V)

Management :

1. Correction of anemia if
necessary.

2. Antibiotics.

3. Dilatation and evacuation under


G/A.

4. Histopathological examination
of product of conception after
removed.

Missed abortion

Definition : Sometimes fetus died


in uterus and retained inside for a
variable period is called missed
abortion.

Clinical features :

1. Amenorrhoea

2. P/V bleeding / Brownish


discharge.

3. Subsidence of pregnancy
symptoms.

4. Fetal heart sound not audible


with doppler.

5. Cervix feels firm.

6. Pregnancy test negative.

7. USG reveals absent fetal heart


movement and fetal motion.

Complication : Blood coagulation


disorders.

Management :
What is
Less than 12 weeks-dilatation, the
evacuation & curettage. managem
ent of
More than 12 weeks-induction by
missed
1. Oxytocin abortion?

2. Prostaglandins

Recurrent (Habitual) Abortion

Definition :

Three consecutive pregnancies


ending in spontaneous abortion
therefore constitute the criterion for
the diagnosis of ‘recurrent
abortion’. In practice, however,
investigation, if not treatment, may
be justified by a woman’s anxiety
over having lost 2 pregnancies.

Investigation

1. Occurrence of previous
abortions

2. Periods of amenorrhoea

3. subsequent bleeding painful and


by home

4. Curettings contain chorionic


villi on histological examination
Special tests

Between pregnancies

(1) Blood count and uninalysis.

(2) Serological tests for syphilis in


wife and husband.

(3) Determination of the blood


groups of wife and husband, with
tests for antibodies in the wife.

(4) Glucose tolerance test.

(5) Estimation of theblood urea


level, and renal function tests
where indicated.

(6) Tests of thyroid function.

(7) Hysterography to determine the


shape of the fundus and the
competence of the internal os is
essential in all cases. Cervical
sphincteric action is beststudied
during the luteal phase.

(8) A formiminoglutamic acid


(FIGLU) excretion test and blood
folate assays.

(9) Study of the chromosome


patterns of wife and husband.

What are
the signs
and
Septic Abortion symptoms
of septic
Definition: An abortion
complicated by infection abortion?

Signs & Symptoms

 Abdominal pain
 Fever

 Vaginal discharge (foul


smelling)

 Sick looking, febrile or


jaundiced

 Tender uterus

 Offensive vaginal discharge or


bleeding

 Cervix is usually soft and may


be dilated

Complications

Haemorrhage

Peritonitis

Pelvic abscess, endometritis,

Septicemia

Septic/haemorrhagic shock

PID

Pelvic adhesions

2° Infertility

Chronic LAP

Management
1.Resuscitation

2.IV fluids: RL, NS

3. Insert urethral catheter

4. Monitor Input/output

5. Blood grouping & Cross


matching

6. Antibiotics: Preferably
cephalosporins, if not available
ampicilin and metronidazole

7. Evacuation

8. Haematenic
5 To enlist 1. Haemorrhage Teacher enlists
min various various complications
2. Septicaemia
complication related to abortions
s related to 3. Bacteraemia shock with rigors,
abortions nausea, vomiting, diarrhoea,
hypotension, confusion,
delirium and coma

4. Renal failure

5. Secondary

6. Infertility

7. Death
5 To Role of midwife during abortion:Teacher discusses the
min understand role o a midwife
 The woman with abortion must
the role o a during abortion
midwife be admitted to gynaecological
during ward for close observation and
abortion
treatment

 History taking to obtain


possible aetiological factors
together with details of
bleeding, pain and products of
conception expelled

 Perform a full physical


examination

 Check and record vital signs i.e.


