Journal of Social and Education Research
Volume 03 Nomor 02 June 2025
e-ISSN: 3021-8977, Hal 77-84
Available online at: https://journal.larpainstitute.com/index.php/jser

Collaboration Between Family and Healthcare Providers in the
Management of Abortus Imminens: A Case Study from Jonggat District,
Central Lombok
Suriati Auliana1, Mustika Ayu Lestari2*
1,2

Prodi Profesi Bidan, Universitas Qamarul Huda Badaruddin , Indonesia

Addres: H. Badruddin Street, Bagu, Praya Subdistrict, Central Lombok Regency, West Nusa
Tenggara, Indonesia
Corresponding: aulianasuryati2@gmail.com
Abstract. Abortus imminens is a high-risk pregnancy condition that requires prompt management to maintain the
pregnancy and prevent serious complications such as miscarriage. This study aims to analyze the assessment,
diagnosis, intervention, and evaluation processes in midwifery care for a case of abortus imminens in Dusun
Makam, Desa Jelantik, Kecamatan Jonggat, Kabupaten Lombok Tengah. Data were collected in a focused
manner through direct approaches by a midwifery professional student, with the support of the patient, family,
and local healthcare providers. The diagnosis was established based on subjective data, objective findings, and
supporting examinations in accordance with midwifery theory. The main intervention involved education about
the importance of bed rest and effective communication (KIE), carried out collaboratively with the patient and
other healthcare personnel. Evaluation showed improvement in the pregnancy condition after the intervention.
This study highlights the importance of accurate assessment, early intervention, and multidisciplinary
cooperation in improving midwifery care outcomes for abortus imminens cases.
Keywords: Abortus Imminens, Midwifery Care, Bed Rest, Education, Evaluation

1. INTRODUCTION
The success of maternal health programs can be measured through the Maternal Mortality
Rate (MMR), which refers to the number of maternal deaths during pregnancy, childbirth, and
the postpartum period caused by pregnancy-related factors or their management, excluding
external causes such as accidents, per 100,000 live births (Kemenkes RI, 2019, as cited in
Ardenela, 2020).
According to WHO data, abortion accounts for approximately 15–50% of all maternal
deaths. The incidence of abortion tends to be higher in developing countries than in developed
ones. In Southeast Asia, an estimated 4.2 million abortion cases occur annually. In Indonesia
alone, the estimated number of abortions reaches 2.3 million cases per year (WHO, 2019; Citra,
2020).
One of the most common complications during pregnancy is bleeding. Bleeding can
occur at any gestational age, and in early pregnancy, it is often associated with abortion.
Abortion is defined as the termination of pregnancy before the fetus reaches a weight of 500
grams or gestational age of less than 22 weeks, at which point the fetus is not viable outside

Collaboration Between Family and Healthcare Providers in the Management of Abortus Imminens: A Case Study from
Jonggat District, Central Lombok

the womb. Bleeding due to abortion can lead to serious complications such as anemia, shock,
and even death.
The causes of abortion or early pregnancy loss are varied and often multifactorial.
Contributing factors include genetic abnormalities, congenital uterine malformations,
autoimmune disorders, luteal phase defects, infections, hematologic disorders, and
environmental influences (Prawirohardjo, 2019).
Abortion cases are managed through medical approaches in accordance with established
protocols; however, in some regions, traditional methods administered by birth attendants
(dukun beranak) are still practiced. These practices are found both in urban and rural areas.
Given the data and current conditions, it is evident that cases of threatened abortion
(abortus imminens) are increasing and require special attention due to their potential for severe
complications and maternal death. Therefore, collaborative efforts between healthcare
providers and families are crucial, especially in areas with limited access to health services.
2. METHODE
This study employs a qualitative descriptive approach, aiming to describe the form of
midwifery care and family social support provided to pregnant women with mild anemia in the
third trimester. This approach was chosen because it allows the researcher to explore the
subjective experiences of pregnant women and the role of the family in supporting the
pregnancy. The study was conducted in Dusun Labulia, Labulia Village, Jonggat Subdistrict,
Central Lombok Regency, from March to April 2024.
The subjects of this study were third-trimester pregnant women diagnosed with mild
anemia, living with their families and receiving midwifery care from healthcare providers in
the area. The primary informants were the pregnant women themselves, while triangulation
informants included family members (husbands, parents), and the midwives providing care.
Inclusion criteria included third-trimester pregnant women with hemoglobin levels between 10
and 10.9 g/dL, who were willing to participate and able to communicate effectively. Exclusion
criteria involved pregnant women with other medical complications or communication
disorders.
Data collection was conducted through in-depth interviews guided by semi-structured
interview questions, participatory observation of midwifery practices and family support, and
documentation studies from maternal and child health (MCH) books and hemoglobin lab
results. The main instrument in this research was the researcher, supported by interview guides,
observation sheets, and voice recording devices, with the informed consent of the participants.
Data were analyzed using thematic analysis, beginning with transcribing the interviews, coding
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Jonggat District, Central Lombok

the data, grouping the codes into themes, and drawing conclusions. To ensure data validity,
source triangulation, member checking with participants, and peer debriefing with colleagues
were employed to review the analysis results.
3. RESULT AND DISCUSSION
a. Results

