PASCUA, AYANAMI T.
BSN 2-B
TYPES OF ABORTION DEFINITION
Threatened This term is used when a
Abortion pregnancy is complicated by
vaginal bleeding before 20th
week.
Imminent When a clinical pregnancy is
(Inevitable) Abortion complicated by both vaginal
bleeding and cramp-like lower
abdominal pain.
SIGNS AND SYMPTOMS NURSING MANAGEMENT
• Light bleeding • Medical treatment is usually not required
• Cramping/lower abdominal pain • Advise the woman to avoid strenuous activity and sexual
• Closed cervix intercourse; complete bed rest is, however, not necessary
• Uterus softer than normal • If the bleeding stops, follow up in an antenatal clinic.
• Size of uterus corresponds to the gestational Reassess if the bleeding occurs
period
• Heavy bleeding If the pregnancy is less than 12 weeks:
• Dilated Cervix
• Cramping/lower abdominal pain • Plan for evacuation of the contents of the uterus
• No expulsion of the products of conception • Give Misoprostol 400 mcg (2 tablets of 200 mcg each)
• The size of the uterus corresponds to the orally. Repeat once after 4 hours, if necessary
gestational period • Arrange for evacuation as soon as possible
If the pregnancy is more than 12 weeks:
• Await spontaneous expulsion of the products of conception
and then evacuate the uterus to remove any retained
products of conception.
• If necessary, augment uterine contractions by giving
Oxytocin 20 U in 500 mL of R/L at 40 drops/minute;
• Administer Tab. Misoprostol, 800 mcg (4 tablets of 200
mcg each), intravaginally, give 2 tablets (400 mcg) again
after 4 hours if the woman has not aborted till then.
Incomplete Abortion In addition to vaginal
bleeding, cramp-like pain, and
cervical dilatation, an
incomplete abortion involves
the passage of products of
conception, often described
by the women as looking like
pieces of skin or liver.
Complete Abortion After passage of all products
of conception, the uterine
contractions and bleeding
abate, the cervix closes, and
the uterus is smaller than the
period of amenorrhea would
suggest.
• Heavy bleeding
• Cramping/lower abdominal pain
• Dilated cervix
• History of partial expulsion of the products of
conception
• The size of the uterus is smaller than that
expected for the gestational period
• Light bleeding, Closed Cervix
• Light cramping/abdominal pain
• History of expulsion of the products of
conception
• The size of the uterus is smaller than that
expected for the gestational period
• Uterus softer than normal
• If the bleeding is light to moderate and the pregnancy is
less than 12 weeks, use your finger or sponge forceps to
remove the products of conception protruding through the
dilated cervix.
• If the bleeding is heavy and the pregnancy is less than 12
weeks, evacuate the uterus.
• Manual vacuum aspiration (MVA) is the preferred method
of evacuation. Do not carry out evacuation by sharp
curettage.
• If evacuation is not immediately possible, give Tab.
Misoprostol 400 mcg orally ( repeated once after 4 hours,
if necessary )
• If the pregnancy is more than 12 weeks: Start an
Oxytocin drip until the products of conception are
expelled.
• If necessary, give Tab. Misoprostol 200 mcg vaginally,
every 4 hours until the products of conception are
expelled; do not administer more than a total of 800 mcg
• Evacuate any remaining products of conception from the
uterus
• Evacuation of the uterus is usually not necessary as all
the products of conception have been expelled
• Observe for heavy bleeding
• Ensure post-abortion follow up of the woman after
treatment
• Check for any retained products of conception and/or
bleeding
• No further management is required if the condition of the
woman is stable
Missed Abortion This term is used when the
fetus has died but is retained
in the uterus, usually for some
weeks.
Recurrent Abortion Refers to any case in which
there have been three
consecutive spontaneous
abortions.
• Uterus is smaller in size than period of • If missed miscarriage has occurred early in pregnancy, a
amenorrhea woman will usually be able to expel the pregnancy tissue
• Cervix feel firm naturally.
• OS is closed • If the fetal tissue remains in the body for a longer time, a
• On doppler cardio scope fetal heart motion is D&C or Manual Vacuum Aspiration (MVA) procedure is
not seen usually recommended
• Immunological test for pregnancy become • In this procedure, the cervix is opened and the contents
negative of pregnancy are removed. This can cut down on
• On USG empty gestational sac with absent infections, which may occur if the fetal tissue remains in
fetal heart motion. the body
• Spotting or bleeding • To alleviate anxiety and improve psychology
• Mild-to-severe back pain (worse than • Hysteroscopic resection of uterine septate
menstrual cramps) • Uterine unification operation (metroplasty) for bicornuate
uterus
• Genetic counselling if chromosomal abnormality
• Endocrine dysfunction has to be controlled