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CHAPTER I

INTRODUCTION

A. Background

Having children is a dreaming of every couple who have marriage but

what we can do that pregnant can’t be protect or we always say miscarriage.

miscarriage is sporadic character or known with repeat miscarriage, where the

sporadic miscarriage do not have pattern and many that are caused by

chromosome disorder, it can be spermatozoid cell or ovum cell.

Miscarriage technical term (abortion) is always used to say if the end of

pregnant before 20 weeks is chronic. This happened about 15-20 % pregnant

and many happen at 12th weeks, that are more than 80 %, there are many

factors of miscarriage etiology such as age, imbalance hormone, chromosome

disorder, womb disorder (weak of womb mouth, tumor or miom and womb

disorder) miscarriage or abortion in medical word, is abortion there two kinds

there are automatic abortion and natural abortion. Automatic abortion is

abortion happened by natural automatic without a present effort from outside

for the end of that pregnant and artificial abortion is abortion is happened by a

present effort for the end of that pregnancy process.

Abortion incomplit is one of abortion form that is often happened in

midwifery and pregnant of bleeding each faginam complaint. Incomplit

abortion can definited which bleeding happen from uterus in pregnant before

20th weeks, when the result of conception is still in uterus and there is servic

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dilatation. Abortion incomplit often happened in the women if it is handed so

fast and correct the complication will be minimilized, But if isn’t handed so

fast will cause the mother died. Because of that abortion incomplit is an

interesting topic that shoud be understood by the doctor or other medical.

Abortion incomplit abortion has complication that can threat mother safety

because there mast bleeding which can make died because of hypovolemic

shock if this condition can’t be fast and exact core. Some mother who get

incomplit abortion can get physical shock, not only the mother but to family

too.

Psychological effect of abortion incomplit to the women who get

spontaneous abortion happen get stress more than 90 %. Sad reaction is

happened until a month in 20 % case, when abortion is threaten or is

happening many of women get stress because don’t know what is happened to

the fetus, which get stress more explanation.

Abortion incomplit especially get bleeding uterus happen with or

without normally uterus constraction,. Etiology of bleeding in early pregnant

often must get rid. The pregnant will continue and the patient can be amuse of

about 5 % case at her pregnancy will be shorter and the baby will be born

preterm.

The biggest abortion are more happened difficult often known for

mother who was stated positive pregnancy and 60-75 % the miscarriage

happen before the 12 th weeks of half pregnancy that cause chromosome

disorder risk of miscarriage happen in the women which pregnancy in three


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months after birth. In early abortion, dismiscal of fetus is often started with

fetus died even though in old women abortion. The fetus often still live before

get out.

According to WHO (world health organization) data in the world

about incomplit abortion is about 10-15 % happen in pregnancy.

Ever though the data was got in Bougenville ward Ambarawa Regional

Hospital since September 2007, November 2007 is 32 among that the abortion

imminens is about 21 (65,03 %) Complit abortion about 4 (12,5 %) and

abortion is about 7 (21,87 %).

More can be seen in the table

Table 1.1 distribution of incomplit abortion in Bougeville Ward Ambarawa

Regional Hospital from September 2007 until November 2007

Abortion kinds Age account Prosentase


15-24 25-40
Imminens abortion 8 13 81 65,07 %
Complit Abortion 1 3 4 12,5 %
Incomplete 3 4 7 21,87 %
abortion

account 12 20 32 100 %

According to explanation and introduction status so the writer interest

to do nursing care to the patient with incomplit abortion in Ambarawa

Regional Hospital.
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B. Purpose

1. General purpose

Can do nursing care be women who get abortion incomplit.

2. Special purpose

a. Can do examine to the women with abortion incomplit

b. Can identity nursing diagnose and on giving nursing care to the

women with abortion incomplit

c. Can determine Nursing intervention which good nursing care to the

women with abortion incomplit

d. Can determine intervention to the women with abortion incomplit

e. Can evaluate intervention nursing has been given to the women with

abortion incomplit

f. Can know the supporting factor and giving nursing care to the women

with abortion incomplit

C. Advantage

1. For the writer

Can compare between the theory and she fact in field about abortion

imminens espicially for Abortion Imminens.

2. For hospital

can increase healt quality service special giving nursing care to the

women with abortion imminens.


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3. For institution

Become maternal input of studying process in teaching nursing maternity

especially in giving nursing care to the women with abortion imminens.