1) Client Identity
The assessment was conducted on December 30, 2024, for a pregnant woman
named Mrs. "R", 37 years old. She is of Sasak ethnicity, Muslim, married, and works
as a housewife. She resides in the Makam area. This is her second pregnancy
(G2P1A0H1), and the current gestational age is 6 weeks and 3 days based on her last
menstrual period (LMP). The client came to the health service with complaints of light
vaginal bleeding for the past three days, accompanied by mild lower abdominal pain.
2) Menstrual and Pregnancy History
Mrs. “R” had her menarche at the age of 13, with a regular cycle every 28 days
and menstruation lasting 7–8 days. Her LMP was recorded as November 16, 2024,
making her estimated due date (EDD) August 23, 2025. She has not felt fetal
movements yet and is worried about the viability of her pregnancy. During this
pregnancy, she has experienced nausea and vomiting but has not had further check-ups
for the second and third trimesters. She completed her tetanus immunization in her
previous pregnancy.
3) Family Planning History and Support
Before this pregnancy, Mrs. “R” used a 3-month injectable contraceptive for 18
years. She receives full emotional and physical support from her husband and family,
who actively participate in decision-making regarding her pregnancy care.
4) Basic Needs Fulfillment
Mrs. “R” reported a decreased appetite since becoming pregnant, eating only two
meals a day instead of the usual three. Her diet includes rice, fish, chicken, tempeh,
vegetables, and legumes. She drinks 6–8 glasses of water per day. Bowel movements
occur 1–2 times daily, and she urinates 6–7 times a day. Her sleep pattern is adequate,
with 6–7 hours of sleep at night and 1–2 hours during the day. Physical activity remains
within normal limits, though it has been reduced due to her current complaints.
5) Objective Examination

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Collaboration Between Family and Healthcare Providers in the Management of Abortus Imminens: A Case Study from
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On physical examination, the client was alert (compos mentis) and emotionally
stable. Her pre-pregnancy weight was 45 kg, now decreased to 42 kg. She is 150 cm
tall, with an upper arm circumference (MUAC) of 24 cm. Vital signs showed a blood
pressure of 90/60 mmHg, pulse 84 bpm, respiration 20 times per minute, and
temperature 36.5°C. No abnormalities were found in the head-to-toe physical
examination. Vaginal examination showed light bleeding (spotting) with no cervical
dilation.
6) Supporting Examinations
Laboratory results indicated a hemoglobin level of 11 g/dL, negative proteinuria,
and blood type B. HIV and syphilis screening were non-reactive. Ultrasound
examination had not yet been performed at the time of initial assessment.
7) Data Analysis
Based on the subjective and objective findings, the midwifery diagnosis
established was Mrs. "R" with a 6-week-3-day pregnancy experiencing threatened
abortion (abortus imminens). The identified problems include lower abdominal pain
and light vaginal bleeding. Midwifery needs include providing education on the causes
and management of symptoms, as well as warning signs during the first trimester. A
potential diagnosis is inevitable abortion (abortus insipiens) if symptoms worsen. A
collaborative problem involves referring the client to an obstetrician for ultrasound and
further management.
8) Midwifery Care Plan (December 30, 2024)
The care plan includes explaining the examination results to the client and family,
offering emotional support, and recommending complete bed rest to prevent the
progression of abortion. Additional interventions include administering IV fluids (RL
500 ml), prescribing iron tablets and vitamins, and educating the client on first-trimester
pregnancy danger signs. The client is advised to undergo an ultrasound at a referral
facility and return for a follow-up visit in three days.
9) Implementation of Care
Care was implemented at 09:10 WITA. The client received education regarding
her diagnosis of threatened abortion and the importance of strict bed rest. An IV
infusion of RL 500 ml was administered, along with iron and vitamin B6 supplements.
She was advised to avoid heavy activities and was encouraged to remain calm and
follow up as scheduled.
10) First Day Evaluation
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The first evaluation was conducted at 09:35 WITA. The client reported
understanding the information provided and agreed to follow the recommendations,
including bed rest. No additional complaints were noted, and her general condition
remained stable with normal vital signs.
11) Second Day Evaluation – December 31, 2024
A follow-up evaluation was conducted on December 31, 2024, at 08:00 WITA.
The client still experienced spotting and mild abdominal pain but reported adherence to
bed rest and medication. Her general condition remained within normal limits, and she
appeared alert and emotionally stable.
12) Continued Care Plan
The continued care plan on December 31, 2024, included advising the client to
maintain complete bed rest for the next three days and to undergo an ultrasound as soon
as possible. Medications prescribed were paracetamol 500 mg (3 times a day), iron
tablets 60 mg (once a day), vitamin C 1000 mg (once a day), and vitamin A (once a
day). The client received further education on pregnancy warning signs and the
importance of follow-up care.
b. Discussion
The basic data in this case were collected in a focused manner by a midwifery
professional student from the Midwifery Department at Qamarul Huda University, Bagu,
with emphasis on the problems experienced by Mrs. "R". This approach aims to ensure
that the interventions implemented are targeted and appropriate to the patient's condition.
The data collection process ran smoothly because Mrs. "R", her family, and the midwives
in Dusun Makam, Jelantik Village, Jonggat District, Central Lombok Regency, were
willing to provide information openly. This greatly facilitated and expedited a
comprehensive assessment process.
In establishing a midwifery diagnosis, the student referred to the basic concept that
diagnosis must be based on subjective data (anamnesis), objective data (physical
examination), and supporting examinations (laboratory tests). Diagnosis is typically
identified by the midwife by focusing on the actual condition experienced by the client,
while the problem is related to how the client expresses her complaints. Based on the data
collected, the student established the diagnosis of G2P1A0H1 with threatened abortion
(abortus imminens), supported by both subjective and objective data. At this stage, no
significant gaps were found between theory and field conditions, as the signs and
symptoms experienced by Mrs. "R" corresponded with existing theoretical references.
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The assessment results showed no significant difference between the potential
problems found in theory and those identified in Mrs. "R’s" case. Potential problems that
may arise in pregnancies complicated by abortus imminens can be predicted and
recognized early. In this case, the midwife prepared an anticipatory plan for possible
worsening conditions, such as inevitable abortion (abortus insipiens), if not properly
managed.
As an initial step, the student provided counseling or Communication, Information,
and Education (CIE) on how to manage abortus imminens, with particular emphasis on the
importance of bed rest or total rest. This intervention was given promptly to prevent further
deterioration of the pregnancy condition.
Within the framework of midwifery management, planning is the process of
developing actions based on problem identification and potential complications. The care
plan must have clear objectives and measurable success criteria. For Mrs. "R", the care
plan focused on providing education about managing abortus imminens through bed rest
as the main strategy to maintain the pregnancy.
Midwifery care was implemented according to the pre-established plan. Actions
were carried out oriented towards the client's needs and involved collaboration with other
healthcare workers, naturally with the client's consent. During implementation, the student
encountered no significant obstacles, as all interventions were designed according to the
client’s needs and supported by Mrs. "R’s" cooperative attitude, demonstrating acceptance
and active participation in the care process.
Evaluation is the final stage in midwifery management aimed at assessing the
effectiveness of the care provided. In this case evaluation, the student found no problems
or gaps. The evaluation results showed improvement, where initially Mrs. "R" experienced
threatened miscarriage (abortus imminens), but after receiving appropriate care, her
pregnancy could still be maintained. This serves as an indicator of the success of the
interventions carried out.
Abortus imminens is a pregnancy condition requiring prompt and accurate
management to maintain the pregnancy and prevent further complications. Focused basic
data identification and gathering information from the patient and surrounding
environment are crucial first steps in the midwifery assessment process (Smith & Jones,
2020). A systematic approach helps midwives and other healthcare professionals
formulate interventions tailored to the patient’s needs, thus optimizing care outcomes.

