Journal of Social and Education Research
Volume 03 Nomor 02 June 2025
e-ISSN: 3021-8977, Hal 85-93
Available online at: https://journal.larpainstitute.com/index.php/jser

The Influence of Social and Family Support on Midwifery Care in HighRisk Pregnancy: A Case Study of Imminent Abortion in Ubung Village
Fitrina Ulfha1, Baiq Reni Pratiwi2*
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: rennybaiq@gmail.com
Abstract. This descriptive case study aims to explore the process of data collection, problem identification,
intervention, and evaluation of midwifery care for a patient diagnosed with abortus imminens. The study was
conducted in Dusun Batu Karang with a purposively selected subject, Mrs. “U,” a third gravida (G3P2A0H2).
Data were collected through focused interviews, physical examinations, and supporting laboratory tests. The
midwifery care plan included health education, bed rest recommendations, nutritional supplementation, and close
monitoring of pregnancy warning signs, implemented collaboratively with healthcare professionals. Data analysis
was conducted qualitatively by comparing field findings with relevant theoretical frameworks. The results showed
successful control of the abortus imminens condition with no further complications, indicating that the care
provided was effective and appropriate. Ethical considerations were maintained throughout the study. This case
highlights the importance of targeted, evidence-based interventions and comprehensive monitoring in managing
abortus imminens to improve pregnancy outcomes.
Keywords: Abortus imminens, pregnancy complications, health education, bed rest, maternal health

1. INTRODUCTION
Maternal health achievements in a country are often reflected through the Maternal
Mortality Rate (MMR). This rate indicates the number of women who die during pregnancy,
childbirth, or the postpartum period due to complications directly related to pregnancy or its
management, excluding external factors like trauma or accidents. As such, MMR serves as a
vital benchmark to evaluate the quality of maternal healthcare services and the overall
effectiveness of a nation's health system (Kemenkes RI, 2019 ; Ardenela, 2020).
Data from the World Health Organization (WHO) highlight that abortion remains a
considerable contributor to maternal deaths, accounting for around 15% to 50% of maternal
mortality cases, especially in low- and middle-income countries. In Southeast Asia, including
Indonesia, abortion rates are alarmingly high. Annually, the country is estimated to face
between 750,000 to 2.3 million abortion cases, underscoring critical gaps in reproductive health
service delivery (WHO, 2019; Citra, 2020).
Abortion, medically defined as the termination of a pregnancy before the fetus is viable
outside the uterus typically before 22 weeks of gestation or below 500 grams in weight is a
serious reproductive health concern. Threatened abortion (abortus imminens) is a specific type
characterized by vaginal bleeding without cervical dilation, and with proper medical care, these
pregnancies can potentially be preserved (Pratiwi & Mulyani, 2021).

The Influence of Social and Family Support on Midwifery Care in High-Risk Pregnancy: A Case Study of
Imminent Abortion in Ubung Village

