INTRODUCTION

Abortion is a complex and sensitive topic that has been debated and discussed for
centuries. Here's a potential introduction:
"Abortion, the intentional termination of a pregnancy, is a deeply personal and
controversial issue that raises ethical, moral, legal, and health concerns. It is a
fundamental aspect of reproductive healthcare, with millions of women worldwide
facing unintended pregnancies and seeking access to safe and legal abortion services.
The debate surrounding abortion encompasses various perspectives, including
women's rights, fetal rights, religious and cultural beliefs, and societal values. As a
significant public health issue, abortion requires a nuanced understanding of its
physical, emotional, and psychological implications for women, as well as the legal
and policy frameworks that govern its availability and accessibility."

REASON FOR SELECTING THE CASE STUDY

 Growing prevalence: Abortion rates are increasing globally, making it a relevant
and timely topic.
 Emotional and sensitive: abortion is an emotionally charged issue, allowing for
exploration of sensitive and personal aspects.
 Advances in medical technology: The field of treatment is rapidly evolving,
with new technologies and controversies emerging.
 Impact on quality of life: abortion significantly impacts individuals' and couples'
quality of life, making it a compelling case study.
 Stigma and awareness: Abortion is often stigmatized, and case studies can help
raise awareness and promote education.
 Patient-centered care: Abortion case studies can focus on patient-centered care,
highlighting empathy and understanding in healthcare.
 Research opportunities: Abortion offers numerous research opportunities, from
epidemiology to treatment outcomes.
 Real-world application: Abortion case studies have real-world applications,
informing healthcare practices and policies.
CASE HISTORY:
PHASE I
Mrs. Srivani Barma, 23 years old women, W/O Mr Laltu barman and residence of
Rajganj, Japaiguri has come to the Gynae OPD on 14/7/24 with the chief complain of
complaints of Per Vaginal Bleeding & pain in abdomen in a case of Early First
Trimester Pregnancy

IDENTIFICATION DATA OF MOTHER:

a. Patient’s Name: Srivani Barman
b. Wife of – Laltu Barman
c. Age in years - 23 years
d. Address – Vill- bhanu pally,PS- Rajganj, Dist- Jalpaiguri
E. Date of admission- 14.07.24 at 6:30 AM

PHASE II
Differential diagnosis:
Threatened abortion - Bleeding or spotting with a closed cervix.
Inevitable abortion - Bleeding with an open cervix, indicating pregnancy loss.
Complete abortion -All tissue is expelled from the uterus
Septic abortion -Infection occurs during or after a miscarriage.
Placental previa- Placental previa
PHASE III
Probable diagnosis:
 Incomplete abortion diagnosed after USG
1. IDENTIFICATION DATA OF MOTHER:

a) Registration number - 38657

b) Educational status- HS Passed
c) Occupation- Housewife
d) Religion- Hindu
e) Duration of marriage- 1 year
f) Obstetric score – G1P0L0A1
g) Bed No- 21
h) Diagnosis- Incomplete Abortion

3. CHIEF COMPLAINTS AT THE TIME OF ADMISSION:

Mrs Sankari Barman was admitted to Gynae Ward of NBMCH with the chief
complaints of: Per Vaginal Bleeding & pain in abdomen in a case of Early First
Trimester Pregnancy.

4. HISTORY COLLECTION:
a. HISTORY OF PRESENT ILLNESS : Mother came to Labour room of NBMCH on
14.07.24 at 1:30 AM with Per Vaginal Bleeding & pain in abdomen in a case of Early
First Trimester Pregnancy. After initial inspection patient shifted to Gynae ward of
NBMCH. As per Ultrasonography result, Incomplete Abortion Diagnosed & after
taking High Risk Consent from Patient & Family members she undergone
EVA( Electric Vacuum Aspiration ) on 14.06.24 at 10:30 PM.
b. PAST MEDICAL HISTORY : There is no significant past medical history of
hypertension, asthma, tuberculosis, pneumonia, hyper or hypothyroidism , any drug
allergy, jaundice etc.
c. PAST SURGICAL HISTORY- She is having a history of
d. FAMILY HISTORY: No significant family history of any illness in family
members like hypertension and tuberculosis etc.
● No of family members- there are a total 4 members in the family.
● Monthly income- Rs. 20000/ month
S.N NAME RELATIONSHI AGE SEX OCCUPATION HEALTH
O P WITH STATUS
PATIENT
1 Laltu Husband 31 M Service Healthy
barman Years
2 Lakhi Mother-in-law 48 F Housewife Healthy
barman Years
3 Asish Father –in Law 54 M Shopkeeper Healthy
barman Years

e. MENSTRUAL HISTORY
● Age of menarche- at 13 years
● Regularity- Regular
● Cycle- 26 土 2 days
● Duration- 3-4 days
● Flow- average blood flow (4-5 pads daily)
● LMP- 28.03.2024

f. MARITAL HISTORY
● Age of marriage- Client got married 2 year back at the age of 21
● Years of married life- 2 Years.

