abortion presentation

1. ANITA RANI
1004
M.Sc. NURSING
1ST YEAR

2. “Abortion is the termination of pregnancy before the
period of viability which is considered to occur at 28th
week”.
or
“Abortion is the process of partial or complete separation
of the products of conception from the uterine wall or
without partial or complete expulsion from the uterine
cavity before the age of viability(28th weeks)”
Acc. To sanju sira

3. Abortion is the expulsion or extraction from its mother
of an embryo or fetus weighing 500gm or less when
it is not capable of independent survival (WHO) .This
500gm of fetal development is attained
approximately at 22 weeks of gestation ,the expelled
embryo or fetus is called abortion. The term
miscarriage ,which is mostly used is synonymous
with spontaneous abortion.
Acc. To D.C. Dutta

4. It may be defined as involuntary loss of product of
conception prior to 2 weeks of gestation.
1. Majority of abortion or miscarriage occurs in first
trimester or within first 12 weeks of pregnancy and
are called early miscarriage.
2. Miscarriage after 13th weeks are termed as late
miscarriages.

5.  15% of all confirmed pregnancies are said to result
in a miscarriage, the majority of which happen in the 1st
trimester. 1-2% spontaneous miscarriages occur after
the 13th week.
 10-20% of all clinical pregnancy and 10% are induced
illegally .75% abortion occur before the 16th week and
of these ,about 75% occur before the 8th week of
pregnancy.

6. 1. Ovular or fetal factors
2. Maternal environment
3. Paternal factor
4. Unknown (25%)

7. 1. Autosomal triosomy having three homologous
chromosomes instead of two autosomes. Any of the
other chromosomes other than sex
chromosomes(commonest).
2. Monosomy condition in without one chromosome of
pair of homologous chromosome is missing.
3. Gross congenital malformation.
4. Blighted ovum(ovum without embryo).
5. Hydropic degeneration of the villi.
6. Interference with the circulation in the umbilical
cord by knots, twists or entanglements may cause

8. cause death of fetus and its expulsion.
7. Faulty placental formation , i.e. circumvallate or low
attachment of placental circulation .
8. Twins of hydroamnios.

9. 1.Maternal illness : it consist of
a.) infection:
 Viral infection – rubella, cytomegalovirus, hepatitis
parvovirus, influenza virus etc.
 Paracitic –malarias
 Protozoal – toxoplasmosis
b.) Maternal hypoxia and shock : due to
 Acute respiratory disease
 Chronic respiratory disease
 Heart failure
 Sever anemia

10.  Anesthesia complications
 Sever gastroenteritis
 Cholera
c.) chronic illness:
 Hypertension
 Chronic nephritis
 Chronic wasting disease
d.) Endocrine factors:
 Hypothyroidism, hyperthyroidism, diabetes mellitus

11. 2. Trauma:
a. Direct trauma on abdominal wall by direct blow.
b. Psychic : emotional upset or change in environment
may lead to abortion.
c. In susceptible individual, even a minar trauma, e.g.
 Rough road
 Internal examination in early month
 Sexual intercourse in early months

12. 3. Toxic agents: environmental toxins like:
a. Lead
b. Arsenic
c. Anesthetic gases
d. Tobacco
e. Caffeine
f. Alcohal
g. Radiation in excess amout

13. 4. cervico-uterine factors: it includes:
 Cervical incompetence.
 Congenital malformation of uterus.
 Uterine tumor(fibroid)
 Retroverted uterus.
5. Immunological factors: include autoimmune factors
like:
 Lupus anticoagulant
 Antiphospholipid antibodies.
 Alloimmune factors.

14. 6. Blood group incompatibility: it includes Rh
incompatibility.
7. Premature rupture of membranes also leads to
abortion
8. Dietetic factors: in this deficiency of folic acid or
vitamin C is often held possible.

15. 1. Defective sperms.
2. Contributing half number of the chromosomes of the
ovum

16. 1. FIRST TRIMESTER:
a. Defective germ plasma
b. Hormonal deficiency
c. Trauma
d. Acute infection
2. MID TRIMESTER:
a. Cervical incompetence
b. Uterine malformation
c. Uterine fibroid
d. Low implantation of placenta.
e. Twin and hydramnios

17. In the early weeks: death of the ovum first followed by
its expulsion .
In the later weeks: maternal environmental factors are
involved leading to expulsion of the fetus which may
have signs of life but is too small to survive.
 Before 8weeks :-
 a.) The ovum surrounded by the villi with the
decidual coverings is expelled out intact. b.)
sometimes ,the external os fails to dilate so that
the entire mass is accommodated in the dilate
cervical canal is called cervical abortion.

