LESSON PLAN
Name of teacher -
Placement – [Link] (N) previous
Subject – Obstetrics and Gynecology
Unit – Abortion.
Topic – Types of abortion.
Allotted time– 45min
Date and time –
Venue -
Overall objectives – At the end of the unit students will be able to
1. Describe the types and causes of abortion.
2. Know the legislations, Clinical rights and professional responsibility of a midwife.
3. Describe the abortion procedures.
4. Have knowledge regarding the complications of abortion.
5. Nursing management
Specific objectives – The group will be able to
1. Understand the legislations, Clinical rights and professional responsibility of a midwife
2. Able to know regarding the indicators of abortion.
3. Have knowledge regarding abortion and its management
4. Will able to analyze deviation from the normal process.
5. Will able to provide evidenced based practice.
S. Time Objectives Content Method of A.V Evaluation Remark
No teaching aids
1. 1 min Introduction of Any bleeding in pregnancy is abnormal. Lecture OHP Assignment
abortion. Vaginal blood loss in early pregnancy should cum
be thought of as a threatened miscarriage until discussion
shown otherwise. The term miscarriage and
spontaneous abortion are synonymous
2. 1 min Define abortion Definition. Lecture OHP, Assignment
Abortion is the process of partial or complete cum black
separation of the products of conception from discussion board.
the uterine wall with or without partial or
complete expulsion from the uterine cavity
before the age of viability.
3. 2 min Describe the causes of Fetal factors: Lecture Black Assignment
abortion. Chromosomal abnormalities. cum boards,
Genetic abnormalities. discussion LCD
Hydropic degeneration of villi.
Multiple pregnancy.
Maternal factors:
Maternal infection TORCH, syphilis
etc.
Maternal diseases- hypertension,
chronic renal disease, uncontrolled
diabetes etc.
Environmental factors- smoking,
alcohol consumption, drugs, exposure
to radiation etc.
Endocrine factors- thyroid
dysfunction, luteal phase defect etc.
Immunological factors.
Uterine factors.
4. 2 min Enlist the types of Abortion is classified into two: Lecture OHP,
abortion. Spontaneous cum Black Written test
Induced discussion board,
And Flash
Spontaneous abortion is further classified demonstrati cards
into: on
Threatened abortion
Inevitable abortion
Complete abortion
Incomplete abortion
Missed abortion
Septic abortion.
Induced abortion is classified into:
Legal abortion
Illegal abortion.
5. 8 min Describe threatened Definition Lecture and Black Written test
abortion. It is a clinical where the abortion process demonstrati board,
has started but not progressed to a state from on method OHP,
which recovery is impossible. LCD
Symptoms
Bleeding per vaginum. Usually slight
and bright red in color. On rare
occasion bleeding is brisk. Stops
spontaneously.
Uterus is soft and no tenderness on
palpation.
Management
General and systemic examination.
Physician do physical examination.
Routine blood investigation like Hb,
blood grouping, Rh.
USG of abdomen to find the status of
fetus.
Serum progestron 25 ng/ml or more
indicate fetus is alive.
Strict bed rest.
Mild analgesics and sedatives if
necessary for pain.
Mild laxatives for bowel evacuation.
Enema should not be given.
Patient is advised to preserve vulval
pads for inspection.
Avoid sexual intercourse.
Anti D for Rh negative mothers.
6. 8 min Describe inevitable Definition Lecture and Black Written test
abortion It is the one in which the changes have demonstrati board,
progressed to a state from where continuation on method OHP,
of pregnancy is impossible. LCD
Symptoms
Increased vaginal bleeding.
Increased pain in lower abdomen.
Examination reveals dilation of os of
cervix through which product of
conception are felt.
On palpation uterus is tender and
smaller than expected.
Management
Patient should be immediately
admitted in the hospital to improve
the general condition and to
accelerate the process of abortion.
Strict aseptic is to be maintained to
prevent infection.
Morphine should be given for pain.
Methargine given for excessive
bleeding 0.5 mg IV/IM.
Check vital signs.
Use of transvaginal USG to detect
retained products.
Shock should be corrected by
IVfluids and blood transfusions.
If pregnancy is less than 12 weeks
dilatation and curettage is effective,
If pregnancy is more than 12 weeks
accelerate uterine contraction by
oxytocin drip and fetus is expelled.
Anti D for Rh negative mothers.
7. 8 min Describe about Definition Lecture and Black Written test
incomplete abortion In this the process of abortion has already demonstrati board,
taken place but the products are only partly on method OHP,
expelled. LCD
Symptoms
History of amenorrhoea and vaginal
bleeding followe by passage of
products.
Abdominal cramps.
Pallor and shock.
Internal os is open.
Size of uterus less than the period of
amenorrhoea.
Management
Resuscitate patient in shock.
Evacuation of uterus by suction
evacuation.
If os is closed, ripe with PGE1 tablet
kept in vagina.