g. OBSTETRICAL HISTORY
Obstetrical score: - G1P1L0A1
LMP- 28.03.2024
EDD – 04.1.2025
Gestational Period(LMP)- 14 weeks
No of visit - 2
h. PERSONAL HISTORY
 Hobbies- Watching TV
 Likes/dislikes- Client likes to cook.
 Veg/Non-veg- Non-vegetarian
 Alcoholic/ smoker- Client is non-smoker and non-alcoholic.
 Sleeping pattern- 6-7 hours in a day.
 Any allergy- Nothing Significant
 Food Habit – Non Vegetarian
i. SOCIO-ECONOMIC STATUS
● Type of house- Patient lives in a pucca house.
● No. of rooms- There are a total 4 rooms in the client's house.
● Electricity facility- There is a proper electricity facility in the client's house e.g.
tubes and bulbs.
● Drainage facility- There is a closed drainage system

5. PHYSICAL EXAMINATION
a) General examination:
Date: 18.07.24
Time: 10:00 am
Height- 5.1 feet
Weight- 41 kg.
BMI- 20.7 Kg/m2

b) Vital signs :
Temperature- 98.6⁰F
Pulse- 90 beats/ min.
Respiration- 20 breaths / min.
Blood pressure- 110/70 mm of hg

General appearance -
Body built-thin

Head:
Hair - Black in Color
Scalp - Itching and dandruff present.
Face - Slight pigmentation
Sinus - Normal

Eyes
Visual activity - Normal
Ocular movement - Normal
Lids - Clear
Lacrimal gland - Proper functioning
Conjunctiva - Pale
Sclera - White

Ears :
External Structure - Normal
Mucus membrane - No discharge
Tympanic membrane - Normal
Hearing - Normal.
 Nose:
Eternal Structure - Short & round
Septum - symmetrical

Mucous Membrane - pink color

Nasal deviation - Normal nasal deviation
Epitasis - not present

Oral Cavity:
Lips - pink color.
Gums - no swelling
Oral cavity - clean, pink color
Teeth - Symmetrical & yellowish.
Tongue - light pink in color,, no white patches present,
Taste - Normal
Voice - Soft

Neck:
General Structure - Normal
Thyroid and Parathyroid -- No enlargement.
Lymph node - No enlargement
Range of motion - All movement present (Flexion, extension,
internal and External rotation and circumduction.)

Chest and respiratory systems

Chest Shape symmetrical

Respiration rate - 22 b/min.
General palpation - no palpable mass present, no fluid

Abdomen
Scar marks - absent
Masses - absent
Palpation - abnormal mass is palpable on lower
Uterus - tenderness is present

Back
No lordosis, kyphosis, sclerosis present.

Genitalia & rectal examination

 No pus inflammation.
 No congenital abnormality present.
 Any infection is not present.
 Vaginal discharge present.
Upper & Lower extremities- Movement

Range of motion (ROM) is normal in upper & lower extremities.

DISEASE ASPECT

INTRODUCTION: Maternal mortality occurs due to various pregnancy-

related complications, childbirth or later during the puerperium due to
hemorrhage, hypertensive disorders of pregnancy, abortion, obstructed labour
or puerperal sepsis. It is now well-recognized that antenatal care alone, no
matter how good the quality and the coverage, cannot alleviate the major
burden of suffering during and around chadbirth. For reducing maternal
mortality and morbidity, skilled attendance at every birth and provision of
emergency obstetric care are essential Countries that have been successful in
bringing down the maternal mortality ratio are those that have ensured that
emergency obstetric care is accessible to all women.

DEFINITION:

According to D.C Dutta: Abortion is the expulsion or extraction from its

mother of an embryo or fetus weighing 500 gm or less when is not capable of
independent survival.

