MAKE IT WITH

NURSING CARE WITH IMMINENS ABORTUS

ARRANGED BY :

ULIL ALBAB

G0A016024

STUDY PROGRAM DIII NURSING

FACULTY OF NURSING AND HEALTH SCIENCE

UNIMUS SEMARANG

2018
 FOREWORD

With the greatness of Allah SWT. the most loving all-merciful, the author
praises his gratitude for His guidance, who has bestowed His mercy, blessings,
and blessings on the author, so that the author can complete the paper "ASKEP
WITH IMMINENS ABORTUS".

The paper "ASKEP WITH IMMINENS ABORTUS" has been tried by the author
to be prepared as well as possible by getting help from various parties, so that the
preparation of this paper can be completed in a timely manner. For this reason, the
author does not forget to express his gratitude to all those who have helped the
author in writing this paper.

Apart from the author's efforts to compile this paper as well as possible, the author
remains aware that of course there are always flaws, both in terms of vocabulary
usage, grammar and other shortcomings. Therefore, the writer openly wide open
to the reader who intends to give criticism and suggestions to the author so that
the writer can improve the quality of this paper.

The author hopes that the paper "ASKEP WITH IMMINENS ABORTUS" is
useful, and the lessons contained in this paper can be taken from the readers'
wisdom and benefits.

Semarang, January 13, 2018

Author
 TABLE OF CONTENTS

I. COVER........................................... ..................................................... ...... i

II. FOREWORD.............................................................................................. ii
III. TABLE OF CONTENTS.......................................................................... .iii

1. CHAPTER I INTRODUCTION
a. Background.............................................. ........................
b. Purpose ............................................... ....................................
c. Benefits ............................................... .................................
2. CHAPTER II REVIEW OF THEORY OF NURSING CARE
a. Definition ............................................... ..................................
b. Etiology ............................................... ..................................
c. Pathophysiology ............................................... ..........................
d. Focus assessment .............................................. ....................
e. Pathways to nursing .............................................. ............
f. Nursing diagnoses .............................................. ............
g. Intervention and rational ............................................. ............
3. CHAPTER III CASE REVIEW
a. Assessment ............................................... ...........................
b. Data Analysis .............................................. ........................
c. Interventions ............................................... ............................
d. Implementation and Evaluation ............................................. ..

4. CHAPTER IV CLOSING
a. Conclusion............................................... ........................
b. Suggestions ............................................... ....................................
5. BIBLIOGRAPHY
 CHAPTER I

PRELIMINARY

A. Background

Maternal and neonatal mortality is a major problem especially in

developing countries. About 98-99% of maternal and perinatal deaths occur in
developing countries, while in developed countries only 1-2%. Actually most of
these deaths can still be prevented if they receive adequate first aid (Manuaba,
2007: 6).

Sri Hermiyati (2008) said that there were 4,692 mothers floating because of three
cases (pregnancy, childbirth, and childbirth). Direct death of pregnant and
childbirth due to bleeding (28%), eclampsia (24%), infection (11%), prolonged
labor (5%) and abortion (5%). Much bleeding causes maternal mortality which is
now commonly found is abortion (Saleh, 2010).

In the world there are 20 million cases of abortion each year and 70,000 women
die from bortions each year. The incidence of abortion in Tenggra Asia is 4.2
million per year including Indonesia, while the frequency of spontaneous abortion
in Indonesia is 10-15% of 6 million pregnancies each year or 600-900 thousand,
while artificial abortion is around 750 thousand 1.5 million annually , 2500 of
them ended in death (Ulfah Ansor, 2006). Manuaba (2007) stated that it was
estimated that there was an unauthorized fall in pregnancy in 2.5-3 million people
/ year for unwanted pregnancies with deaths of around 125,000-130,000 people /
year in Indonesia. The results of the preliminary survey conducted in the 2015
Lampung Hospital found an imminene incidence of abortion in 155 cases
(63.3%).

Abortion can be experienced by all pregnant women, the risk factors include age
and history of recurrent baortus (Koesno, 2008). Age can affect the incidence of
recurrent abortion because at the age of less than 20 years the maturity of
reproductive organs to become pregnant can be detrimental to maternal health and
fetal growth and development, while abortion that occurs at more than 35 years is
due to reduced reproductive function, chromosomal abnormalities and chronic
diseases (Manuaba, 1998).

Based on the background above, the authors are interested in writing a paper
entitled "Nursing Care for Pregnant Women Ny. M Ages 39 Years G3P2A0 With
Abortion Imminence at Rs. Roemani Semarang.