Administer prophylactic antibiotic.
Anti D for Rh negative mothers.
USG for diagnosis of retained
products.
8. 8 min Explain about Definition Lecture and Black Written test
complete abortion All products of conception have been demonstrati board,
expelled from the uterus. on method OHP,
LCD
Symptoms
Initial stage- severe abdominal pain
and vaginal bleeding.
Os is closed.
Uterus is firm and contracted on
palpation.
Management
USG confirms abortion.
No further medical intervention is
needed.
Anti D not indicated if less than 12
weeks.
Resuscitate if the patient is in shock.
9. 8 min Describe missed Definition Lecture and Black Written test
abortion There is intrauterine death of the embryo or demonstrati board,
non viable fetus, which is then passively on method OHP,
retained in the uterus. LCD
Symptoms.
History of amenorrhea followed by
vaginal bleeding or spotting.
Signs and symptoms of early
pregnancy slowly disappear.
No abdominal pain.
Bleeding- some spotting or brown
loss.
Cervical os closed.
Uterus smaller than expected.
Management
If less than 12 weeks gestation, PGE1
tablets kept in vagina usually result in
spontaneous expulsion without
surgical intervention.
Evacuation of uterus under general
anesthesia.
If more than 12 weeks, 6 hourly or 12
hourly PGE1 tablets used vaginally
result in spontaneous expulsion.
If fails, extraamniotic instillation of
ethacridine lactate is useful.
Anti D is given.
Antibiotics are given.
Investigations
Pregnancy test negative.
USG show gestational sac smaller
than expected with irregular margins.
There may be fetal node or fetus but
no cardiac activity.
Complications
Sepsis, if retained for long time.
Disseminated intravascular
coagulation, if gestation exceeding 16
weeks.
Psychological trauma.
10. 10 min Describe septic Definition Lecture and Black Written test
abortion. It is the infection of the product of conception demonstrati board,
and the uterus either as the consequences or on method OHP,
as the cause of abortion. LCD
Causes
Induced abortion by untrained person
without aseptic technique.
Poly microbial from normal flora of
genital tract.
Gram negative, gram positive and
anaerobic pathogens.
Grade
Grade 1- infection involving uterus.
Grade 2- extension to adnexae and pelvic
structures.
Grade 3- generalized peritonitis.
Clinical features
Period of amenorrhea.
Fever.
Abdominal pain.
Vomiting.
Diarrhea.
Foul smelling purulent discharge.
Bleeding per vaginum.
Tachycardia.
Hypotension.
Cervical os open.
Bulky, tender and painful uterus.
Maternal pyrexia.
Uterine perforation.
Bowel injury.
Investigations
Complete blood count.
Blood urea, serum creatinine and
electrolyte.
High vaginal swabs.
Blood culture.
Ultrasound to detect retained products
of conception or pelvic abscess.
X – ray abdomen if peritonitis or
bowel injury is suspected.
X – ray chest if difficulty in
respiration.
Complications
Septic shock.
Adult respiratory distress syndrome.
Peritonitis.
Disseminated intravascular
coagulation.
Acute renal failure.
Management
Broad spectrum antibiotics.
Evacuation of uterus.
Vigorous intravenous transfusion with
crystalloids.
CVP line is inserted.
Blood transfusion done if needed.
Indwelling catheter is inserted.
Oxygen is administered.
If pelvic abscess, it is drained by
posterior colpotomy.
11. 2 min Summary and Summary Lecture Black Written test
conclusion of Any bleeding in pregnancy is abnormal. cum board
abortion. Vaginal blood loss in early pregnancy should discussion
be thought of as a threatened miscarriage until
shown otherwise. The term miscarriage and
spontaneous abortion are synonymous
Abortion is classified into two:
Spontaneous
Induced
Spontaneous abortion is further classified
into:
Threatened abortion
Inevitable abortion
Complete abortion
Incomplete abortion
Missed abortion
Septic abortion.
Induced abortion is classified into:
Legal abortion
Illegal abortion.
BIBLIOGRAPHY:
1) Basvantthapa BT (2006): Text Book Of Midwifery and Reproductive Health Nursing: New Delhi; Jaypee Publication.
2) Dutta D.C (2004); A Text Book of Obstetrics including Perinatology and Contraception; 6 th edition: Kolkata: New Central agency
Publication.
3) Emily and James, S (2008) Maternal And Child Health Nursing Care of Infants; 3rd edition; US; Elsevier health Science publication.
4) Jacob, A (2012); A Comprehensive T.B of Midwifery and Gynecology Nursing; 3rd edition; New Delhi; Jaypee Publication.
5) Kenneth J ( 2007) William Manual Of obstetrics; Pregnancy Complication; 2nd edition ; U.S; M.C Graw publications.
ONLINE REFERENCE:
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[Link] Mensah/PUERPERAL_SEPSIS.pdf