CHAPTER I INTRODUCTION

A. Background Having children is a dreaming of every couple who have marriage but what we can do that pregnant cant 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 isnt 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 cant 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 dont 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 12th

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 15-24 Imminens abortion 8 Complit Abortion 1 Incomplete 3 abortion account 12

account 25-40 13 3 4 20 81 4 7 32

Prosentase 65,07 % 12,5 % 21,87 % 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 cant 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 mothers 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 mothers 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 contents 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 isnt 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 intravaskuler more Goal : not happened hypovolemic Intervention :

volume related

to lost liquid

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 infection d. Assest canged colour, consitent and amounth rabas vagina e. Assest the frequency urine, sign and symptomp

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 analgesic c. Defense of damp air inspiration edecuate d. Planning periode take a rest after cough before eat e. Wont with motivation and there are program

protrude a cough

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(Doengoes, 2001; 487)

TABLE OF CONTENT TITTLE OF PAGE.............................................................................................. i

vi

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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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