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CHAPTER II

BASIC CONCEPT

A. Definition

Abortion is stopped pregnancy before the fetus to viabilitation (age

pregnancy 22 weeks) and weight less 500 gram (Saifuddin, 2002 : 10)

Abortion is failed pregnancy before 20 weeks or weight the fetus less

1000 gram.(manuaba,2001;584)

Abortion is threat or dismissal conceptual result before the fetus can

live of uterus, as age pregnancy 28 weeks and before the fetus 1.00 gram

(Mansjoer, 2004 : 260)

Abortion is stopped pregnancy before the fetus can live or

viabilitation the fetus in reaction on before weeks to 22 (Wiknjosastro,

2005 : 649)

So from the definition can be concluded that the abortion is failed

pregnancy threat or dismissal conception before the fetus can live out

pregnancy where the fetus can live or viabilitation the fetus.

Abortus incomplit is a abortion which in out tissue but a part still on

uterus (Manoeaba, 2007 : 688).

B. Kinds of abortion

1. Abortion spontaneous is stopped pregnancy before the fetus viabilitation

kinds abortion spontaneous are :


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a. Abortion imminens is an indicate miscarriage and will be happened

out the fetus still can be prevented with giving the hormonal medicine

and antisipasm medical and bedrest

b. Abortion insipiens (pregnancy can’t be continued and will bloom

become abortion incompletes/complete)

c. Abortion incompletes/ a part conception has been out

d. Abortion complete (the all conception result has been out)

e. Abortion habitualis is condition when the sufferer experience

miscarriage in 3 day or more.

2. Abortion provocatus or abortion that is done.

a. Abortion medisialis is an abortion because intervention my self with

reason when pregnancy in continue can be danger for mother (based

on medical indication)

b. Abortion criminalis is abortion which is happened because the

intervention which does not based on medical.

(Saefuddin, 2002 : M-12, Achadiat, 2004 : 26)

C. Etiology

1. Abnormally chromosome

a. Chromosome

The disturbance is happened since the all meeting at chromosome

include sex chromosome


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b. Endometrium, environment factor

Endometrium is ready accept result, the less of mother’s anemia or

does not short time of pregnancy

c. External factor

1) Infection of endometrium

2) Can cause the growth conception result has been disturbance

2. Abnormally of placenta

a. Infection at placenta

b. Disturbance blood vessel placenta among DM

c. Hypertension can cause disturbance bleeding the placenta so do

miscarriage

3. Mother disease

Sudden disease pneumonia, thypoid abdominalis, malaria, anemia,

poisoned bacteria and virus can cause abortion.

4. Abnormally which is in womb

The growth the fetus condition abnormally on type of myoma uteri, servic

incompletens, operation at cervic

5. Stimulate at the mother which cause the very surpise constraction, the

medicine, afraid, laparatomy or the fetus directly because damage and the

medicine.

6. Abnormally the growth conception result, usually cause at pregnancy

before 8 weeks

7. Movement body which coplous on age pregnancy the first or finished (age
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pregnancy under 2 months, because future the fetus at womb yet strong

and on age pregnancy 7 months because condition placenta already old so

easy released

8. Because impact or short at mother’s body or example fall from ladder or

because of the other.

(Mansjoer, 200 : 261; Saiffudin, 2002: M-13)

D. Pathophysiology

Abortion is started from the released a part or on of the placenta which

cause bleeding so the fetus less the nutrient and oxygen a part which released

considered as a strong things, so the uterus has the effort to come out with

contraction.

It happens spontaneously all of or a part still living which all of the

difficult disease. So because bleeding contraction and with dismissal all or a

part conception result. Type bleeding variation between little and go on log

and long sum which big with clod so bleeding mentioned can be shock syock,

thacycardi, hypotension, anemia and the area tip cool.

The first will happen bleeding on desidua basalic and than along

necrosis in around, this mention can cause conception result released a part on

all, so is a storage things on the uterus this condition can cause the uterus

condition on pregnancy less from 8 weeks conception result that usually out

all because villi coriales yet pierce desidua deepened on pregnancy between 8

to 14 weeks the placenta not is released perfect which cause much bleeding on

pregnancy 14 weeks general sign which out on various type there are packed
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amnion empty or measles in depth small thing without type which cleared

(blighted ovum), may be the fetus has been long dead (missed abortion).

When the mudigah dead is not out on time, so it can cover layer

blood clot. The uterus content’s name is mola kruerta. This type become mola

carnosa when blood pigment has been absorb and on residue happen

organitation, so the all measles bruised become hematoma between amnion

and corion.

On the focus which has been dead and isn’t out can happen process

mummification of the fetus compressus in story more continue become typical

as fetus papiroseus.

And then the other on the died fetus which is not quickly out

happened meration, can loose skin cranium become flabby and big stomach

because filled liquid and all the fetus the colors are red.

(Wiknjosastro, 2002: 304, Derek, 2002: 98)


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E. Pathway
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F. Supporting Examination

1. Pregnancy test.

Positive if the fetus still lives even 2-3 weeks after abortion.