18. 2.) 8-14 weeks :-
a.) here , the expulsion of fetus occurs leaving behind
the placenta and membranes
b.) A part of it may be partially seprated with brisk
hemorrahage or remains totally attached to the
uterine wall.
3.) Beyond 14th weeks :-
a.) The process of expulsion is similar to that of a
“minilabour”
b.) The fetus expelled first followed by expulsion of the
placenta.

19. Threatened Inevitable complete incomplete
missed Septic
TYPES OF ABORTION
SPONTANEOUS
ISOLATED (SPORADIC)
RECURRENT
INDUCED
LEGAL (MTP) ILLEGAL (CRIMINAL)
SEPTIC (
COMMON)
THREA
TENED
INEVITAB
LE
COMPLEE

20. DEFINITION :- “It is clinical entity where the process of
abortion has started but has not progressed to a state from which
recovery is impossible”.
Or
It is a type of abortion without passage of fleshy tissue but with
possibility of continuation of pregnancy
CLINICAL FEATURES :-
SYMPTOMS:
1.Bleeding per vaginam:
a.) It is slight
b.) The color is bright red
c.) In the late second trimester, bleeding may be brisk and sharp
which suggest low nidation of placenta.
d.) The bleeding usually stops.

21. 2.Pain:
a. Bleeding is usually painless.
b. There may be mild backache.
c. There may be dull pain in lower abdomen. (the pain
resembles dysmenorrhea or menstrual pain.)
d. No history of expulsion of any fresh lump.
SIGNS:
1.Per abdominally: gravid uterus is felt soft, enlarged
corresponding to the period of amenorrhea.
2. Speculum examination or vaginal palpation: the cervical
os is closed. Stained discharge is present.

22. 1. Blood: for Hb, ABO and Rh grouping
2. Urine : for immunological test of pregnancy. It is
done to confirm the fetal death.
3. Bimanual palpation gives the diagnosis.
4. Pelvic ultrasonography.
5. Transvaginal ultrasonography.

23. 1. Assure the mother: as there is no fetal malformation ,
assure the mother that everything would be fine. Clear
all her doubts and queries. Never give false assurance.
2. Complete bed rest:
a. advise the patient to have bed rest until the bleeding
stops.
b. Advise not to do the household work at least 1month
especially heavy strenuous work and exercise
c. Advise her not to engage in sexual activity throughout
the pregnancy

24. 3. Vulval swabbing:
a. Vulval swabbing should be performed at least twice
daily while discharge persists in order to minimize
discomfort. If brownish discharge or bleeding is
present then clean the vulva and perineum every 4 to
12 hourly.
b. Advice the patient to preserve the vulval pads or
anything expelled out per vaginam for inspection
c. Vulval toileting is done using antiseptic lotions, e.g.
hibitane 1:2000

25. 4. Drugs:
a. For poor sleep anxiety give the mother
 Tab diazepam
 Tab calmpose 5-10mg before night meal
 Tab valium
b. For good bowel activity, give her mild laxative, i.e.
milk of magnesia at bed time.
c. Never give enema (as this may stimulate the uterine
contraction) mild purgatives or suppositories may be
used after 48 hours if the client is constipated.

26. 5.Ask to report if :
a. Bleeding becomes more.
b. Pain becomes aggravated
6. Routinely note the:
a. Pulse
b. Blood pressure
c. Temperature
d. Amount of bleeding
7. At the end of 1st week pelvic ultrasound is done:
a. If there is live fetus: continue with the pregnancy but
carefully.
b. If there is blighted ovum: go for suction and evacuation

27. 8. Speculum examination: it is done to exclude local
leisons and to note the state of cerviacal os.
9. Diet: high fiber diet is given to prevent constipation .
Good feeding is encouraged and supplements given i.e.
 ferrous sulphate 200mg(b.i.d.)
 folic acid 5mg/day(t.i.d.)
the client is provided diet that contains high protein and
vitamine E.