B. Purpose

1. General Purpose

Students are able to carry out nursing care with imminent abortion

2. Specific goals

a. Students are able to conduct a thorough study with imminent

abortion

b. Interpret data by formulating nursing diagnoses, problems, and

needs for pregnant women with imminent abortion

c. Identify potential diagnoses in pregnant women with imminent

abortion

d. Identify immediate action in pregnant women with imminent

abortion

e. Carry out comprehensive and rational care planning based on

decisions made in pregnant women with imminent abortion

f. Carry out nursing care for mothers with imminent abortion

according to effective planning of safe funds

g. Evaluating care given to pregnant women with imminent

abortion
C. Benefits

a. For students

Students can apply the theory gained in college in practice on the land and
gain hands-on experience in the problem of providing nursing care to
pregnant women with imminent abortion.

b. For Institutions

Add literature to nursing care campuses for pregnant women with

imminent abortion.
 CHAPTER II

REVIEW OF THEORY OF NURSING CARE

A. Definition

Abortion or better known as miscarriage is the result of conception before

the fetus can live outside the uterus. The fetus has not been able to live outside the
uterus, if it weighs less than 500 g, or the gestational age is less than 28 weeks
because the placentation process is not yet finished. In the first month of
pregnancy which increases abortion, it is almost always preceded by the death of
the fetus in the womb. Manuaba, 2007: 683).

Imminent abortion uses bleeding from the uterus in pregnancy before 20

weeks with or without real uterine contractions with conception in the uterus and
without cervical uterine dilatation (Sarwono, 1996, p. 261). Imminent abortion is
a spotting hemorrhage that shows a fight against a pregnancy. In conditions like
this, renewal can still be completed or carried out. (Syaifudin. Bari Abdul, 2000)
Imminent abortion is vaginal bleeding in pregnancies of less than 20 weeks,
without signs of increased cervical dilatation (Mansjoer, Arif M, 1999). Imminent
abortion is a secret that is issued by vaginal origin that appears at first (William
Obstetri, 1990).

B. Etiology

In young pregnancies abortion is not infrequently preceded by maternal

death. Conversely, in a further pregnancy, the fetus is usually excluded while still
alive. Things that cause abortion can be divided as follows.

1. Growth abnormalities resulting from conception

Growth abnormalities resulting from conception can cause fetal death or

disability. Severe abnormalities usually cause the death of young people to get
pregnant easily. The factors that cause abnormalities in growth are as follows:
 a. Chromosomal abnormalities. Abnormalities that are often found in
spontaneous abortion are trisomy, polyploidy and also the possibility of
sex chromosomal abnormalities.

b. The environment is not perfect. If the environment in the endometrium

around the implantation site is less than perfect so the administration of
food substances to the results of conception is disrupted.

c. External influences. Radiation, viruses, drugs, etc. can affect both the
results of conception and the environment in the uterus. This influence is
generally called the effect of teratogens.

2. Abnormalities in the placenta

Endarteritis can occur in the villi koriales and cause the oxygenisation of
the placenta to be disrupted, causing disruption of fetal growth and death. This
situation can occur from a young pregnancy for example due to chronic
hypertension.

3. Mother's disease

Sudden diseases, such as pneumonia, abdominal typhus, pyelonephritis,

malaria, and others can cause abortion. Toxins, bacteria, viruses, or plasmodium
can pass through the placenta into the fetus, causing fetal death, and then abortion
occurs. Severe anemia, poisoning, laparotomy, general peritonitis, and chronic
diseases such as brusellosis, infectious mononucleosis, toxoplasmosis can also
cause abortion even less frequently.

4. Genital tract abnormalities

Retroversion of the uterus, uterine myoma, or congenital uterine

abnormalities can cause abortion. However, it must be remembered that only
retroversio uterine gravidi or submucous myoma plays an important role. Another
cause of second trimester abortion is incompetent cervix which can be caused by
congenital weakness of the cervix, excessive cervical dilation, conization,
amputation, or extensive, un sewn cervical tears.

5. Endocrine disorders (hyperthiroid, diabetes mellitus, lack of progesterity)

6. Trauma

7. Nutritional disorders

8. Psychological stress

C. Female Reproductive Anatomy and Physiology

The structure of the female reproductive organs includes the internal

reproductive organs and external reproductive organs. Both are interconnected
and inseparable. The internal reproductive organs are inside the abdominal cavity,
including a pair of ovaries and reproductive tracts consisting of the oviduct
(oviduct / fallopian tube), uterus (uterus) and vagina. The outer reproductive
organs include mons veneris, clitoris, a pair of labium majoras and a pair of
labium minora.