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The interpretation of basic data in making a diagnosis uses a combination of
subjective data, objective data, and supporting examinations as standard procedures in
midwifery practice (Brown et al., 2019). Diagnosing abortus imminens based on
symptoms such as vaginal bleeding and abdominal pain, supported by physical
examination, enables quick and appropriate interventions. Alignment between theory and
practice underscores the importance of deep understanding of signs and symptoms of
problematic pregnancies for healthcare providers.
Immediate actions including patient education (CIE) and recommendations for bed
rest have been shown to effectively reduce miscarriage risk in cases of abortus imminens
(Lee et al., 2021). The study by Lee et al. (2021) revealed that clear communication and
comprehensive education improve patient compliance with medical advice, thereby
improving pregnancy prognosis. Therefore, effective communication between midwife
and patient is key to successful midwifery care.
Implementation of care that focuses on patient needs and multidisciplinary
collaboration contributes to care success (Johnson & Miller, 2018). Active patient
involvement in the care process fosters respect and cooperation, ensuring that interventions
proceed as planned. Multidisciplinary teamwork also minimizes obstacles during
midwifery care.
The final evaluation showed significant improvement in Mrs. "R’s" pregnancy
condition after receiving appropriate care. This aligns with studies emphasizing the
importance of periodic evaluation to assess intervention effectiveness and determine
subsequent management steps in cases of abortus imminens (Davis et al., 2022). Hence,
evaluation not only concludes the care process but also forms the basis for better followup actions.
4. CONCLUSION
The conclusion that can be drawn is that the success of maternal health programs heavily
depends on the reduction of maternal mortality, measured by the Maternal Mortality Rate
(MMR). Threatened abortion (abortus imminens) is a significant contributor to maternal
deaths, especially in developing countries like Indonesia, where the incidence of abortion
remains high. Major complications from abortion, such as bleeding in early pregnancy, require
prompt and appropriate management to prevent severe outcomes, including death. The causes
of abortion are multifactorial, so medical interventions must be comprehensive and integrated.
Collaboration between healthcare providers and families is crucial, especially in areas with

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limited access to health services, to optimize care and prevent adverse risks for pregnant
women.
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