ABORTION

INTRODUCTION:
Abortion is the termination of a pregnancy by removal or expulsion of
an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or
"spontaneous abortion". These occur in approximately 30% to 40% of all pregnancies. When
deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less
frequently "induced miscarriage". The unmodified word abortion generally refers to an
induced abortion. The most common reasons women give for having an abortion are for
birth-timing and limiting family size. Other reasons reported include maternal health, an
inability to afford a child, domestic violence, lack of support, feeling they are too young,
wishing to complete education or advance a career, and not being able or willing to raise a
child conceived as a result of rape or incest.

DEFINITION:
Abortion is a medical term for the disruption of a pregnancy before the fetus reaches its
viable age of more than 20 to 24 weeks of gestation or weighs at least 500g

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
There are always precipitating factors for every condition. Here are the risk factors that
concerns abortion:

 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.

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  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.
 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.

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  Recurrent/Habitual abortion: Abortion becomes recurrent once the woman has
had 3 consecutive miscarriages at the same gestational age.

SIGN AND SYMPTOMS:

As nurses, we are tasked with assessing our patient to provide baseline and accurate
information to other caregivers. 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 coming out of the woman’s vaginal opening. This usually occurs when the
cervix slightly dilates because the woman may have tried to lift heavy objects or mild
trauma to the abdomen occurred.
 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 and could be caused by trauma or premature contractions that might cause
cervical dilation.
 Uterine contractions felt by the mother: 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.

DIAGNOSTIC TESTS

 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

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 Medical interventions should also be incorporated in the patient’s care plan to reinforce his
treatment. These are physician’s orders wherein nurses and other caregivers would assist or
take into action, thus ensuring the recovery of the patient.

 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: Such as Lactated Ringer’s, IV therapy
should be anticipated by the nurse 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.
 The physician might also order an ultrasound examination to glean more information
about the fetal and also maternal well-being.

Our role as nurses in these medical interventions would be to assist in every aspect
possible, and ensure the wellbeing of both the mother and the fetus. Through our nursing
interventions, we could initiate care without needing to run after the physicians and ask
for their orders. We should be able to function independently as caregivers and promote
their wellness in our own way as nurses. The most vital pieces of information are always
handed to us first, so it would be up to us to initiate the first intervention to make or
break the condition of the client before a doctor arrives. Nurses are the first line of
defence of every hospital, and we should live up to that expectation.

SURGICAL MANAGEMENT
Aside from the medical interventions ordered by physician, 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

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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 intervention
 If bleeding is profused, place the women flat in the bed on her side and monitor
uterine contraction and fetal heart rate.
 Also measure intake and output to establish renal function and assess the women’s
vital sign to establish maternal response to blood loss.
 Measure the maternal blood loss by checking used pads.
 Check for any tissue found in the pads because it may be the part of product of
conception.