1. Ovary.
 The number of pairs, an oval shape 3-4 cm long, hangs intertwined
through the mesentrium to the uterus. It is a female gonade that functions to
produce ovum and secrete female sex hormones namely estrogen and
progesterone. The ovary is encased in a protective capsule that is strong and
contains a lot of follicles. A woman has approximately 400,000 follicles from
both of her ovaries since she was still in her mother's womb. But only a few
hundred develop and release the ovum during a woman's reproductive period,
which is from menarche (first menstruation) to menophause (stopping
menstruation). In general, only a mature follicle releases the ovum every one
menstrual cycle (approximately 28 days) from one of the ovaries alternately.

During maturation, the follicle secretes the hormone estrogen. After the
follicle ruptures and releases the ovum, the follicle will turn into a corpus luteum
which secretes estrogen and the progesterone hormone. The estrogen that is
secreted by the corpus luteum is not as much as that which is secreted by the
follicle. If the egg is not fertilized, the corpus luteum will lysis and a new follicle
will ripen in the next cycle.

2. Fallopian tubes / oviduct (oviduct)

The number of pairs, the tip of which is like a frayed funnel called the
infundibulum serves to catch the ovum released from the ovary. Epithelium in the
inner part of this duct is ciliated, cilia movement will push the ovum to move
towards the uterus.

3. Uterus (uterus)

The number of one fruit, muscular smooth thick, shaped like a pear, the
lower portion is called the cervix. The uterus is the place where the embryo grows
and develops, the wall can expand during pregnancy and re-wrinkle after giving
birth. The inner wall is called the endometrium, producing lots of mucus and
blood vessels. The endometrium will thicken before ovulation and decay during
menstruation.
4. Vagina

Is the end of the female reproductive tract. A blood vessel called a hymen
covers a portion of the vaginal canal. This membrane can be torn due to heavy
physical activity or during intercourse. The vagina functions as a tool for female
copulation and also as a birth canal. The walls are many-fold, can expand when
giving birth to a baby. On the inner wall of the vagina empties the Bartholin
glands which secrete mucus during sexual stimulation.

5. Mons veneris

It is a part that is thick and contains a lot of fat tissue located at the very
top of the vulva.

6. Labium mayora

The number of pairs, is a thick fold that surrounds the vagina and
overgrown with hair.

7. Labium minora

The number of pairs, is a thin fold inside the labium mayora, containing a
lot of blood vessels and nerves. Labium minora fuses at the top to form the
clitoris. Labium minora surrounds the vestibule, a place where there is a urethral
opening at the top and a vaginal opening at the bottom.

8. Clitoris

In the form of a small bulge, it is the most sensitive part of stimulation

because it contains a lot of nerves (Bobak, 2000).

D. Clinical Manifestations

Usually, but not always, bleeding will occur first, which after several
hours to several days will be followed by abdominal cramps. Pain in abortion can
be anterior and rhythmic as usual labor pain; the pain can be persistent lower back
pain accompanied by pressure on the pelvis; or the pain can be a dull ache or
midline pain in the suprasympetic region accompanied by tenderness in the
uterine area. However the form of pain that occurs, the continuity of pregnancy
with bleeding and pain shows a poor prognosis. However, in some women who
suffer from pain and are threatened with abortion, bleeding can stop, the pain
disappears and a normal pregnancy occurs.

At first the bleeding is only a little later and repeats and increases.
Sometimes repeated bleeding can take days or weeks or even months. The blood
color is more fresh red, except it has mixed with old blood so that the color is
brownish. Signs of young pregnancy persist. The pain in the suprasimysis or the
waist is initially absent or mild.

Signs and symptoms of Imminen abortion:

1. There is a delay in coming months

2. There is bleeding, accompanied by abdominal pain or mules

3. At the examination found the size of the uterus is the same as the age of
pregnancy and uterine muscle contractions occur

4. The results of the examination are bleeding from the cervical canal, and
the cervical canal is still closed, uterine muscle contractions can be felt

5. The results of the pregnancy test are still positive.

E. Pathophysiology

At the beginning of abortion there is bleeding in the decidua basalis then

followed by surrounding tissue necrosis. This causes the results of conception to
be released in part or in full, so that it is a foreign body in the uterus. This
condition causes the uterus to contract to release its contents. In pregnancies of
less than 8 weeks the results of the conception are usually taken out entirely
because the villi koriales have not penetrated the decidua in depth. In pregnancy
between 8 to 14 weeks the villi penetrate the decidua more deeply, so that the
placenta is not completely released which can cause bleeding. In pregnancy, 14
weeks and above, generally the one that is released after the rupture of the
membranes is the fetus, followed some time later by the placenta. There is not
much bleeding if the placenta is immediately released completely. These abortion
events resemble labor in miniature form.

