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ON "ABORTION INCOMPLIT"
IN THE NIFAS 2
In stacking
by
M Ridho Hidayatullah
NPM : 1614401110052
College student
M Ridho Hidayatullah
Approve
ABORTUS INCOMPLITES
1. Definition of
Abortion is the threat or expenditure of conception results at gestational age less than 20
weeks or fetal weight less than 500 grams, before the fetus is able to live outside the womb
(Nugroho, 2010).
Incomplete abortion is where most of the conception tissue is still left in the uterus where
bleeding is still occurring and the amount can be much or little depending on the remaining
tissue, which causes some placental site to remain open so that bleeding continues (Sujiyatini
et al, 2009)
Incomplete abortion is bleeding in young pregnancies where some of the conception results
have come out of the uterine cavity through the cervical canal which is left in the decidua or
placenta (Ai Yeyeh, 2010).
2. Etiology
The cause of miscarriage is largely unknown, but there are several factors as follows:
Abnormalities of growth resulting from conception can cause fetal death and subordinate
defects that cause the conception results to be removed. Impaired growth of conception results
can occur due to:
3) External influences
b) The results of conception affected by drugs and radiation cause the growth of the
conception results are disturbed.
1) Infection of the placenta for various reasons, so that the placenta cannot function.
2) Disorders of the placental blood vessels which include patients with diabetes mellitus
c. Maternal
Disease Sudden diseases such as pneumonia, abdominal typhus, malaria, syphilis, anemia
and maternal chronic diseases such as hypertension, kidney disease, liver disease, and diabetes
mellitus.
Uterus is a place where fetal growth and development found abnormal conditions in the
form of uterine myoma, arch uterine uterus, uterine septus, uterine retro flexia, incompetent
cervix, surgery on the cervix (conization, amputation of the cervix), postpartum cervical tears
(Manuaba, 2010 )
3 . Pathophysiology
in early abortion, there is bleeding in the decidua basalis, followed nerloisi tissue that
causes the products of conception apart and considered a foreign object in the uterus. Thus
causing the uterus to remove foreign objects.
If the pregnancy is less than 8 weeks, the value of khorialis not penetrate the decidua and
deep so that the results of conception can come out entirely.If the pregnancy is 8-14 weeks
villi khori asli has penetrated too deeply until the placenta cannot be released completely
and causes a lot of bleeding from the placenta.If
the dead baby is not released in a short time, then he can be covered by him pisan blood
clot. In fetuses that have died and are not expelled can occur a process of modification of
the fetus dries and because the amionic fluid becomes less due to absorption. He became
rather flat. In a further level it becomes thin.
Another possibility for a dead fetus that is not quickly released is maceration, exfoliate
skin, softened skull, enlarged abdomen due to fluid and all reddish colored fetuses
PATHWAY
4. Signs and symptomps
a. Incomplete abortion is characterized by the partial release of conception results from the
uterus, so that the rest provide clinical symptoms as follows:
3) vaginal bleeding is or does not have conception tissue, there is a foul odor from the vulva
5) On vaginal examination, the tissue can be palpated in the uterine cavity or sometimes
protruding from the external or part of the tissue out.
6) Bleeding will not stop before the remaining fetus can cause shock (Maryunani, 2009).
5. Medical Management
a. General examination:
1) Assess quickly the general condition of the patient, including vital signs.
2) Check for signs of shock (pale, heavy sweating, fainting, systolic pressure less than 90
mmHg, pulse more than 112 times per minute).
3) If shock is suspected, immediately deal with shock. If there are no signs of shock, keep
that possibility in mind when the helper evaluates a woman's condition because her
condition can deteriorate quickly. If shock occurs, it is very important to start shock
treatment immediately.
5) Install an infusion with a large infusion needle (16 G or more), give a physiological
saline solution or ringer lactate with 500 cc quick drops in the first 2 hours
(Syaifuddin, 2006).
1) Determine the size of the uterus, recognize and overcome any complications (severe
bleeding, shock and sepsis)
2) If there is a lot of bleeding or continues and <16 weeks of gestation, evacuation of the
remaining conception with:
5) If there is an infection give ampicillin 1 gram and Metrodidazole 500 mg every 8 hours.
6) If the patient looks anemic, give sulfasferosus 600 mg / day for 2 weeks (moderate
anemia) or blood transfusion (severe anemia).