temperature, pulse, respiration
and blood pressure

 Observe aseptic technique


when performing vaginal
examinations

 Provide pads to observe


severity of blood loss

 Put up intravenous fluids if the


woman is bleeding severely i.e.
normal saline, ringers lactate

 If necessary Check Hb,


grouping and cross matching
and arrange for blood donor

 Give antibiotics to treat


infection in case of septic
abortion

5 To Legislation & professional Teacher discusses


mins understand Responsibilities: legislation and
legislation professional
I.Abortion in India is legal only up
and responsibilities
to twenty weeks of pregnancy
professional related to abortion in
under specific conditions and
responsibiliti India.
situations which are broadly
es related to
defined as:
abortion in
India. 1.the continuance of the pregnancy
would involve a risk to the life of
the pregnant woman or of grave
injury of physical or mental health,
or

2.there is a substantial risk that if


the child were born, it would suffer
from such physical or mental
abnormalities as to be seriously
handicapped.

Recently, the Supreme Court


permitted a rape survivor to
terminate her pregnancy at 24
weeks, which is beyond the
permissible 20 weeks limit
prescribed under the Medical
When did
Termination of Pregnancy Act,
1971. MTP Act
came in
II.According to The Pre-Natal
India?
Diagnostic Techniques(Regulation
and Prevention of Misuse)
Amendment Act, 2002 the
following are cognisable, non-
bailable and non-compoundable
offences

 Conducting or associating or
helping to conduct Pre-Natal
Diagnostic tests for determining
the sex of the foetus.

 Sex selection on a woman or a


man or both on any tissue,
embryo, conceptus fluid or
gametes derived from either or
both of them

 Advertisement or
communication in any form in
print, by electronic media or
internet by units, medical
professionals or companies on
the availability of sex
determination and sex selection
in the form of services,
medicines, or any kind of
techniques.

5 To I.First trimester abortion. Teacher discusses


mins understand different abortion
Medical Methods in the first
different procedure used in
trimester:
abortion practice.
procedure i.The methotrexate
What are
used in
practice. ii.The mifepristone the
methods
Surgical methods:
of
(i) Cervical dilatation followed by abortions
evacuation of uterus by: used
during
Curettage /Suction evacuation / first
vacuum aspiration / Dilatation and trimester?
evacuation

(ii) Menstrual aspiration (MR)

II.Second trimester abortion.

Methods of second trimester


abortion (13 – 20 week)

Medical methods using drugs like:

i.Ethacridine lactate.

Ii.prostaglandin

Surgical methods

i.Aspirotomy

ii.Hysterotomy

iii.Hysterectomy

III.Third trimester abortion.

There are at least three medical


procedures associated with late-
term abortions:

i.Dilation and evacuation (D&E)

ii.Early labor induction


(sometimes called "induction
abortion")

iii.Intact dilation and extraction


(IDX or D&X)
1 Summary

Min Today we learnt about


abortion its definition,
types , etiology,
causes,
manifestations,
management, role of
midwife during
abortion, Legislations
and professional
resposibilties,
different abortion
1 procedures.
min
Conclusion

Abortion practices is
different in different
countries. Hence, a
midwife must learn
about different
practices and
legislation and her
responsibilities during
abortion to carry out
safe midwifery
practices.

BIBLIOGRAPHY
1.Women and health: today's
evidence, tomorrow's agenda.
Geneva: World Health
Organization; 2009.
2.Myers JE, Seif MW. Global
perspective of legal abortion –
trends, analysis and accessibility.
Best Practice and Research Clinical
Obstetrics and Gynaecology.
2010;24:457–466.

3.Warriner IK, et al. Can midlevel


health-care providers administer
early medical abortion as safely
and effectively as doctors? A
randomised controlled equivalence
trial in Nepal. Lancet.
2011;377:1155–1161.

4.Kishen M, Stedman Y. The role


of advanced nurse practitioners in
the availability of abortion services.
Best Practice and Research Clinical
Obstetrics and Gynaecology.
2010;24:569–578.

5.Jejeebhoy S, et al. Can nurses


perform MVA as safely and
effectively as physicians? Evidence
from India. Contraception.
2011;84:615–621.