F. Classification

Classification of abortion is classified into 2, namely:

1. Spontaneous abortion, which is abortion that occurs not preceded by

mechanical or medical factors, but due to natural factors. The clinical aspects of
spontaneous abortion include:

a. Imminent Abortion

Imminent abortion is the occurrence of bleeding from the uterus in

pregnancy before 20 weeks, where the conception results are still in the
uterus, and without cervical dilation. The diagnosis of imminent abortion
is determined if vaginal bleeding occurs in the first half of pregnancy. The
first to appear is usually bleeding, from a few hours to a few days later
there is abdominal cramping pain. Abortion pain may be felt anteriorly and
is clearly rhythmic, pain can be persistent lower back pain accompanied by
a feeling of pressure in the pelvis, or discomfort or dull pain in the
suprapubic midline. Sometimes there is mild bleeding for several weeks.

b. Abortion incisions

Insertion Abortion is an event of uterine bleeding in pregnancy before 20

weeks with increased cervical uterine dilatation but the results of
conception are still in the uterus. In this case the taste of mules becomes
more frequent and the quality of bleeding increases.

c. Incomplete abortion
Expending a portion of the conception in pregnancy before 20 weeks with
still remaining in the uterus. If the placenta (in whole or in part) is retained
in the uterus, bleeding will occur sooner or later which is the main sign of
incomplete abortion. In further abortion, bleeding is sometimes so massive
that it causes severe hypovolaemia.

d. Complete abortion

In complete abortion all the results of conception have been excluded. In

patients with minor bleeding, the uterine os has closed, and the uterus has
shrunk a lot. Diagnosis can be made easier if the conception results can be
examined and it can be stated that everything has come out completely.

e. Cervical Abortion

In cervical abortion, the results of conception from the uterus are blocked
by the external uterine ostium which does not open, so that everything
accumulates in the cervical canal and the uterine cervix becomes large,
more or less round, with thinning walls. On examination it was found that
the cervix was enlarged and above the external uterine os was felt by the
tissue. Therapy consists of dilating the cervix with Hegar plugs and
scrapings to remove the results of conception from the cervical canal.

f. Missed Abortion

Missed abortion is the death of a fetus before 20 weeks, but the dead fetus
is not released for 8 weeks or more. Etiology missed abortion is unknown,
but it is thought to be the effect of the hormone progesterone. The use of
Hormone progesterone in abortion imminens may also cause missed
abortion.

g. Habitual Abortion
 Habitual abortion is spontaneous abortion that occurs 3 or more
consecutive times. In general, sufferers are not difficult to become
pregnant, but the pregnancy ends before 28 weeks

2. Provocatus abortion (deliberately made abortion) that is stopping pregnancy

before the fetus can live outside the mother's body. In general, babies are
considered unable to live outside the womb if the pregnancy has not reached the
age of 28 weeks, or the baby's body weight is not yet 1000 grams, although there
are cases that babies under 1000 grams can continue to live. This abortion is
divided into two, namely:

a. Medisinalis Abortus (therepeutika abortion)

is abortion because of our own actions, on the grounds that if the

pregnancy continues, it can endanger the mother's life (based on medical
indications). Usually two to three teams of experts need approval

b. Criminal abortion

is abortion that occurs because of actions that are not legal or not based on
medical indications.

G. Complications

1. Bleeding

Bleeding can be overcome by emptying the uterus from the

remnants of the conception and if necessary giving tranfusidarah. Death
due to bleeding can occur if the aid is immediately given in time.

2. Perforation

Uterine perforation in scrapings can occur mainly in the uterus in a

hyperetroflexion position. If this happens, the sufferer needs to be
observed carefully. If there is a danger sign, laparatomie needs to be done
immediately, and depends on the extent and shape of the perforation,
 suturing the perforated wound or need hysterectomy. Uterine perforation
in abortion done by lay people causes serious problems because the uterine
injury is usually wide, there may also be injury to the bladder or intestine.
With the presumption or certainty of a perforation, laparatomie must be
carried out immediately to determine the extent of the injury, to then take
the necessary measures to overcome complications.

3. Infection

Abortion Infectionosus is an abortion accompanied by infection in

genetalia. The diagnosis is determined by the presence of abortion
accompanied by symptoms and signs of genital infection, such as heat,
tachycardia, odorous vaginal bleeding, enlarged uterus, softness, and
tenderness, and leukocytosis.

4. Shock

Shock to abortion can occur due to bleeding (hemorrhagic shock),

and due to severe infection (endoseptic shock).