28. DEFINITION :- It is the clinical type of abortion where
the changes have progressed to a state from where
continuation of pregnancy is impossible.
 or
 It is the type of abortion where process of expulsion of
conceptus is in progress with the dilation of cervical
canal. In this case pregnancy cannot be saved because of
a good portion of the placenta has detached.
CLINICAL FEATURES
 Increased vaginal bleeding .
 Aggravation of pain in the lower abdomen.
 The general condition of the patient is proportion to the
visible blood loss.
 Dilated internal os.

29. Symptoms:
1.Increased vaginal bleeding due to the detachment of
considerable part of the placement from the uterus.
2. sever colicky, lower abdominal pain.
3. No tissue is expelled.
4. Faint due to heavy blood loss.
Signs:
1. Maternal vital signs remain normal in majority.
2. Sign of shock due to blood loss.
3. Skin may be cold and clammy.
4.Uterus felt contracted

30. 5. On pelvic examination, the internal cervical os dilates
admitting index finger; conceptus is felt by finger
COMPLICATION:
1. Blood loss: it may cause shock and death.
2. Infection of conceptus and uterus

31. Principles of management:
1. To look after general condition of mother.
2. To accelerate the process of expulsion.
3. To maintain strict asepsis.
MANAGEMENT:
1. The patient is admitted in the hospital.
2. If blood loss is moderate, ringer lactate is started I/V.
3. Blood transfusion are needed in heavy blood loss.
4. In all cases of abortion, blood Hb, ABO Rh group and
random blood glucose are tested.
5. Inj. Morphine 15mg is given I/M

32. 6. Excessive bleeding is controlled by administration of
inj. Methargin 0.2mg, if the cervix is dilated and the
size of uterus is less than 12 weeks.
7. The shock is corrected by I/V fluid therapy and blood
transfusion.
8.If the abortion process is before 12 weeks then under
GA(general anesthesia) the dilatation and evacuation is
done followed by curettage. Alternatively, suction and
evacuation may be employed.
9. If the abortion process is beyond 12weeks then the
uterine contractions are accelerated by oxytocin drip(10
units in 500 ml of 5%dextrose) at 40-60drops/min.

33. 10. If the fetus is expelled and the placenta is retained it
is removed by ovum forceps, if lying separated.
11. If the placenta is not separated, digital separation is
done followed by its evacuation under GA.
12. If bleeding is profuse with the cervix
closed(suggested of low implantation of placenta) then
evacuation of uterus may have to be done by abdominal
hysterectomy.
13. Treat shock in case of excessive blood loss.

34. DEFINITION :- when the products of conception are expelled
in masses ,it is called complete abortion.
CLINICAL FEATURES:-
1. Subsidence of abdominal pain.
2. Vaginal bleeding becomes trace or absent.
3. Internal examination reveals:
a. Uterus is smaller than the period of amenorrhea.
b. Cervical os is closed.
c. Bleeding is trace.
d. Examination of the expelled fleshy mass is found intact.
5. Transvaginal ultrasonography shows empty uterine cavity

35. 1.Observe the condition of mother meticulously.
2.Note the effect of blood loss, if any should be assessed
and treated.
3.If there is doubt about complete expulsion of the
products then uterin curettage should be done.
4.Trans vaginal sonography is useful to prevent
unnecessary surgical procedure.
5. An RH NEGATIVE WOMEN:- without antibody in
her system should be protected by anti – D gamma
globulin – 100 microgram intramuscularly in cases of
early abortion or respectively within 72 hours.

36. DEFINITION :- when the entire products of conception are
not expelled, instead a part of it is left inside the uterine cavity
,it is called incomplete abortion.
CLINICAL FEATURES:
1.History of expulsion of a fleshy mass per vaginam.
2.Continuation of pain lower abdomen(colicky in nature).
3.Persistence of vaginal bleeding .
4.Internal examination reveals :-
a. Uterus smaller than the period of amenorrhea .
b. Patulous cervical os often admitting tip of the finger.
c. Varying amount of bleeding.
d. On examination , the expelled mass is found incomplete.

37. TERMINATION :- The products left behind may lead
to :-
1.Profuse bleeding .
2.Sepsis.
3.Placental polyp.
4.Rarely choriocarcinoma.
MANAGEMENT :-
 Early abortion :- Dilatation evacuation under
general anaesthesia is to be done.
 Late abortion :- The uterus is evacuated under
general anaesthesia and the product are removed by
ovum forceps or blunt curette.