7) Be sure to keep an eye on the mother's condition after handling (Syaifuddin, 2006).
c. Supporting Examination
1) Blood
Hb level, where normal Hb in pregnant women is ≥ 11 gr% (TM I and TM III 11 gr%
● Hb ≥ 11 gr%: no anemia
2) Urine
To check urine protein and urine glucose. For clients with pregnancy and Normal delivery
of protein and urine glucose is negative.
3) Ultrasound
To check whether the gestation pocket is still intact and amniotic fluid is still present.
B. CONCEPT OF NURSING CARE
1. Nursing Assessment
a. Client Identity
b. Main Complaints: Abdominal pain, bleeding, pain in suture wounds, fear of moving.
- Current health
- Past health
d. Surgical History
h. History of pregnancy, childbirth, and postpartum: Assess how the condition of the
client's child starts from the womb until now, how is the condition of the child's health.
i Sexual history: Assess the client's sexual activity, the type of contraception used
and the accompanying complaints.
j. Drug use history: Assess history of oral contraceptive medications, digitalis drugs
and other types of drugs.
l. Physical Examination
- Inspection
The things that are inspected include: observing the skin for color, discoloration,
lacerations, drainage lesions, respiratory pattern of depth and symmetry, body language,
movement and posture, limb use, physical limitations, and so on.
- Palpation
Touch: feel a swelling, record temperature, degree of moisture and skin texture or
determine the strength of uterine contractions.
- Pressure: determine the character of the pulse, evaluate edema, pay attention to the
position of the fetus or pinch the skin to observe turgor.
Examination in: determining the voltage / muscle tone or abnormal pain response
- Percussion
Using fingers: tap the knees and chest and listen to the sounds that indicate the presence or
absence of fluid, mass or consolidation.
Using a percussion hammer: tap your knees and observe whether there is reflex / movement
on the lower leg, check for abdominal skin reflexes or not abdominal wall contraction
- Auscultation
- listen in the antechubial room for blood pressure, chest for abdominal heart / lung sounds
for bowel sounds or The fetal heart rate. (Johnson & Taylor, 2005: 39)
M. Psychosocial examination
2. Nursing diagnosis
Systole <140 mHg 4. Measure TTV: TD, pulse, be used as an indicator for
respiration and temperature
Diastol < 90 mHg intervention
5. Give the right analgesic
N: 80 - 90x/ min further
medication
R: 16 - 24x/ minute 5. Reducing the client's
6. Prepare for curettage
focus on the range of pain
T: 36 - 37oC procedures
6. Action against basic
deviations will eliminate
pain
- Patients express not weak, 5. Perform bed rest and 3. Tranfusion may be
and no longer thirsty avoid the mother for valsalva needed in massive bleeding
maneuvers. conditions
- Moist lip mucosa
6. Report and record the 4. Ensure the availability of
- Normal skin turgor
number and nature of blood blood available to the
- Not sunken eyes loss brain, pelvic elevation
avoids venous
compression.
- There is no sign of
Inflammation:
- Rubor (redness)
- Tumor (swelling)
- Heat (heat)
- Dolor (pain)
- Function of laesa
(impaired function)
4. Anxiety decreases / 1. Assess the level of anxiety 1. Know how far the
disappears in 3 × 24 hours experienced by clients anxiety level can be
of treatment with Result overcome
2. Listen to client problems
criteria:
and listen actively 2. Increase the sense of
- Reporting a decrease in control over the situation
3. Measure TTV: TD, pulse,
anxiety until the stage can and provide opportunities
respiration and temperature
be resolved for client develops its own
4. Explain the curettage solutions
- Showing the condition of
procedure and the meaning
relaxation of clients 3. Severe anxiety situations
of symptoms and the
understanding of disease can be manifested from
prognosis of abortion
conditions and curettage TTV
procedures 5. Evaluation / validation of
4. Knowledge can help
the information provided
- TTV within normal limits reduce anxiety and increase
the
5. Knowing the
extent to which
information / methods can
be received by clients
REFERENCES
Mansjoer, Arif, et al. 2000.Kapita SelektaThird edition, volume I, Media Aesculapius Jakarta
2000.
MedisWiknjosastro Hanifa, et al, 2007, Midwifery Science, Edition III. Mold IX. YBP SP. Jakarta.
Wiknjosastro Hanifa, et al, 2008, Gynecology, Edition II. Prints VI. PT Bina Pustaka. Jakarta.