Abortion: Health Impacts and Statistics

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Questions and Answers

Which term best describes a woman who has experienced three or more consecutive spontaneous abortions?

  • Failed pregnancy
  • Habitual abortion (correct)
  • Occasional abortion
  • Recurrent miscarriage

What is the recommended action if manual vacuum aspiration (MVA) is not available after 16 weeks of pregnancy?

  • Administer antibiotics and refer for higher medical management (correct)
  • Provide analgesics and monitor the patient for 48 hours
  • Perform an immediate cesarean section
  • Continue with MVA treatment despite its unavailability

Which treatment is administered every 6 hours for up to 48 hours to manage a septic condition in a patient following an abortion?

  • Gentamicin 5mg/kg body weight IV
  • Metronidazole 500mg IV
  • Ampicillin 2g IV (correct)
  • Paracetamol 2 tabs (1gm) thrice daily

In the context of managing a patient after a failed pregnancy with retention of products of conception, which of the following is NOT a recommended action?

<p>Allow the patient to engage in physical activities (A)</p> Signup and view all the answers

What is the first course of action once a pregnancy is confirmed in a patient at risk for abortion?

<p>Admission and bed confinement (C)</p> Signup and view all the answers

What is a characteristic symptom of a threatened abortion?

<p>Closed cervix (C)</p> Signup and view all the answers

Which stage of abortion is described by heavy bleeding and progressive cervical dilation?

<p>Inevitable abortion (A)</p> Signup and view all the answers

Which management step is NOT recommended for a threatened abortion?

<p>Hormonal treatment (B)</p> Signup and view all the answers

What is typically performed if a pregnancy is less than 16 weeks in the case of an inevitable abortion?

<p>Manual Vacuum Aspiration (MVA) (B)</p> Signup and view all the answers

Which of the following conditions can develop from excessive blood loss during an abortion?

<p>Anemia and shock (A)</p> Signup and view all the answers

What is the most common cause for spontaneous abortion?

<p>Genetic abnormalities (A)</p> Signup and view all the answers

What classifies a late abortion?

<p>Abortion between 12 and 24 weeks of gestation (B)</p> Signup and view all the answers

During septic abortion, what type of vaginal discharge can be expected?

<p>Reddish brown/yellowish green and foul smelling (C)</p> Signup and view all the answers

What is characterized as therapeutic abortion?

<p>Abortion performed for medical reasons by qualified practitioners (A)</p> Signup and view all the answers

Which of the following is NOT a reason for therapeutic abortion?

<p>Desire for family planning (C)</p> Signup and view all the answers

What is the primary risk factor associated with criminal abortions?

<p>Severe complications such as infections (B)</p> Signup and view all the answers

What is septic abortion primarily a sequel of?

<p>Criminally induced abortion (B)</p> Signup and view all the answers

What would NOT be a common sign or symptom of septic abortion?

<p>Excessive fluid retention (B)</p> Signup and view all the answers

Which medication is commonly used for managing septic abortion?

<p>Ampicillin (B)</p> Signup and view all the answers

Which management step is suggested if MVA is not available after 16 weeks in septic abortion cases?

<p>Start antibiotics and refer immediately (B)</p> Signup and view all the answers

Which statement about the classification of abortion is accurate?

<p>Criminal abortions are illegal and unsafe (B)</p> Signup and view all the answers

What is a major consequence of criminal or unsafe abortion in certain regions?

<p>Increased maternal mortality (A)</p> Signup and view all the answers

Which characteristic distinguishes therapeutic abortion from criminal abortion?

<p>Conducted for the mother's health by qualified practitioners (B)</p> Signup and view all the answers

What is a common sign of complete abortion?

<p>Light bleeding (B)</p> Signup and view all the answers

Which management step is NOT appropriate for incomplete abortion if bleeding is heavy and pregnancy is less than 16 weeks?

<p>Use ring forceps to remove products of conception (C)</p> Signup and view all the answers

What distinguishes a missed abortion from an incomplete abortion?

<p>Closed cervix in missed abortion (D)</p> Signup and view all the answers

What is the appropriate management option for heavy bleeding in a pregnancy greater than 16 weeks?

<p>Infuse oxytocin and monitor (D)</p> Signup and view all the answers

Which of the following is a sign of incomplete abortion?

<p>Persistent heavy bleeding (A)</p> Signup and view all the answers

In case of heavy bleeding and pregnancy less than 16 weeks, what should be done if MVA is not available?

<p>Perform curettage (D)</p> Signup and view all the answers

What is the most appropriate action if bleeding does not stop for a complete abortion?

<p>Refer immediately for further evaluation (D)</p> Signup and view all the answers

Which medication is commonly administered for incomplete abortion management?

<p>Cytotec (misoprostol) (D)</p> Signup and view all the answers

What vital sign should be routinely checked during the management of abortion?