38. DEFINITION :- When the fetus is dead retained
inside the uterus for a variable period more than
4weeks it is called missed abortion or silent
miscarriage or early fetal demise.
PATHOLOGY :- The cause of prolonged retention the
dead fetus in the uterus is not clear beyond 12 weeks,
the retained fetus becomes macerated or mummified
the liquor amine gets absorbed and the placenta
becomes pale, thin and may be adherent,before 12
weeks ,the pathological process differs when the ovum
is more or less completely surround by the chorionic
villi.

39. 1.Persistence of brownish vaginal discharge .
2.Subsidence of pregnancy symptoms .
3.Retrogression of breast changes.
4.Cessation of uterine growth.
5.Non audibility of the fetal heart sound .
6.Cervix feels firm.
7.Immunological test for pregnancy becomes negative.
8. Radiology shows collapsed fetal skeleton.
9. Real time ultrasonography reveals an empty sac(in
early pregnancy), absenceof fetal motion or
absence of FHS in later pregnancy.

40. 1. Uterus less than 12 weeks :-
a. Vaginal evacuation can be carried out without delay.
b. suction and evacuation or slow dilatation of cervix by
luminaria tent followed by dilatation and evacuation
(d&c) of the uterus under general anesthesia .
c. Keep in mind the risk of hemorrhage during operation.
Uterus more than 12 weeks:-
a. oxytocin
1. Initially started with 10 -20 units oxytocin in
500ml of 5% normal saline in drip with 30
drops/min.

41. 2. If the above regimen fails then escalate the dose
of oxytocin to 100IU in a pint of 5% dextrose
saline at drip rate of 30drops/min.
b.Prostaglandins :-
1.It is more effective than oxytocin.
2. inj. 15 methyl PGF 2α (carboprostromethamine )
is given 250µg I/M at 3hrly. Interval for a maximum of
10 such.
3.Prostaglandins E1 analogue (Gemiprost pessary)is
inserted in to the posterior vaginal fornix every 3hours for a
maximum of 5 such.


42. DEFINITION :- “Any abortion associated with
clinical evidences of infection of the uterus and its
contents is called septic abortion” .
INCIDENCE :- it is10% of all abortions.
CAUSES:-
1. It is caused by micro-organisms involved in the
sepsis that are usually present in the vagina
(endogenous ).

43. 2. The micro-organisms are:
a.Anaerobic:
i. Bacteroides group(fragilis)
ii. Anaerobic streptococci
iii. Clostridium welchii
iv. Tetanus bacilli
b. Aerobic:
i. E.Coli
ii. Klebsiella
iii. Staphylococcus
iv. Pseudomonas, hemolytic streptococcus

44. 3. The increased association of sepsis in illegal induced
abortion is due to the fact that:
a. Proper antiseptic and asepsis are not taken.
b. Incomplete evacuation.
c. Inadvertent injury to the genital organs and adjacent
structures, particularly the gut.

45. 1.Pyrexia
2.Pain in abdomen
3.A rising pulse rate
4.Variable systemic and abdominal findings.
CLINICAL GRADING
Grade 1 :- The infection is localized in the uterus .
Grade 2 :- The infection spreads beyond the uterus to the
parametrium ,tubes and ovaries or pelvic peritoneum.
Grade 3 :- Generalized peritonitis and /or
endotoxic shock or jaundice or acute renal failure.

46. Routine investigation include
1.Cervical or high vaginal swab is taken prior to
internal examination for
2.Culture in aerobic and anaerobic media to finding out
the dominant micro- organisms.
3.Sensitivity of the micro-organism to antibiotics.
4.Smear for gram stain.
5.Blood for haemoglobin
6.WBC

47. 7.ABO and Rh grouping
8.Urine analysis including culture.
9.Special investigation :-
10.Ultrasonography
11.Blood test
12.Culture
13.Serum electrolytes
14.Coagulation profile

48. It is of two type :-
(1)Immediate (2) remote
IMMEDIATE
a. Hemorrhage.
b. Injury
c. Spread of infection
 Generalized peritonitis
 Perforation of the uterus.
 Injury to the gut
 Endotoxic shock
 Acute renal failure
 Thrombophlebitis.

49. 2. REMOTE COMPLICATIONS:
a. Chronic debility.
b. Chronic pelvic pain and backache.
c. Dyspareunia
d. Ectopic pregnancy
e. Emotional depression
f. Tubal blockage leads to secondary infertility.

