ABORTION

By Cristyl Shine G. Bariao

BSN – 2D
TABLE OF CONTENTS
I. Introduction/Background
II. Classifications
III. Causes/Risk Factors
IV. Diagnostic Test
V. Medical and Surgical Treatments
VI. Complications
VII. Nursing Management/Interventions
VIII.Nursing Diagnosis
IX. Health Teachings
X. Summary
BACKGROUND
A medical term for
termination of a pregnancy
before a fetus is viable and
ABORTION weight less than 500 grams
(0.5 kg).
CLASSIFICATION
SPONTANEOUS ABORTION
1. SPONTANEOUS - also called miscarriage.
ABORTION
Classify into two:
2. ELECTIVE/INDUCED  Early Miscarriage
 Late Miscarriage
ABORTION
 5 TYPES OF SPONTENOUS ABORTION
1. THREATENED
- defined as a vaginal
bleeding before 20 weeks of
gestation but the cervix is
closed and the products of
conception are still intact.
SIGNS AND SYMPTOMS:
 scant bleeding, usually bright red
(1st sign)
 mild uterine cramping felt at the
back and lower abdomen
 (-) cervical dilatation-closed
cervix
 no passage of tissue
 soft, no tender, enlarged uterus
 5 TYPES OF SPONTENOUS ABORTION
NURSING MANAGEMENT: MEDICAL MANAGEMENT:
• Instruct the patient to avoid strenuous • Progestational agents to relax uterine
activity or limit to no strenuous vasculature.
activity.
• For 1-2 days, Initiate complete bed rest
without bathroom privileges.
• Coitus should be avoided for up to 2
weeks after the bleeding has stopped.
• Keep all the perineal pads and blood
clots.
• Provide psychological support
 5 TYPES OF SPONTENOUS ABORTION
2. INEVITABLE/IMMINENT
- Threatened abortion
becomes imminent when
cervical dilatation and uterine
contractions occur
SIGNS AND SYMPTOMS:
 vaginal bleeding
 (+) uterine contractions
 (+) cervical dilatation and rupture
of membranes
 (-) FHT
 5 TYPES OF SPONTENOUS ABORTION
2 KINDS OF
INEVITABLE/IMMINENT
a. COMPLETE
S/S: Self-limiting vaginal
bleeding, Cervical dilatation and
cramping, and products of conception
are completely expelled.
b. INCOMPLETE
S/S: (+) uterine contractions, (+)
cervical dilatation, Profuse vaginal bleeding,
and Incomplete products of conception.
NURSING MANAGEMENT: Psychological support
MEDICAL/SURGICAL MANAGEMENT:
Administering Oxytocin
Performing D&C (Dilatation & Curettage)
 5 TYPES OF SPONTENOUS ABORTION

3. EARLY PREGNANCY SIGNS AND SYMPTOMS:

FAILURE (MISSED)
- A dead embryo or fetus is not
expelled from the uterus for 4
weeks or more.
 (-) fetal movement
 (-) FHT
 regression of uterus and mammary
glands with or without bleeding
 coagulation defects
 (-) HCG titer
 5 TYPES OF SPONTENOUS ABORTION
MEDICAL/SURGICAL
NURSING MANAGEMENT: MANAGEMENT:
 Psychological support  Sonogram/Ultrasound
 Labor induction and performing D&E
(Dilatation and Evacuation)
 If the pregnancy is over 14 weeks, labor
can be induced with prostaglandin or
misoprositol (Cytotec) to dilate the cervix,
followed by oxytocin or mifepristone.
 5 TYPES OF SPONTENOUS ABORTION

4. SESPTIC/INFECTED SIGNS AND SYMPTOMS:

- Infection can occur after a  Vaginal discharge has a foul odor.
 Fever of 38°C or higher
spontaneous miscarriage, but it is
 pelvic cause pain (cramp
more common in women who
abdominal pain)
attempted to self-abort or were
 When the uterus is palpated, it
illegally aborted using a nonsterile
feels tender.
instrument such as a knitting needle.
 5 TYPES OF SPONTENOUS ABORTION

NURSING MANAGEMENT: MEDICAL/SURGICAL

Intravenous infusion
Hourly insertion of an
indwelling Foley catheter.
MANAGEMENT:
 Subcutaneous administration of
tetanus toxoid
 Antibiotics Broad-spectrum
antibiotic therapy
 D&C Procedure.
 5 TYPES OF SPONTENOUS ABORTION