INCOMPLETE ABORTION: Incomplete abortion: Uterus retains part or all

of the placenta. Before the 10th week of gestation, the fetus and placenta
usually are expelled together, after the 10th week, separately. Because part of
the placenta may adhere to the uterine wall, bleeding continues. Hemorrhage
is possible because the uterus doesn't contract and seal the large vessels that
fed the placenta.

ETIOLOGY

LISTED IN BOOK PRESENT IN PATIENT

Genetic factor Absent
Endocrine disorder Absent
Maternal medical illness Absent
Rh incompatibility Absent
Bacterial or viral infection Present
Cigerratte smoking Absent
Alcohol consumption Absent
PATHOPHYSIOLOGY:

In this variety of miscarriage, the cervix opens and there part of the product of
conception are expelled. Usually the fetus is passed, and the placenta and
membranes are retained.

The patient is offen more than 12 weeks pregrsant, so the placenta is firmly
embedded and the slender cord breaks.

The bleeding continues and may become profuse, because of the presence of
retained products, does not allow for efficient contraction and retraction of the
uterus and therefore control of the bleeding

There is pain, as well as backache, the cervical OS is usually open and the
uterus remains bulky.

SIGN AND SYMPTOMS

Listed in book Present in patient

History of partial expulsion of fleshy mass Present
Heavy bleeding Present
Dilated cervix Present
The size of the uterus is smaller product of Present
conception
Lower abdominal cramping pain Present
Incomplete expelled mass Present
Patulous cervical os admitting tip of the Present
finger
6. INVESTIGATION

SL NO DATE INVESTIGATIO NORMAL PATIENT REMARKS

N VALUE VALUE
1. 14.07.24 Hemoglobin >/ 11 g/dl 9.2 gm/dl Mild Anemia
2. 14.07.24 HBSAg - NR Normal
3. 14.07.24 HIV - NR Normal
4. 14.07.24 Blood Group - 0 +ve -
5. 14.07.24 Radiological USG shows Suggesting
Investigations single intrauterine Incomplete
USG fetus of about 7 Abortion
weeks 06 days
without any
demonstrable

MANAGEMENT OF INCOMPLETE ABORTION:

 If the bleeding is light to moderate and the pregnancy is less than 12 weeks, use
your fingers or a pair of ring (or sponge) forceps to remove the products of
conception protruding through the dilated cervix.

 If the bleeding is heavy and the pregnancy is less than 12 weeks, evacuate the
uterus

 Manual vacuum aspiration (MVA) is the preferred method of evacuation

 "Procedure for manual vacuum aspiration for incomplete abortion". Do not carry
out evacuation by sharp curettage.

 If evacuation is not immediately possible, give Tab. Misoprostol 400 meg orally
(repeated once after 4 hours, if necessary)

 If the pregnancy is more than 12 weeks:

 Start an Oxytocin drip, ie. 20 U of Oxytocin in 500 ml of R/L @ 40 drops/minute
until the

 products of conception are expelled.

 If necessary, give Tab. Misoprostol 200 meg vaginally every 4 hours until the
products of conception are expelled; do not administer more than a total of 800
mcg.

 Evacuate any remaining products of conception from the uterus.

 Afler 12 weeks of pregnancy the foetus is usually expelled in to but the placenta
may be retained, which has to be expelled.

 If the placenta does not deliver normally, and there is no bleeding, start an
Oxytocin drip (as in the case of a delayed third stage of labour with retained
placenta). You can keep the patient at the PHC for about 2 hours after starting the
Oxytocin drip, waiting for the placenta to be expelled. However, if bleeding
occurs, refer immediately to an FRU..

 If the placenta is still retained, and the woman is bleeding, she needs immediate
referral to the FRU, Establish an IV line, start the Oxytocin drip, and refer.

 In rare cases, even after expulsion of the placenta, the woman may bleed. Such
patients too need to be referred to an FRU.