50. 1.To boost up family planning acceptance in order to
curb the unwanted pregnancies.
2.To rigid enforcement of legalized abortion in practices
and to curd the pre valences of unsafe abortions.
3.To take antiseptic and aseptic precautions either during
internal examination or during operation in
spontaneous abortion.

51. General management :-
1.Hospitalization is essential for all cases of septic
abortion
2.the patient in isolation.
3.To take high vaginal or cervical swab for culture
,drug sensitivity test and gram stain .
4.Vaginal examination is done to note the state of the
abortion process and extension of the infection .if the
products are found loosely lying in the cervix ,it is
removed by an ovum forceps.

52. 4.Over assessment of the case is to be done and
the patient is leveled in accordance with the
clinical grading.
5.Investigation protocols as outlined before are done .

53.  To control sepsis.
 To remove the sources of infection .
 To give supportive therapy to bring back the normal
homeostatic and cellular metabolism.
 To assess the response of treatment.

54. 1. The management of patient with septic abortion depend
upon the severity of infection or sepsis.
2. Even a mild case of septic abortion is not to be
hospitalized.
3. Get the mother high vaginal or cervical swab culture, drug
sensitivity test and gram stains.
4. Perform vaginal examination to note the state of abortion.
if the products are found loosely lying in the cervix, they
should be removed by spong holding forcep.
5. Do overall assessment of the case and grading is done for
further treatment.
6. Get all the investigations done.
7. Formulate the line of treatment to control sepsis, remove
source of infection.

55. 8. Give the mother supportive therapy to bring back the
normal homeostatic and cellular metabolism.
9. In grade 1 or mild septic abortion the drug of choice or
abtibiotic used are capsule.
a. Ampicillin/Amoxicillin 500mg TDSx7days
b. cap. Cephadroxil 500mg BDx7days
c. cap. Chloromycetin 500mg 6hrly x 7days.
10. While giving cap. Chloromycetin blood test are done of
Hb,TLC,DLC and placenta.
11.In grade 1 prophylactically anti gas-gangrene serum of
8000units and 3000units of antitetanus serum are given I/M.

56. 12. Analgesics and sedatives are given as per the
prescription of the doctor.
13. To minimize oliguria, anemia or shock, blood
transfusion are done.
14. In grade-1 abortion, an incomplete evacuation should
be done within 24hrs. Following antibiotic therapy.
15. While doing currettage, practise gentelness to avoid
and minimize injury if any and spread of infection in
deeper tissues.
16. In grade-2 the drugs given are according to the type
of organisms, i.e. gram positive and gram negative.

57. FOR GRAM POSITIVE:
 inj. Aqueous penicilline G5 million unit every 6hrly
 Inj. Ampicillin 0.5-1gm IV every 6hrly
FOR GRAM NEGATIVE:
 inj. Gentamicin 1.5mg/kg every 8hrly
 Inj. Ceftriaxone 1.5mg,IV 12hrly
FOR ANAEROBES:
 inj. Metronidazole 500mg IV/8hrly
 Inj clindamycin 600mg IV/6hrly
17. Side by side note the vital signs of the mother
especially pulse, blood pressure and temperature.

58. 18. Evacuation of uterus is done by suction evacuation
within 6hrs of antibiotic therapy.
19. Laparotomy is done if the uterus or intestines are
injured.
20. If there is injured or infected uterus, hysterectomy is
done.
21. When the infection is localized in pouch of douglas,
then posterior colpotomy is done.
22. In grade-3, it is known as sever septic abortion along
with antibiotic therapy . The mother is resusitated and
fluid & electrolyte balance is maintained.

59.  Definition :- recurrent miscarriage is defined as a
sequences of three or more consecutive spontaneous
abortions before 20 weeks.
 Incidences :- The incidence of recurrent abortion is 0.4% to
2%
 ETIOLOGY:
 First trimester abortion
1.Genetic factors 6.Inherited thrombophilia
2.Endocrine and metabolic 7.Inherited thrombophilia
3.Infection 8.Immunological causes
4.Autoimmunity. 9.Alloimmunity.
5.Unexplained

60.  Second trimester abortion
1.Anatomic abnormalities :- the cause may be
congenital or acquired .
2.Congenital anomalies due to defects in mullerian duct
fusion or resorption.
3.Acquired anomalies are intrauterine adhesions,
uterine fibroid and endometriosis and cervical
incompetence’s.