<p>Oxygen concentration (A)</p> Signup and view all the answers

What is a distinguishing feature of the signs and symptoms of a missed abortion?

<p>Complete closure of the cervix (D)</p> Signup and view all the answers

What is the most common cause of bleeding in early pregnancy?

<p>Abortion (D)</p> Signup and view all the answers

What percentage of pregnancies worldwide are estimated to be unplanned?

<p>38% (C)</p> Signup and view all the answers

At what gestational age is pregnancy usually terminated?

<p>6-12 weeks (C)</p> Signup and view all the answers

Which maternal condition is NOT associated with abortion?

<p>Hypertension (D)</p> Signup and view all the answers

What is the primary symptom indicating the occurrence of an abortion?

<p>Vaginal bleeding (D)</p> Signup and view all the answers

Which of the following fetal conditions is a recognized cause of abortion?

<p>Chromosomal abnormalities (B)</p> Signup and view all the answers

How much does abortion contribute to maternal mortality?

<p>29% of cases (C)</p> Signup and view all the answers

Which of the following is considered a social condition leading to abortion?

<p>Unmet family needs (C)</p> Signup and view all the answers

What role does quality post-abortion care play in maternal health?

<p>Reduces maternal mortality (B)</p> Signup and view all the answers

What maternal health issue is related to exposure to teratogenic chemicals?

<p>Fetal maldevelopment (D)</p> Signup and view all the answers

Flashcards

Threatened Abortion

A type of miscarriage where bleeding and cramping occur, but the cervix is closed, and the uterus size matches the pregnancy's gestational age.

Inevitable Abortion

A type of miscarriage with heavy bleeding, cervical dilation, and a uterus size smaller than or corresponding to the pregnancy's gestational age. The pregnancy cannot be saved.

Spontaneous Abortion

Loss of pregnancy occurring before 24 weeks of gestation, often referred to as a miscarriage, usually occurring without intervention.

Signs of Septic Abortion

Severe vaginal discharge (reddish brown/yellowish-green, foul-smelling), accompanying abdominal tenderness (local or general), and potentially toxic appearance of the patient.

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Manual Vacuum Aspiration (MVA)

Procedure to remove pregnancy tissues in a miscarriage, used when pregnancy is less than 16 weeks.

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Early Abortion

Pregnancy loss before 12 weeks of gestation.

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Late Abortion

Pregnancy loss between 12 and 24 weeks of gestation

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Signs of Shock

Symptoms like cold, clammy skin, rapid pulse, low blood pressure, and rapid breathing due to excessive blood loss.

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Induced Abortion

The intentional termination of a pregnancy, for reasons other than saving the mother's life or removing a dead fetus

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Therapeutic Abortion

Legally performed abortion by a qualified doctor to safeguard the mother's health or life.

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Criminal Abortion

Illegal abortion performed by unqualified individuals, with no regard for safety standards

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Septic Abortion

An abortion complicated by infection, usually a consequence of an incomplete, unsafe abortion.

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Management of Septic Abortion

Immediate antibiotic treatment (IV Ampicillin, Gentamicin, Metronidazole), followed by assessment and referral.

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Maternal Mortality in Nigeria

Unsafe abortions contribute significantly to maternal mortality in Nigeria.

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Gestational Age

The duration of pregnancy, usually determined from the woman's last menstrual period.

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Nursing Management of Abortion

Comforting the patient, assessing history for accurate determination of gestational age, active listening, and empathy.

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Reporting Vaginal Bleeding

The necessity for pregnant women to report any vaginal bleeding to healthcare providers

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What is Abortion?

Abortion is the ending of a pregnancy before 24 weeks of gestation, leading to the loss of the fetus.

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Commonest cause of bleeding in early pregnancy?

Abortion is the most common cause of bleeding in early pregnancy.

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Major cause of maternal deaths?

Abortion is a significant contributor to maternal deaths worldwide.

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What is Maternal Ill-health?

Conditions like malaria, anemia, or infections can negatively impact a pregnancy, increasing the risk of abortion.

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What is Hormonal Imbalance?

Hormonal issues in a mother can lead to an abortion.

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What are Uterine Malformations?

Abnormalities in the uterus, such as a bicornuate uterus, can make it difficult to carry a pregnancy to term.

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What are Uterine Infections?

Infections within the uterus, like endometritis, can cause abortion.

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What is Cervical Incompetence?

A weak cervix that opens too early can lead to a miscarriage.

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What is the Cardinal Sign of Abortion?

Vaginal bleeding is the primary indicator of an abortion.

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What are the Social Factors of Abortion?

Factors like teenage pregnancy, unwanted pregnancies, or rape can contribute to abortion.

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Habitual abortion

Three or more consecutive spontaneous abortions.

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Shirôdkar stitches

Sutures used to keep the pregnancy till term in cases of habitual abortion.