5. RECURRENT PREGNANCY CAUSES:

LOSS(HABITUAL)
- 3 abortions in a row
before the 20th week at the
same gestational age were
labeled "habitual aborters“.
 Spermatozoa or ova that are
defective
 Endocrine factors
 Uterine deviations
 Chorioamnionitis or uterine
infection
 Autoimmune conditions
 RISK FACTORS
A. FETAL FACTORS
B. PLACENTAL FACTORS
C. IMMUNOLOGIC
D. MALNUTRITION
E. LOW PROGESTERONE LEVEL
F. INFECTION OR OTHER
DISEASES/TRAUMA
G. ABNORMALITY IN REPRODUCTIVE
ORGANS
H. DRUG INTAKE
I. PATERNAL FACTORS
CLASSIFICATION
1. SPONTANEOUS ELECTIVE/INDUCED ABORTION
ABORTION - Pregnancy termination by
artificial methods.
2. ELECTIVE/INDUCED
ABORTION
 2 TYPES OF ELECTIVE/INDUCED ABORTION

1. THERAPEUTIC/MEDICAL 2. CRIMINAL
- refers to the termination - Intentional termination
of a pregnancy as considered of pregnancy under any condition
necessary by a physician. prohibited by law.
PURPOSES OF ELECTIVE ABORTION
 When woman's life is in endangers, such as pregnancy in a
dangerous situation a woman suffering from chronic heart disease.
 This entails a fetus discovered via amniocentesis having a
chromosomal error.
 Undesirable because it is the result of rape or incest.
 A woman who chooses not to have a child at this time in her life due
to factors such as being too young, not wanting to be a single parent,
not wanting any more children, financial difficulties, or failed
contraception.
 MEDICAL AND SURGICAL
DIAGNOSTIC TEST MANAGEMENT
 MEDICAL TREATMENTS:
 PREGNANCY TEST  PROGESTERONE
ANTAGONIST/MORNING-AFTER
 ULTRASOUND PILL
 PROSTAGLANDIN INFUSION
 SALINE INDUCTION
 MEDICAL AND SURGICAL POSSIBLE COMPLICATION
MANAGEMENT OF ABORTION
 SURGICAL TREATMENTS:
 Hemorrhage
 MENTSRUAL EXTRACTION (ME)
 Infection
 VACUUM EXTRACTION
 Isoimmunization
 VACUUM ASPIRATION
 Cervical Injury
 DILATATION AND CURATTAGE
 Infertility
 DILATATION AND EVACUATION
 Depression
 HYSTEROTOMY
NURSING MANAGEMENT/INTERVENTIONS
 Encourage family members to be there for the patient before, during, and after the
abortion.
 Ensure that the patient is physically and psychologically prepared for the procedure
before performing an induced therapeutic abortion.
 Keep an eye on the patient for signs of complications and initiate appropriate
treatment:
 Monitor vital signs
 Check for vaginal bleeding.
 Place the woman flat on her side on her left lateral side of the bed to maintain
optimal placental and renal function and to avoid supine hypotension/supine vena
cava syndrome.
 Begin IV fluid administration, such as lactated Ringer's, to replace intravascular
fluid volume.
NURSING MANAGEMENT/INTERVENTIONS
 Administer oxygen as needed-at 2-4 LPM, provide adequate maternal
oxygenation despite decreased circulating blood volume.
 Take antibiotics as directed.
 Use an external monitor to track uterine contractions and FHR to see
if labor is present.
 Weigh perineal pads and save any clots or tissues passed in order to
determine maternal blood loss.
 Monitor Intake and Output to assess renal function.
 Nutritional Diet
 Provide emotional support
NURSING DIAGNOSIS HEALTH TEACHINGS
 Risk for fluid volume deficit r/t Health Education about
maternal bleeding Family Planning Methods
 Anticipatory grieving r/t loss of
pregnancy, cause of abortion, future Sexual Health Education
childbearing Programs to Young Adults.
 Risk for infection r/t dilated cervix and Antenatal Counselling
open uterine vessels
 Acute pain r/t uterine cramping and
possible procedures
 Knowledge deficit r/t signs and
symptoms of possible complications
 THANK YOU FOR LISTENING!

REFERENCES:
Sebastian, S, (2015). “Abortion.ppt for 2nd msc.” Retrieved from
https://www.slideshare.net/sindhujojo/abortionppt-for-2nd-msc
Belleza, M, (2017). “Abortion.” Retrieved from https://nurseslabs.com/abortion/
Pillitteri, Adele, (2019). MATERNAL AND CHILD HEALTH NURSING, 8TH ED. WOLTERS KLUWER,
LIPPINCOTT WILLIAMS & WILKINS, SINGAPORE.
Pillitteri, Adele, (2010). MATERNAL AND CHILD HEALTH NURSING, 6TH ED. WOLTERS KLUWER,
LIPPINCOTT WILLIAMS & WILKINS, SINGAPORE.