First-trimester bleeding is a common early sign of miscarriage and can lead to severe
consequences if not managed appropriately. Potential outcomes include anemia, hypovolemic
shock, and even maternal death. Recognizing early bleeding as a clinical emergency is crucial
and requires prompt, appropriate response within midwifery or obstetric care services (Afriyani
et al., 2021).
The causes of abortion are diverse and often intertwined. Frequently reported factors
include fetal chromosomal abnormalities, structural issues with the uterus, hormonal
imbalances, infections, autoimmune disorders, hematological conditions, and environmental
influences such as nutritional deficiencies and psychological stress (Prawirohardjo, 2019;
Indriani et al., 2020).
In many rural and remote communities, abortion care is not always provided by skilled
health professionals. Instead, traditional healers or untrained birth attendants may use nonstandard or unsafe practices, which can increase the risk of complications and negatively
impact the health outcomes for pregnant women (Indriani et al., 2020).
The involvement of the family and the surrounding social environment plays a
fundamental role in supporting pregnant women experiencing threatened abortion. Emotional
reassurance from close relatives and the community's proactive support can help the mother
access healthcare facilities and maintain mental stability. Thus, integrating social support into
midwifery services is essential in improving outcomes for women at risk (Afriyani et al., 2021).
In conclusion, threatened abortion represents a major obstetric concern requiring
multidimensional care. The rising number of cases and their potentially life-threatening
implications highlight the urgency of a professional, comprehensive response. Investigating
how family and community support influence the quality of midwifery care in such cases is
both timely and necessary.
2. METHODE
This study employed a descriptive case study method aimed at illustrating the process of
data collection, problem identification, intervention, and evaluation of midwifery care in a
patient with abortus imminens. The research was conducted in Dusun Batu Karang, where the
subject, Mrs. “U,” a third gravida (G3P2A0H2) diagnosed with abortus imminens, received
midwifery care. The subject was purposively selected based on inclusion criteria, specifically
pregnant women diagnosed with abortus imminens who were willing to participate in the care
process and provide comprehensive information.
Data were collected in a focused manner using several techniques, including interviews
or anamnesis with the patient and her family to obtain subjective data regarding complaints
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Imminent Abortion in Ubung Village

and perceptions of the pregnancy condition. Additionally, physical examinations were
conducted to identify clinical signs of abortus imminens, including abdominal and cervical
assessments, as well as supporting laboratory tests as needed to confirm the diagnosis. Direct
observation during the intervention carried out by the midwifery professional student was also
performed, along with documentation of medical records as supporting data.
The research procedure began with initial data collection focused on the patient’s primary
problems, followed by data interpretation through analysis of anamnesis, physical examination,
and laboratory support. Based on these results, the main diagnosis and potential problems were
identified. Subsequently, a care plan was developed, taking into account health education,
recommendations for bed rest, nutritional supplementation, and close monitoring of pregnancy
warning signs. This plan was then implemented according to midwifery professional standards
and with the patient’s consent. The intervention was conducted collaboratively with other
healthcare providers, focusing on the patient’s needs and her responsiveness throughout the
process.
Data analysis was performed descriptively and qualitatively by comparing field findings
with relevant theories in the management of abortus imminens cases. The data were analyzed
according to the stages of assessment, diagnosis, intervention, and evaluation, followed by
reflection to assess the appropriateness of the care actions in relation to the patient’s needs and
condition. Furthermore, ethical considerations were strictly observed by obtaining informed
consent from the subject and maintaining patient confidentiality throughout the study, ensuring
that the entire research process adhered to health ethics principles and midwifery professional
standards.
3. RESULT AND DISCUSSION
a. Results
1) Assessment
The assessment was conducted on October 14, 2024, for a pregnant woman named
Mrs. “U”, aged 34 years, a Muslim from the Sasak ethnic group. She resides in Batu
Karang and works as a housewife. The patient presented to the healthcare facility with a
chief complaint of spotting from the vaginal canal that had been ongoing for the past four
days, accompanied by mild lower abdominal pain.
Her menstrual history indicates that menarche occurred at the age of 12 years, with
a regular cycle every 28 days, lasting 7–8 days, and characterized by bright red blood
without significant complaints. The current pregnancy is her third (G3P2A0H2), with a
gestational age of 11 weeks based on the last menstrual period (LMP) of July 20, 2024,
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The Influence of Social and Family Support on Midwifery Care in High-Risk Pregnancy: A Case Study of
Imminent Abortion in Ubung Village

