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GENERAL OBJECTIVES
At the end of my class students will be able to gain indepth knowledge about Abortion.
SPECIFIC OBJECTIVES
 To define Abortion.
 To explain various types of Abortions.
 To list out etiological factors related to Abortion.
 To discuss the clinical features of Abortion.
 To enumerate the investigations related to Abortion.
 To discuss the treatment related to Abortion.
 To explain the management related to Abortion.

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
To define the
Abortion.
2 min
3 min
INTRODUCTION
Abortion is the ending of pregnancy by 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".
DEFINITION
1) Expulsion or extraction from its mother of an embryo or
fetus weighing 500gm or less when it is not capable of
independent.
-According to WHO
2) Abortion is the removal of pregnancy tissue, products of
Lecture
method
Black board
Power
point
presentation
What is
Abortion?

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
conception or the fetus and placenta from the uterus. In
general, the terms fetus and placenta are used after
eight weeks of pregnancy. Pregnancy tissue and products
of conception refer to tissue produced by the union of an
egg and sperm before eight weeks.
-According to the text book of Myles
3) Abortion is the termination of a pregnancy by removal or
expulsion of an embryo or fetus. An abortion that occurs
without intervention is known as a miscarriage or
"spontaneous abortion"; these occur in approximately 30%
to 40% of all pregnancies.
-According to the text book of DC Dutta

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
To explain
the different
types of
Abortions.
To list out
the
etiological
factors
related to
Abortions.
3 min
5 min
TYPES OF ABORTIONS
1) Spontaneous
2) Induced
 Threatened  Legal
 Inevitable  Illegal (criminal)
 Incomplete
 Complete
 Missed
 Septic
ETIOLOGY
 Genetic factors
 Infection
 Endocrine and metabolic factors
Lecture
method
Lecture
method
Power
point
presentation
Power
point
presentation
What are the
different
types of
Abortions?
What are the
etiological
factors
related to
Abortions?

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
To discuss
the
threatened
abortion.
5 min
 Immunological
 Anatomical factors
 Others
Threatened Abortion
Definition : It is a clinical entity where the process of abortion
has started but has not progressed to a state from which
recovery is impossible.
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.
Lecture
method
Power
point
presentation
What is
threatened
Abortion?

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
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 present.
2. Drugs : Sedation and relief of pain.
3. General measure : Pulse, Blood Pressure,

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
To explain
the
inevitable
abortion.
5 min
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 :
1. Amenorrhoea
2. P/V bleeding
3. Lower abdominal pain : Aggravation of pain colicky in nature.
4. P/V examination /Bleeding Present (+)or (++) :
P/S: Dilated internal os of the cervix through which the
products of conception are felt.
Lecture
method
Power
point
presentation
What is
inevitable
abortion?

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
To explain
the complete
abortion.
5 min
Management :
1. Correction of anemia
2. Correction of dehydration
3. To accelerate process of expulsion
4. To maintain strict asepsis (to reduce post abortion
complication).
Treatment :
1. Before 12 weeks : Dilatation, evacuation, curettage Suction
evacuation and curettage Under G/A.
2. After 12 weeks : Oxytocin drip Prostaglandin tablet
Complete abortion
Definition : When product of conception are expelled
Lecture
method
Power
point
presentation
What is
complete
abortion?

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
completely.
Clinical Features :
1. Amenorrhoea
2. History of expulsion of fleshy 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.

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
To discuss
the
incomplete
abortion.
5 min
Management :
1. Correction of anemia 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.
Lecture
method
Power
point
presentation
What is the
incomplete
abortion?

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
3. Continues lower abdominal colicky pain.
4. Per vaginal bleeding.(irregular).
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

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
To explain
the missed
abortion.
5 min
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.
Lecture
method
Power
point
presentation
What is
missed
abortion?

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
To explain
the recurrent
abortion.
5 min
6. Pregnancy test negative.
7. USG reveals absent fetal heart movement and fetal motion.
Complication : Blood coagulation disorders.
Management :
Less than 12 weeks-dilatation, evacuation & curettage.
More than 12 weeks-induction by
1. Oxytocin
2. Prostaglandins
Recurrent (Habitual) Abortion
Definition :
Three consecutive pregnancies ending in spontaneous abortion
therefore constitute the criterion for the diagnosis of ‘recurrent
Lecture
method
Power
point
presentation
What is
recurrent
abortion?

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
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.

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
To discuss
the septic
abortion.
5 min
(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.
Lecture
method
Power
point
presentation
What is
septic
abortion?

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
(9) Study of the chromosome patterns of wife and husband.
Septic Abortion
Definition: An abortion complicated by infection
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

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
 Pelvic abscess, endometritis,
 Septicemia
 Septic/haemorrhagic shock
 PID
 Pelvic adhesions
 2° Infertility
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

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
To listout
the
complications
related to
abortions.
To explain
the
management
of abortion.
5 min
10
min
ampicilin and metronidazole
7. Evacuation
8. Haematenic
COMPLICATIONS
1. Haemorrhage
2. Septicaemia
3. Bacteraemia shock with rigors, nausea, vomiting, diarrhoea,
hypotension, confusion, delirium and coma
4. Renal failure
5. Secondary
6. Infertility
7. Death
Lecture
method
Lecture
method
Power
point
presentation
Power
point
presentation
What are all
the
complications
of abortion?
What is the
management
of abortion?

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
Role of midwife during abortion:
 The woman with abortion must be admitted to
gynaecological ward for close observation and 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.

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
Legislation & professional Responsibilities:
I. Abortion in India is legal only up to twenty weeks of
pregnancy under specific conditions and situations which are
broadly defined as:
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
Termination of Pregnancy Act, 1971.
II.According to The Pre-Natal Diagnostic Techniques(Regulation
and Prevention of Misuse) Amendment Act, 2002 the following

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
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.
I.First trimester abortion:
Medical Methods in the first trimester:
i.The methotrexate
ii.The mifepristone
Surgical methods:
(i) Cervical dilatation followed by evacuation of uterus by:
Curettage /Suction evacuation / vacuum aspiration / Dilatation

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION
and 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).

SPECIFIC
OBJECTIVE
TIME CONTENT METHOD
OF
TEACHING
AV AIDS EVALUATION

Summary
Today we learnt about abortion its definition, types , etiology, causes, manifestations, management, role of midwife during
abortion, Legislations and professional resposibilties, different abortion procedures.
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.

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