H. Diagnostic Check

1. Investigation

a. Positive pregnancy test if the fetus is still alive and negative if

the fetus is dead

b. Dopler or ultrasound examination to determine whether the fetus

is still alive

c. examination of fibrinogen in the blood for missed abortion

2. Laboratory data

a. Urine test
 b. hemoglobin and hematocrit: hemoglobin decreased (<10 mg%)
and hematocrit decreased (<35 mg%)

c. counting platelets

d. blood and urine culture

I. Management

Handling of imminent abortion consists of:

1. Take a break. Sleeping lying down is an important ingredient in

treatment, because this method increases blood flow to the uterus and
decreases mechanical excitability.

2. Regarding the administration of the hormone progesterone in abminent

abortion there is no understanding of understanding. Most experts
disagree, and those who agree state that it must be determined in advance
that there is a lack of the hormone progesterone. If you think that most
abortions are preceded by cell death, the results of conception and death
can be caused by many factors, so the administration of the hormone
progesterone does not benefit much.

3. An ultrasound examination is important to determine whether the fetus

is still alive.

4. Give sedatives, usually phenobarbital 3 x 30 mg. Give hematinic

preparations such as ferrous sulfas 600 / 1,000 mg

5. A diet high in protein and added to vitamin C

6. Clean the vulva at least twice a day with antiseptic fluids to prevent
infection, especially when still removing brown fluid

7. When bleeding
 a. Stop: do scheduled antenatal care and reassess if there is more
bleeding.

b. Lasts a long time: the return value of the fetus. Confirm the
possibility of other causes (ectopic or molar pregnancy).

A. Pathway

Gangguan Gangguan Gangguan faal

Infeksi akut Trauma
endokrin Gizi/Anemia organ

Abortus (mati janin

<20 minggu)

Abortus Retensi Janin Abortus Resiko

Abortus Spontan
Infeksiosa (missed abortion) tinggi

Abortus Perdarahan, bercak ada

Imminens ancaman kehamilan

Kurang
Perdarahan Nyeri abdomen
pengetahuan
 Nyeri akut ansietas
Shock

Risiko infeksi

Kekurangan
volume cairan

K. Nursing care

1. Assessment

Data that needs to be reviewed by nurses are:

a. Basic data which includes:

- Biological aspects

- Psychological aspects

- Cultural social aspects

- Spiritual aspects

b. Focused data are: data that is appropriate to the patient's current

condition which includes:

- History of pregnancy

- Previous history, contraceptive use and type, history of previous

pregnancy, live birth or stillbirth, menstrual history which includes
the menstrual cycle, length of menstruation and end of hair

- Physical assessment includes:

• Current gestational age, signs of early pregnancy

 • Attention to bleeding that occurs

• An infection

• Pain during bleeding

• There is a history of treatment problems

• Activities carried out during pregnancy

- psychological problems

- There is support from the family

- LAB examination: pregnancy test, Hb, Ht Leukocytes.

- Ultrasound examination to find out fetal growth

- Monitor fetal heart rate and uterine fundus height.

2. Nursing diagnoses that may appear

a. Acute pain is associated with uterine contractions in young pregnancy

b. Lack of fluid volume is associated with bleeding

c. Anxiety is related to the possibility of fetal loss

d. Risk of infection b.d bleeding, and the condition of the vulva is moist

e. Knowledge deficiency causes - causes of miscarriage are related to lack

of information.

3. Intervention (Nic-Noc)

4. Implementation

5. Evaluasion (SOAP)
 CHAPTER IV

COVER

A. Conclusion

Based on the discussion on nursing care for pregnant women with imminent
abortion, it can be concluded that:

1. Management of nursing care properly and accurately

2. Nursing care provided in accordance with needs

3. There are gaps in theory and practice in providing drug therapy given by
doctors

B. Suggestions

1. Patient

Knowing the signs and dangers of abortion imminens and reduces daily
activities if there are signs and symptoms of imminent abortion

2. Health Workers

Knowing how to overcome the causes of imminent abortion

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St. Louise, Missouri: Mosby, Inc.

4. McCloskey, Joanne C, 2008. Nursing Intervention Classification (NIC).

St. Louise, Missouri: Mosby, Inc.

5. Carpenito, Lynda, (2001), Pocket Book of Nursing Diagnoses, Medical

Book Publishers EGC, Jakarta.

6. Affandi B, Adriaansz G, Gunardi ER, Koesno H. Practical contraceptive

contraceptive service guidebook. Edition 3. Jakarta: PT Bina Pustaka

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American Heart Association Guidelines for Cardiopulmonary
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