 Ensure post-abortion follow up of the woman after treatmen

7. TREATMENT
Medication:
SL NO DRUG CHEMICAL DOSE ROUTE FREQUENCY
NAME NAME
1. Injection Inj 1gm Intravenous BD
Xone Ceftriaxone
2. Infusion Injection 500 mg Intravenous TDS
Metrogyl Metronidazole
3. Injection Injection 40 mg Intravenous ODAC
Pan Pantoprazole
4. Injection Injection 4 mg Intravenous TDS
Ondem Ondensetron
5. Infusion Injection 1 gm Intravenous TDS
PCM Paracetamol
6. Injection Injection 500 mg Intravenous TDS
Pause Tranaexamic
Acid
7. IVF NS Intravenous 500 ml Intravenous QDS
Fluid Normal
Saline
NURSING MANAGEMENT: it includes the following guidelines to be carried out
 Guidelines for complete clinical assessment of a woman with spontaneous
abortion Complete clinical assessment
 History (Ask about and record the Period of amenorrhea (ask her the date of her
LMP) information)
 Bleeding (duration and amount)
 Abdominal cramping (duration and severity)
 Foul-smelling vaginal discharge
 Abdominal or shoulder pain
 Allergy to drugs
 Hio passage of the products of conception/foetus/blood clot

 H/o inserting something into the vagina (suggestive of an illegal abortion)

 Routine physical examination Check the vital signs (temperature, pulse,
respiratory rate, blood pressure)
 Examine the general condition of the woman (malnourished)
 Look for pallor
 Examine the respiratory system, cardiac system and extremities
 Abdominal examination Auscultate for bowel sounds (absent in peritonitis due
to septic abortion)
 * Check whether the abdomen is distended (hydatidiform mole, ectopic
pregnancy)
 Assess the presence, location and severity of pain
 Palpate for abdominal rigidity (tense and hard) and guarding (peritonitis, ectopic
pregnancy)
 Palpate for rebound tenderness
 Assess the abdominal mass (molar ectopic pregnancy)
 Pelvic examination External pelvic and vaginal examination:
 Look for lacerations outside the vagina, or over the external genita lin
 Assess the amount of bleeding (light/heavy)
 Look for protruding products of conception lying outside the vaginal canal
P/V examination
Look for:
 Any visible product of conception protruding from the cervical os or visible in
the vaginal canal
 Foul-smelling vaginalcervical discharge
 *Cervical lacerations (indicative of instrumentation; may be suggestive of illegal
abortion)
 Foreign bodies in the vagina
P/V examination
 Assess the amount of bleeding (light/heavy)
 Check whether the cervical os is open or closed (to determine the stage of
abortion)
 Bimanual examination
 Estimate the size of the uterus
 Palpate for any pelvic masses
 Examine for pelvic pain (note severity, location, and what causes the paint is it
present at rest; does it occur increase with touch and pressure; does it occur
increase on moving of the cervix).
APPLICATION OF THEORY: My patient is a case of incomplete abortion. She requires
intense psychological support along with physiological care in order to avoid
abortion associated complications. The theory well suited for this case is Orlando's
theory of Nursing Process
ORLANDO'S THEORY OF NURSING PROCESS: Orlando's theory was developed in the
late 1950s from observations she recorded between a nurse and patient.

MAJOR DIMENSIONS OF THE THEORY

 Discuss the experience of a patient whose need has not been met
 Nursing role is to discover and meet the patient's immediate need for help.
 Patient's behavior may not represent the true need.
 The nurse validates his/her understanding of the need with the patient.
 Nursing actions directly or indirectly provide for the patient's immediate need.
 An outcome is a change in the behavior of the patient indicating either a relief
from distress or an unmet need.
 Observable verbally and non verbally.
 Function of professional nursing organizing principle
 Presenting behavior problematic situation
 Immediate reaction internal response
 Nursing process discipline investigation
 Improvement resolution

8. NURSING DIAGNOSIS

A. Acute Pain in lower abdomen related to mass expel from the uterus as evidenced
by Painful Facial Expression and Verbalization.
B. Ineffective Tissue Perfusion related to profuse blood loss as evidenced by
Decreased haemoglobin level, Pallor and Weakness.
C.Self care deficit related to pain and weakness as evidence by poor personal hygiene
D.Imbalance nutrition less than body requirement related to less diet intake as
evidence by weakness
E. Altered sleeping pattern related to pain and grief as evidenced by restlessness &
fatigue.
F. Knowledge deficit related to diet, personal hygiene and treatment procedure as
evidenced by frequent questioning and agitation.
G. Vulnerability to life threatening injury related to helplessness, hopelessness
secondary to recent miscarriage
H.Risk for infection related to incomplete abortion and EVA procedure.
Assessment goal Nursing Planning Intervention Evaluation
diagnosis