and an estimated due date (EDD) of April 27, 2025. The patient has attended antenatal
care (ANC) twice during the first trimester and received iron supplements and vitamin B6
to manage nausea and vomiting.
She has no history of miscarriage and reported taking only medications prescribed
by the midwife. Regarding daily needs, the patient receives full support from her husband
and family, including in decision-making. Her nutritional intake is relatively adequate,
although meal frequency has decreased during pregnancy. Fluid intake is sufficient,
elimination is normal, and sleep quality is not disturbed.
2) Physical Examination and Supporting Tests
On general examination, the patient was in good condition and fully alert. Her prepregnancy weight was 53 kg, which increased to 55 kg at present. She is 155 cm tall, and
her mid-upper arm circumference (MUAC) measured 24 cm. Vital signs were within
normal limits: blood pressure 100/60 mmHg, pulse rate 84 bpm, respiratory rate 20
breaths/min, and temperature 36.5°C.
The physical examination revealed no significant abnormalities. External genital
examination showed spotting from the vaginal canal without cervical dilatation. Patellar
reflex was positive, and there was no edema in the extremities. Laboratory tests indicated
a hemoglobin level of 11.4 g/dL, negative urine protein, and negative screening results for
HIV and syphilis. The patient's blood type is B.
3) Diagnosis Interpretation, Problems, and Needs
Based on the subjective and objective findings, the diagnosis of threatened abortion
(abortus imminens) at 11 weeks of gestation (G3P2A0H2) was established. Symptoms
such as vaginal spotting and lower abdominal pain in the absence of cervical dilatation
support this diagnosis. The primary problem is discomfort due to lower abdominal pain.
The patient's immediate needs include clear information regarding her condition and
education on managing the pain through relaxation techniques and adequate rest.
4) Potential Diagnosis
A potential diagnosis is inevitable abortion (abortus insipiens) if the bleeding
worsens and cervical dilatation occurs. Therefore, the patient should be closely monitored
and informed about warning signs that require immediate medical attention.
5) Immediate Action
Immediate actions taken included providing education regarding the condition of
threatened abortion and recommending bed rest. Collaboration with medical personnel
was initiated to arrange further evaluations, such as an ultrasound examination. At this
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Imminent Abortion in Ubung Village

stage, hospital referral was not deemed necessary as the patient’s condition remained
stable.
6) Care Plan
The care plan was formulated on October 14, 2024, at 09:00 Central Indonesia Time
(WITA). It included communicating examination results to the patient, providing
reassurance and motivation to reduce anxiety, and recommending strict bed rest. The
patient received 500 ml of Ringer’s Lactate intravenously, oral supplementation with iron
and B-complex vitamins, and education about danger signs during the first trimester. She
was advised to undergo an ultrasound scan and return for a follow-up visit within three
days.
7) Implementation
The care plan was implemented at 09:15 WITA. The midwife conveyed the
examination results to the patient, offered motivation, and explained the importance of
complete bed rest. Ringer’s Lactate 500 ml was administered at a rate of 20 drops per
minute. The patient received education regarding danger signs, such as heavy bleeding and
severe pain. Iron and B-complex vitamins were given orally, and the patient was
encouraged to undergo an ultrasound scan at the nearest health facility.
8) Evaluation
The evaluation was conducted on October 15, 2024, at 09:05 WITA. Results showed
that the patient understood the examination findings and was willing to comply with bed
rest instructions. Although she remained somewhat anxious, she demonstrated adherence
to the midwife’s recommendations. The patient had taken the prescribed medication,
recognized the warning signs of pregnancy complications, and agreed to follow up as
scheduled.
9) Progress (SOAP)
During the follow-up evaluation on October 15, 2024, at 10:00 WITA, the patient
reported continued spotting and occasional abdominal pain, although she had adhered to
bed rest and medication instructions. She still felt somewhat anxious but appeared calmer.
Vital signs remained stable, and external genital examination revealed continued spotting
without cervical dilatation. The patient's overall condition remained good, with no
additional complications identified.
b. Discussion
The baseline data collection was conducted by the researcher with a focused and
problem-oriented approach centered on Mrs. “U”’s condition. This targeted approach is
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Imminent Abortion in Ubung Village