61. 1.A through medical ,surgical and obstetric history is taken.
2. careful history taking should include:-
a. The nature of previous abortion process .
b. History of the placenta or karyo-typing of the
conceptus, if available .
c. Any chronic illness.
3. Blood glucose level checking
4. VDRL
5. Thyroid function test
6. ABO and Rh grouping

62. 7. Toxoplasma IgG and IgM.
8. Serum LH on D2/D3of cycle
9. Ultrasonography
10. Hysterosalphingography
11. Hysteroscopy or laproscopy
12. Karyotyping of husband & wife
13. Endocervical swab
14. Semen analysis

63. 1. The anxiety of mother is removed or alleviated.
2. If there are anatomic defects they are then corrected
surgically.
3. Hypothyroid state is treated by eltroxin
4. For syphilis, penicillin therapy is given
5. If there is uterine pathology then treat it, eg
a. Metroplasty for double or bicornuate uterus.
b. Removal of septum or myomectomy for submucous
fibroid distorting the uterine cavity.
6. Advice the couple for genetic counselling if there are
chromosomal abnormalities.

64. 7. Advice the mother to take proper rest i.e. for a period of
atleast 2 weeks beyond the expected time of abortion.
8. Advise the mother to avoid strenuous activities of
intercourse and travelling.
9. Ask the mother not to use these drug.
a. inj. Profasi- tab gestin-hCG5000-10000
b. inj. Proluton depot- tab. Duvadilan or yutopar
10. Patient with cervical incompetence is treated by cervical
suture operation, i.e. cerclage operation.
11. The operation is done around 14 weeks to 16weeks of
pregnancy.
12. In this non-absorable encircling suture is placed around
the cervix at level of internal orifice , the suture must be
removed at about 38th week.

65. 13. post-operatively the patient is given bed rest for 5-
7days and sedate by inj. Diazepam 10mg I/M or inj.
Pethidine hydrochloride 75mg 8hrly/for 48 hrs.
14 . The patient is given inj. Proluton depot 500mg I/M
every week for 4 week
15. Tab. Duvadilan 10mg is given TDS for 7days or
earlier if labor pain starts or features of abortion appear
16. Advice the mother to avoid sex, reassure her, clear
her all queries and allay her fear and anxiety.
17. Advice her for regular check-ups and follow up.

66. “It is the deliberate termination of pregnancy before the
viability of the fetus.”
Or
“Therapeutic abortion is evacuation of the uterus done by
qualified medical practitoners in the interest of mother’s life
or her total well being (usually done before 24 weeks of
gestation).”
The induced abortion may be:
1.Legal (MTP)
2. Illegal (criminal)
In India, induction of abortion is legalized by Medical
Termination of pregnancy act of 1971 and has been
enforced in the year April 1972. it was revised in 1975.

67. 1.When the continuation of pregnancy may involve
serious risk of life or grave injury to the physical and
mental health of the pregnant woman.
2.When there is risk of the child being born with
serious physical and mental abnormalities so as
to be handicapped in life.
3.When the pregnancy is caused by rape ,both in
cases of major and minor girl and in mentally
imbalanced women.
4. When the pregnancy is caused as result of
contraceptive failure.

68. Intra –amniotic :- intra-amniotic instillation of
hyper amniotic (20%) is less commonly used now
it is instilled through the abdominal route.
Procedure :- a fine polythene tube is passed
through the needle in to the amniotic sac followed
by withdrawal of the needle .the polythene tube is
connected with the drip set containing the required
amount of hypertonic saline .the amount of number
of weeks of gestation multiplied by 10mt .the amount is
to be infused slowly at the rate of 10l/mt.

69.  To be sure that the needle is in the amniotic cavity evidenced
by clear liquor coming out .if there is a bloody tap, the needle
should be pushed further or change the direction until ,clear
comes out . if fails ,the procedure is to be abandoned .
 The instillation should be a slow process (10l/min) .
 Vital signs should be checked immediately after the
instillation and she should be kept at bed rest for at least 1
hours.
 To stop the procedure if the untoward symptoms like acute
abdominal pain ,headache ,thirst or tingling in the fingers
appear.
 Strict vigilances is taken during and following instillation till
expulsion occurs.
 Routine antibiotic is given such as ampicillin 500mg thrice
daily for 3-5 days.

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