Subjective data: To Acute Pain  Level, intensity  Level ,intensity Pain reduced
reduce in lower and duration of and duration of to some extent
Patient verbalized pain should be pain assessed.
pain abdomen
“ I am having assesse.
related to
pain at abdominal
mass expel
site ”  Give Comfortable  Patient is given
from the
position . fowler position
uterus as
evidenced
 Method of  Method of
by Painful breathing and breathing and
Objective data : Facial relaxation relaxation
Expression technique to be technique
Patients’ Painful and taught. taught.
Facial Verbalizatio
Expression. n.  Reassurance to be
given  Reassurance for
possibility of
next pregnancy

 Divertional  Patient is
Therapy to be introduced with
given same group
patients having
miscarriage

 Injection
Analgesic to be Paracetamol
administered as per 1gm IV TDS
advice. given as per
advice.
Subjective data: To  Assess the tissue  Assessed the
maintain perfusion level of tissue perfusion
Patient verbalized Ineffective
normal patient level of patient
“ I am having Tissue
tissue
blood loss ” Perfusion  Advise mother to  Advised
perfusio
related to take more of fluid mother to take
n
profuse more of fluid
blood loss
as evidenced  Provide
Objective data : by comfortable  Provided
Patients looks Decreased position to mother comfortable
weak and dull. haemoglobi position to
n level, mother
Pallor and  Advise mother to
Weakness take high calorie ,
less fat diet  Advised mother
to take high
calorie , less fat
 Advise mother to diet
take medicine
properly
 Advised mother
to take
medicine
properly

Subjective To Self care  Assess for  Assessed for Personal

improve deficit weakness and weakness and hygiene of
data :
self care related to level of level of mother is
patient verbalized activity pain and immobility immobility maintained
“I can’t able to weakness as
take care of evidence by
myself properly”. poor  Assist her to do  Assisted her to
personal perineal care do perineal care
hygiene

 Apply sterile  Applied sterile

Objective data:
Patients look vulval pad vulval pad
untidy.

 Advise to take  Advised to take

daily bath. daily sponging
 Assist patient
family member to
 Assist patient
keep the patient
family member
surrounding clean
to keep the
and tide.
patient
surrounding
clean and tidy .

To Imbalance  Assess the  Assessed the Patient

maintain nutrition nutritional status nutritional maintained
Subjective data : adequate less than and deficiencies of status and balance
patient verbalized nutrition body mother deficiencies of nutritional
“I can’t able to requirement mother diet .
take proper food” related to
less diet  Assess the level of
intake as weakness  Assessed the
evidence by level of
weakness weakness
Objective data :  Provid small
Patient looks dull frequent , soft ,
easily digestible  Provided small
diet frequent , soft ,
easily digestible
diet
 Advise to take

normal balance
diet such as fish ,  Advised to take
milk , vegetables , normal balance
fruits diet such as fish
, milk ,
 vegetables ,
fruits
 Advise to increase
the amount of food
than previous as
 Advised to
extra calorie as
increase the
needed during post
amount of food
- natal period
than previous as
extra calorie as
needed during
 Advise to drink
post - natal
adequate amount
period
of water

 Advised to
drink adequate
amount of water

 .

HEALTH EDUCATION:

DIET: patient was advised to take nutritious diet inchading high protein, iron and
folic acid rich diet. She was encouraged to take plenty of water.
REST: patient was advised to take proper rest and reduce heavy workload. She was
encouraged not to take stress and practice diversional therapies like music, art ete.
PERSONAL HYGIENE: patient was asked to give specific importance to personal
hygiene, especially menstrual hygiene. She was also advised to observe the pattern of
bleeding, its color and duration, and to report any variation to the doctor immediately.
MEDICATIONS: the patient was encouraged to take medicines regularly on time.
FOLLOW UP CARE: The patient was advised to come to the hospital for follow up
check up. She was instructed to meet the physician if any complications occur.

CONCLUSION:
Patient was admitted in the ELR ward as a case of incomplete abortion, she was been
treated under Dr. Santosh. At the time of admission, she was having cramping
abdominal pain and vaginal bleeding. After the procedure Dilatation and curettage,
and administration of proper medication, the condition of patient got stable.

SUB: OBSTETRICs AND GYNAECOLOgical nursing

CASE study
ON
ABORTION

SUBMITTED TO : SUBMITTED BY:

MADAM S. SARKAR
BISHAKHA MAITY SENIOR LECTURER
MSC ( N) PART 1
CON, NBMCH CON , NBMCH.