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Bed rest and observation

Recommended treatment in cases of miscarriage, especially for monitoring vital signs and signs of infection.

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Incomplete Abortion

The products of conception are not completely expelled. The fetus is usually expelled, but the placenta and membranes remain.

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Complete Abortion

All products of conception are expelled completely. This happens more often before the 8th week of pregnancy.

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Missed Abortion

The fetus dies in the uterus but is retained, with painless brownish discharge.

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What are the signs of an incomplete abortion?

Persistent heavy bleeding, dilated cervix, uterus smaller than the expected gestational age.

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What is the management for heavy bleeding in an incomplete abortion within 16 weeks?

If MVA is available, perform MVA. If not, perform curettage. If both unavailable, stabilize and refer urgently.

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What medications are given for incomplete abortion?

Ergometrine 0.5mg IM or misoprostol 400 µg orally can be used.

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What is the management for heavy bleeding in an incomplete abortion beyond 16 weeks?

Infuse oxytocin if MVA is available. If MVA is not available, use misoprostol vaginally and then perform MVA if needed. Refer urgently if necessary.

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What are the signs of a complete abortion?

Light bleeding, closed cervix, uterus smaller than the expected gestational age, uterus softer than normal.

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What is the management for a complete abortion?

Observe for heavy bleeding, administer ergometrine or misoprostol orally, and refer immediately if bleeding doesn't stop or is sustained.

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What are the signs of a missed abortion?

Painless brownish vaginal discharge, no signs of fetal life, closed cervix.

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Study Notes

Abortion

  • Abortion is the termination of a pregnancy before 24 weeks of gestation.
  • It's a common cause of bleeding in early pregnancy and a significant contributor to maternal deaths worldwide.
  • Globally, roughly 35 abortions per 1000 women of childbearing age occur annually. Rates vary greatly across countries, from as low as 10 per 1000 to as high as 80 per 1000.
  • Approximately 38% of pregnancies worldwide are unplanned, and 22% result in abortions. In developing countries, including Nigeria, an estimated 36% of pregnancies are unplanned, leading to 20% ending in abortion.
  • In Nigeria, about 40% of maternal deaths are attributed to complications from abortion.
  • The proportion of pregnancies ended by abortion is highest at the start and end of a woman's childbearing years.
  • Abortion contributes significantly to maternal mortality (29%) and morbidity (eg., reproductive health infections and infertility).
  • Quality post-abortion care and counseling are crucial for reducing complications and improving outcomes.

Causes of Abortion (Maternal)

  • Maternal illnesses (malaria, anemia, diarrhea, dysentery, tuberculosis, pyelonephritis, hepatitis, diabetes, etc.)
  • Hormonal imbalances
  • Uterine malformations (e.g., bicornuate uterus)
  • Uterine infections (e.g., endometritis)
  • Submucous fibroids
  • Cervical incompetence
  • Exposure to harmful chemicals
  • Emotional distress or extremes of emotion
  • Violence
  • Physical exertion

Causes of Abortion (Fetal)

  • Gross fetal malformation/maldevelopment
  • Chromosomal abnormalities
  • Teenage pregnancy or unwanted pregnancy
  • Unmet family needs
  • Rape

Signs and Symptoms of Abortion

  • Missed periods, followed by vaginal bleeding (ranging from slight to profuse).
  • Pain, particularly lower abdominal or back pain.
  • Rupture of membranes with expulsion of products of conception.

Types of Abortion

  • Threatened abortion: Bleeding and cramping, but the pregnancy may continue.
  • Inevitable abortion: Heavy bleeding and/or cervical dilation; the pregnancy cannot be saved.
  • Incomplete abortion: Products of conception are not fully expelled.
  • Complete abortion: Products of conception are fully expelled.
  • Missed abortion: The fetus dies, but the body does not expel it.
  • Septic abortion: Infection is present, a serious complication.

Management of Abortion

  • Management of threatened abortion: Advising the patient to avoid strenuous activity and refrain from intercourse. Monitoring for signs of progression.
  • Management of inevitable abortion: Medical management (drugs to induce labor) or surgical intervention (e.g., D&C) depending on gestational age and other factors.
  • Management of incomplete abortion: Surgical intervention (e.g., D&C) to remove the retained products of conception. Antibiotics may be necessary to treat infection
  • Management of missed abortion: Surgical intervention to remove the retained products of conception.
  • Management of induced abortion: Methods that intentionally terminate a pregnancy.

Nursing Management of a Patient with Abortion

  • Thorough history-taking, including details of the last menstrual period.
  • Assessing vital signs and the patient's overall condition.
  • Providing emotional support and education.
  • Monitoring for complications like excessive bleeding, pain, or infection.
  • Providing appropriate and safe care for the patient, including antibiotics, fluids and other supportive care as needed

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