ABORTIONS

ABORTIONS
• Interruption of pregnancy or expulsion of the product of conception
before the fetus is viable is called abortion.
• The fetus is generally considered to be viable any time after the 5th to
6th month of gestation.
• Pathophysiology
• The most common cause of an abortion is abnormal fetal
development, which is either due to a chromosomal aberration or a
teratogenic factor.
• Another common cause is the abnormal implantation of the zygote,
where there is inadequate endometrial formation or the zygote was
implanted on an inappropriate site.
• This would cause inadequate development of the placental circulation,
leading to poor nutrition of the fetus and eventually, to an abortion.
Risk Factors

• Congenital Structural Defect. This structural defect may be due to chromosomal aberration or a

serious physical defect.
• Low Progesterone. Progesterone maintains the decidua basalis. If the corpus luteum fails to
produce enough progesterone, it would risk the life of the fetus inside the uterus.
• Rh Incompatibility. The fetus could get rejected from a mother’s body if they have an incompatible
Rh.
• Undernutrition. Lack of nutrients would cause undernourishment to both the mother and the fetus,
leading to abortion.
• Drugs. There are drugs which are contraindicated for pregnant women. Ingestion might compromise
the fetus and lead to abortion.
• Infection. In infection, the fetus would fail to grow and estrogen and progesterone production would
fall. This would lead to endometrial sloughing, then prostaglandins would be released leading to
uterine contractions and cervical dilatation along with expulsion of the products of pregnancy.
Types

• Several types of abortion are used to classify every case for a pregnant woman. Once
a thorough assessment is done, that would be the time that the type of abortion that
occurred could be established.
• Threatened abortion. The embryo is already viable. The products of conception are
still intact and the cervix is closed, but there is vaginal bleeding present.
• Inevitable/Imminent abortion. The embryo is dead with the products of conception
either intact or expelled. The cervix is already dilated and there is presence of vaginal
bleeding.
• Complete abortion. All products of conception are expelled and the embryo is dead.
The cervix is dilated, and there is mild bleeding.
• Incomplete abortion. The embryo is dead but some products of conception are still
intact. The cervix is already dilated and there is severe vaginal bleeding.
Types

• Missed abortion. The embryo is already dead while inside the uterus. The
products of conception are still intact and the cervix is closed. There are brown
vaginal discharges present.
• Recurrent/Habitual abortion. Abortion becomes recurrent once the woman has
had 3 consecutive miscarriages at the same gestational age.
• elective abortion. A voluntary induced termination of pregnancy is called an
elective abortion and is usually performed by skilled health care providers.
• Habitual or recurrent abortion is defined as successive, repeated, spontaneous
abortions of unknown cause. As many as 60% of abortions may result from
chromosomal anomalies. After two consecutive abortions, the patient is referred
for genetic counseling and testing and other possible causes are explored.
Precaution and management of H-A
• If bleeding occurs in a pregnant woman with a past history of habitual abortion, conservative
measures,
such as bed rest and
administration of progesterone to support the endometrium,
 Supportive counseling is crucial in this stressful condition.
 Bed rest,
sexual abstinence,
a light diet,
and no straining on defecation may be recommended in an effort to prevent
spontaneous abortion.
If infection is suspected, antibiotics may be prescribed.
a surgical procedure called cervical cerclage may be used to prevent the
cervix from dilating prematurely,
 although its effectiveness is unclear. It involves placing a purse-string
suture around the cervix at the level of the internal os.
 Bed rest is usually advised to keep the weight of the uterus off the cervix.
 About 2 to 3 weeks before term or at the onset of labor, the suture is cut.
 Delivery is usually by cesarean section.
signs and Symptoms

• The signs and symptoms of abortion must be identified first before ruling out any
other relative causes.
• Vaginal spotting. Vaginal spotting appears as small brownish to reddish spots of 
blood.
• Vaginal bleeding. Bleeding is a serious occurrence during pregnancy because it
might indicate that the cervix has opened and products of conception might be
expelled.
• Cramping/sharp/dull pain in the symphysis pubis. This could occur on both sides
that might cause cervical dilation.
• Uterine contractions. Uterine contractions can be false or true, but either of the two
could be alarming during the early stages of pregnancy because it could expel the
contents of the uterus thereby leading to abortion.
signs and Symptoms

• Pregnancy test. This is to confirm the pregnancy first if vaginal

bleeding occurs.
• If test turns out negative, then the woman would be subjected to other
diagnostic tests that could confirm the nature and cause of the vaginal
bleeding.
• If it is positive, then abortion would be considered and it would be
classified according to the presenting signs and symptoms.
• Ultrasound. The safest and confirmatory test for pregnancy,
• the ultrasound would be able to confirm if the pregnancy is positive,
and also confirm if the products of conception are still intact.
Medical Management

• Medical interventions should also be incorporated in the patient’s care plan to reinforce
his treatment.
• Aside from our own nursing management, physicians would also have to order a series
of therapeutic management for the pregnant woman.
Administration of intravenous fluids. 
• Lactated Ringer’s, Iv as well as administration of oxygen regulated at 6-10L/minute by
a face mask to replace intravascular fluid loss and provide adequate fetal oxygenation.
• Avoid vaginal examinations. The physician would also avoid further vaginal
examinations to avoid disturbing the products of conception or triggering cervical
dilatation.
• an ultrasound examination to glean more information about the fetal and also maternal
well-being.
Surgical Management

• Aside from the medical interventions , incidences might occur which would
lead to a surgical operation.
• Dilatation and evacuation. This is to make sure that all products of
conception would be removed from the uterus. However, before undergoing
this intervention, the physician must be sure that no fetal heart sounds could
be heard anymore and the ultrasound must show an empty uterus.
• Dilation and curettage. This is most commonly performed for incomplete
abortions to remove the remainder of the products of conception from the
uterus. Since the uterus would not be able to contract effectively, the
contents might be trapped inside and could cause serious bleeding and
infection.
Nursing Management

• Nurses must also have their own independent functions to ensure the safety and well-
being of the patient. The following are measures that would allow the nurse to act
independently.
Nursing Assessment
• The presenting symptom of an abortion is always vaginal spotting, and once this is
noticed by the pregnant woman, she should immediately notify her healthcare provider
• As nurses, we are always the first to receive the initial information so we should be
aware of the guidelines in assessing bleeding during pregnancy.
• Ask of the pregnant woman’s actions before the spotting or bleeding occurred and
identifies the measures she did when she first noticed the bleeding.
• Inquire of the duration and intensity of the bleeding or pain felt. Lastly, identify the
client’s blood type for cases of Rh incompatibility.
NURSING DIAGNOSIS
• Risk for deficient fluid volume related to bleeding during pregnancy
• Nursing Interventions
• If bleeding is profuse, place the woman flat in bed on her side and monitor
uterine contractions and fetal heart rate through an external monitor.
• Also measure intake and output to establish renal function and assess the
woman’s vital signs to establish maternal response to blood loss.
• Measure the maternal blood loss by saving and weighing the used pads.
• Save any tissue found in the pads because this might be a part of the
products of conception.
Evaluation

• The aim for evaluation is inclined towards restoring the maternal

blood volume and stopping the source of the bleeding.
• The client’s blood pressure must be maintained above 100/60 mmHg.
• The pulse rate should be below 100 beats per minute and the fetal
heart rate must be at a normal level of 120-160 beats per minute.
• The client’s urine output should be more than 30 mL/hr, and only
minimal bleeding should be apparent for not more than 24 hours.