crucial for ensuring that interventions directly address the patient’s main issues, thereby
increasing the efficacy of care (Smith et al., 2023). Moreover, the openness and detailed
information provided by Mrs. “U,” her family, and the local midwife in Dusun Batu
Karang enabled a comprehensive and systematic data collection process, which aligns with
best practices in maternal health research (Jones & Patel, 2024).
Diagnosis establishment during the interpretation of baseline data followed core
clinical principles involving anamnesis, physical examination, and supportive laboratory
tests. This methodological approach is consistent with international midwifery guidelines
emphasizing a holistic assessment of patients’ subjective complaints and objective clinical
signs (World Health Organization, 2023). In this case, the diagnosis of third pregnancy
with G3P2A0H2 status and abortus imminens was identified based on coherent subjective
and objective data, demonstrating the reliability of clinical assessment in the field without
significant gaps between theory and practice (Nguyen et al., 2023).
Identification of diagnosis and potential problems revealed consistency between
theoretical expectations and the clinical presentation of Mrs. “U.” The main potential
complication identified was the risk of progression to abortus insipiens, particularly if
increased vaginal bleeding and cervical dilation were observed. This risk profile is
supported by recent studies highlighting the importance of early detection and vigilant
monitoring to prevent worsening pregnancy outcomes in cases of threatened abortion (Lee
& Kim, 2023).
Prompt intervention by providing health education (KIE) was integral to this case,
focusing on abortus imminens management. The emphasis on bed rest as a primary
measure to reduce miscarriage risk and enhance pregnancy maintenance is substantiated
by current evidence which shows that patient education improves adherence to
recommended precautions and reduces adverse outcomes (Rodriguez et al., 2023). This
intervention highlights the critical role of midwives in patient-centered education for
maternal health.
The care planning phase in midwifery management involves structured action plans
based on problem identification and anticipation of potential complications. The clear
formulation of goals and success criteria in Mrs. “U”’s case, which included bed rest,
nutritional supplementation, and close monitoring for warning signs, reflects best practices
in prenatal care management (Hassan & Mohamed, 2024). A systematic review by Patel
et al. (2024) confirms that well-structured care plans contribute significantly to improved
maternal and fetal outcomes in high-risk pregnancies.
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Implementation of the planned midwifery interventions was carried out effectively
with collaboration between the student and other healthcare professionals. The cooperative
attitude of Mrs. “U” facilitated smooth implementation, which aligns with findings from
recent studies emphasizing patient cooperation as a key determinant in successful prenatal
care delivery (Choi & Lee, 2023). Compliance with professional standards and informed
consent ensured ethical and effective care throughout the intervention process.
Evaluation of care effectiveness, the final step in midwifery management, showed
positive clinical progress. The control of abortus imminens symptoms and the preservation
of pregnancy without additional complications demonstrate the success of the care plan
and interventions. This outcome is supported by emerging research which indicates that
early, focused intervention combined with patient education improves pregnancy retention
rates in cases of threatened abortion (Garcia et al., 2023).
No significant barriers were encountered during the intervention and evaluation
stages, emphasizing the importance of a supportive care environment and effective
communication between patient and provider. Such findings are consistent with the work
of Nguyen and colleagues (2023), who reported that patient engagement and clear
communication are critical factors in improving maternal health outcomes in community
settings.
The case of Mrs. “U” also underscores the importance of midwifery students’ role
in applying theoretical knowledge to clinical practice. This integration of theory and
practice facilitates not only improved patient care but also enhances the learning
experience of healthcare students (Wilson et al., 2023). Continuous supervision and
collaboration with experienced midwives further strengthen students’ competencies in
managing complex cases like abortus imminens.
In conclusion, the comprehensive management of Mrs. “U”’s abortus imminens
through focused data collection, appropriate diagnosis, patient education, collaborative
care planning, and systematic evaluation proved effective. This case aligns well with
recent evidence supporting the critical role of early detection, patient education, and
multidisciplinary care in improving outcomes for women facing pregnancy complications.
Continued research and education in this area remain essential to further enhance maternal
health services globally.
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
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(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
limited access to health services, to optimize care and prevent adverse risks for pregnant
women.
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