AbortionAbortion

What is abortion?

An abortion is the premature exit of the

products of conception (the fetus, fetal membranes, and placenta) from the uterus. It is the loss of a pregnancy and does not refer to why that pregnancy was lost.

Types of AbortionTypes of Abortion

Spontaneous Abortion Induced Abortion

Threatened abortion Inevitable abortion Complete abortion Incomplete abortion Missed abortion

Types of spontaneous abortion:

Menstrual Extraction (endometrial or vacuum aspiration)

Dilation and Evacuation (D & E) (also called vacuum suction or suction curettage) and Dilation and Curettage (D & C). 

Prostaglandin or Saline Administration

Hysterotomy

Types of induced abortion:

The most frequent cause of miscarriage is abnormal fetal formation, due to either to a teratogenic factor or a chromosomal abberation.

Poor maternal nutritional statusIn others, immunologic factors may

be .present or rejection of the embryo through an immune response.

It also involves the implantation abnormalities.

Etiology

It also occurs if the corpus luteum fails to produce enough progesterone to maintain the decidua basalis.

Infection such as rubella, syphilis, poliomyelitis, cytomegalovirus and toxoplasmiosis can also cause abortion.

Ingestion of teratogenic drugs can cause abortion.

•Uterine cramping, low back pain.•Vaginal bleeding usually begins as dark spotting, then progresses to frank bleeding as the embryo separates from the uterus.•ß-hCG level may be elevated for as long as 2 weeks after loss of the embryo.

Clinical Manifestations

Diagnostic EvaluationDiagnostic Evaluation

Ultrasonic evaluation of the gestational sac or embryo

Visualization of the cervix; presence of dilatation or tissue evaluated

ComplicationsComplicationsUterine infectionSepticemiaHemorrhageDisseminated Intravascular

Coagulation(DIC) in missed abortion.

Abnormal Fetal

Formation

Immunologic Factors

Infection

Teratogenic Factors

(smoking, alcohol, drugs)

Rejection of the embryo

through immunologic

response

Crosses placenta

Fetus fails to grow

Decrease estrogen and progesterone production

Endometrial sloughing

Release of prostaglandin which causes

uterine contractions and

cervical dilatation

Miscarriag

e

Schematic Diagram of Abortion

Nursing Diagnoses

Nursing Diagnosis

•Risk for fluid volume deficit r/t maternal bleeding

Nursing Interventions

•Report any tachycardia, hypotension, diaphoresis, or pallor, indicating hemorrhage and shock.•Draw blood for type and screen for possible blood administration.•Establish and maintain an IV with large-bore catheter for possible transfusion and large quantities of fluid replacement.

•Anticipatory grieving r/t loss of pregnancy, cause of abortion, future childbearing

Nursing Diagnosis

Nursing Interventions

•Assess the reaction of patient and support person, and provide information regarding current status, as needed.•Encourage the patient to discuss feelings about the loss of the baby’ include effects on relationship with the father.•Do not minimize the loss by focusing on future childbearing; rather acknowledge the loss and allow grieving. •Providing time alone for the couple to discuss their feelings.

Nursing Diagnosis

•Risk for infection r/t dilated cervix and open uterine vessels

Nursing Interventions

•Evaluate temperature q 4H if normal, and every 2H if elevated.•Check vaginal drainage for increased amount and odor, which may indicate infection.•Instruct on and encourage perineal care after each urination and defecation to prevent contamination.

• Acute pain r/t uterine cramping and possible procedures

Nursing Diagnosis

Nursing Interventions

•Instruct patient on the cause of pain to decrease anxiety.•Instruct and encourage the use of relaxation techniques to augment analgesics.•Administer pain medication as needed and as prescribed.

Nursing Diagnosis

Nursing Interventions

•Knowledge deficit r/t signs and symptoms of possible complications

•Teach the woman to observe for signs of infection (fever, pelvic pain, change in character and amount of vaginal discharge), and advise to report them to provider immediately.•Deal with client’s anxiety. Present information out of sequence, if necessary, dealing first with material that is most anxiety producing when the anxiety is interfering with the client’s learning process.•Teach client of the complications for a mother has reason to be especially worried about her infant’s health.