2. Examination dopper or USG for

determine are the fetus can still live.

3. Examination degree fibrinogen blood

at missed abortion. (Mansjoer, 2000:

261)

F. Clinical Manifestation.

1. Menstruation late or aminorche less than 20 week

2. Examination Physhical : general condition appear weak or

conscious go down, blood pressure normal or quickly and

small, body temperature normal at rise.

3. Bleeding vagina, where concept result still on the a part

uterus there are serviks opening.

4. Followed by stomach or not followed, followed by pain

waist

5. Big the uterus not some with pregnancy

(Wiknjosastro, 2006 : 309).

G. Supporting Examination

1. Story bleeding (much or by aut the contant prgnancy)


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2. Story pain in the stomach (there are or not)

3. There are serviks opening

4. The test of pregnancy is positive

5. Dopler examination or user for determine the fetus can still

live or dead

6. Examination degree fibrinogen blood at mused abortion

(Sarwono, 2002 : 712)

H. Focus Intervention

1. Disturbance comfortable pain relacted to process uterus

contraction

Goal : pain decrease to last

a. Assesst scale pain

b. Learned technique relaxation

c. Give to information and

explained about cause pain

d. Give much take a rest at pain

game

e. Evaluation blood pressure and

pulse

2. Anxiety related to knowledge family about the bleeding and

lost pregnancy (Carpenito, 2001 : 493).

Goal : the patient not anxiety


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Intervention

a. Assest of layer anxiety

b. Inform about disease and nursing procedure

c. Give motivate morale

d. Observation vital sign

e. Protrude followed to nursing procedure

3. Decrease of liquid volume related to lost liquid

intravaskuler more

Goal : not happened hypovolemic

Intervention :

a. Evaluation and note bleeding characteristic

b. Protrude badrest, avoid to coitus

c. The position patient which appropriate

d. Note vital sign patient

e. Exceedingly membrane mucosa color / skin, temperature

f. Monitor activity uterus, status the fetus there are pain pressure

4. High risk happened infection related to there are not

defense sekunder (as : hemoglobin decrease). Defense

primer (as : damage skin, body liquid statis) (Carpenito,

2001, 495).

Goal : not happened infection

Intervention
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a. Monitor frequent live style and

protection with are with are

factors risk which related

b. Assest the background culture

patient with risk

c. Assest sign and symptomp

infection

d. Assest canged colour, consitent

and amounth rabas vagina

e. Assest the frequency urine,

desuria, turbid

f. Collaboration with antibiotic

5. Changed tissue perfotion related to hypovolemic (Doenges,

2001 : 492)

Goal : changed tissue perfotion not happened

Intervention

a. Attention fisiologis status mother, status sirculation and volume

blood

b. Careful throb heart the fetus, brakikardi, trakikardi, activity

changed the fetus

c. Note be lost blood mother

d. Not changed uterus big/high, fundus uteri

e. Protrude of badrest on position sideaways


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6. Disturbance fulled needed nutrition lost from needed

related to anorexia

Goal : Changed tissue portation not happened

Intervention

a. Protrude eat small portion but

often

b. Assest phase needed nutrition

patient

c. Helped on cleaned patient mouth

d. Protrude eat beloved patient

7. Uneffectifally cleaned breathways related to mobilitis

sekunder because general anastesi (Doenges, 2001 : 510).

Intervention

a. Instruction individual for do

cough which control

b. Assest there are program

analgesic

c. Defense of damp air inspiration

edecuate

d. Planning periode take a rest after

cough before eat

e. Wont with motivation and

protrude a cough
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(Doengoes, 2001; 487)

TABLE OF CONTENT

TITTLE OF PAGE.............................................................................................. i
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vi

APPROVAL PAGE............................................................................................. ii

LEGALIZED PAGE........................................................................................... iii

ACKNOWLEDGMENT..................................................................................... iv

TABLE OF CONTENT ..................................................................................... vi

CHAPTER I INTRODUCTION

A. Background.................................................................................... 1

B. Purpose.......................................................................................... 4

1. General Purpose....................................................................... 4

2. Specific Purpose...................................................................... 4

C. Advantage...................................................................................... 4

CHAPTER II BASIC CONCEPT

A. Definition....................................................................................... 6

B. Kinds of abortion........................................................................... 7

C. Etiology......................................................................................... 8

D. Pathofisiology................................................................................ 9

E. Pathway......................................................................................... 11

F. Supporting Examination................................................................ 12

G. Management.................................................................................. 12

H. Clinical Manifestation................................................................... 13

I. Focuc intervention......................................................................... 14

REFERENCES.................................................................................................... 18
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