ABORTION with no cervical dilation.

It may subside
BACKGROUND/ DESCRIPTION or an incomplete abortion may follow.
Abortion has been practiced for CAUSE:
millennia. Approximately 53 million  Small fall
abortions are performed each year. An  Injuries
estimated one third of these are  stress during the first trimester of
performed in unsafe circumstances, pregnancy
mostly in developing countries, and  It occurs in almost one half of all
account for one out of eight maternal pregnancies.
deaths worldwide. Surgical abortion in SYMPTOMS:
safe settings has the lowest complication Vaginal bleeding, scant, slight cramping,
rates. Complications are 2.3 times higher no cervical dilation
for dilation and curettage (D&C) as INTERVENTION:
compared with vacuum aspiration.  Instruct the patient to avoid
Complications of surgical abortion strenuous activity
include infection, incomplete evacuation,  Ultrasound
cervical trauma, uterine perforation,
 Fetal heart tone
hemorrhage, complications with
 Emotional support
anesthesia, and possible associations
with infertility; miscarriages, and low birth
2. IMMINENT OR INEVITABLE
weight in subsequent pregnancies.
ABORTION
Medical abortions use pharmaceuticals to
terminate pregnancy growth or stimulate - it is the clinical type of abortion
expulsion of uterine contents. Four where the changes have progressed to a
protocols are commonly used: miso- state from where continuation of
prostol (prostaglandin E1), mifepristone, pregnancy is impossible.
mifepristone with misoprostol, and - is a characterized by bleeding,
methotrexate with misoprostol. pain or cramping and cervical dilatation.
Methotrexate stops rapid cell replication. Termination cannot be prevented.
Misoprostol causes uterine contractions. INTERVENTION:
Both methotrexate and miso-prostol are -Assess for vaginal bleeding
teratogenic. Side effects of medical -Save the tissue Fragments
abortion are moderate to heavy bleeding, -Ensure the woman FHT
pain, nausea, vomiting, diar-rhea, and -Ultrasound
more observed blood loss and passage
of tissue. 3. COMPLETE ABORTION
Abortion is a medical term for the - When the products of conception are
disruption of a pregnancy before the completely expelled
fetus reaches its viable age of more than - is characterized by complete expulsion
20 to 24 weeks of gestation or weighs at of all products of conception. Cervical
least 500g. os is closed.
- Bleeding usually slows within 2 hours
TYPES OF SPONTANEOUS and then ceases within a few days after
ABORTIONS passage of the products of conception.
1. THREATENED ABORTION Because the process is complete, no
- it is a clinical entity where the therapy other than advising the woman
process of abortion has started but has to report heavy bleeding is needed.
not progressed to a state from which
recovery is impossible. 4. INCOMPLETE ABORTION
- is a characterized by cramping
and vaginal bleeding in early pregnancy
- when the entire products of
conception are not expelled, instead a
part of it is left inside the uterine cavity.
- is characterized by expulsion of
only part of the products of conception.
Continuous bleeding occurs with cervical
dilation. The cervix is already dilated and
there is severe vaginal bleeding.
5. MISSED ABORTION
- also commonly referred to as early
pregnancy failure without expulsion of
the products of conception. The cervix is
closed, and the client may report dark
brown vaginal discharge.
6. RECURRENT ABORTION
- is spontaneous abortion of three or
more consecutive pregnancies.
CAUSES:
 Defective spermatozoa or ova
 Endocrine factors, poor thyroid
function or luteal phase defect
 Defective uterus
 Resistance to uterine artery blood
flow
 Chorioamnionitis or uterine
infection
 Autoimmune disorders
MISCARRIAGE RISK FACTORS
Several risk factors can increase the rate
of miscarriage.
 AGE – Older individuals are more
likely to have a miscarriage than
younger persons.
 PREVIOUS MISCARRIAGE –
Having a miscarriage in the past
may increase the risk for a future
miscarriage.
 SMOKING –Smoking more than
10 cigarettes a day
increases the risk of
miscarriage.
 DRUGS. There are drugs which are
contraindicated for pregnant women.
Ingestion might compromise the
fetus and lead to abortion.
 ALCOHOL – No amount of alcohol
is known to be safe during
pregnancy because it can cause
health problems for the baby.
Drinking alcohol also increases the
risk of miscarriage.
- it can contribute to pregnancy loss
because of abnormal fetal growth
(Bingham, 2015).
 TRAUMA – Trauma to the uterus
can increase the risk of miscarriage.
This includes some forms of prenatal
testing, such as amniocentesis or
chorionic villus sampling. The effect
of minor trauma to the mother’s
abdomen is unknown, because
during early pregnancy the uterus is
generally protected from blunt
trauma.
 OTHER CAUSES – People who are
exposed to certain substances or
conditions may have an increased
risk of congenital abnormalities and
miscarriage. This includes exposure
to certain infections, medications,
radiation, physical stresses, and
environmental chemicals.
SIGNS AND SYMPTOMS
 VAGINAL SPOTTING. Vaginal
spotting appears as small brownish
to reddish spots of blood coming out
of the woman’s vaginal opening.
This typically happens when the
cervix gradually dilates as a result of
the woman trying to lift heavy objects
or modest abdominal trauma.
 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. 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.
 ULTRASOUND. The ultrasound is
the safest and most reliable way to
confirm pregnancy since it can show
whether or not the fetus and its
products are still intact.
 PELVIC EXAM. The health care
provider might check to see if the
cervix has begun to dilate.
MEDICAL MANAGEMENT
 ADMINISTRATION OF
INTRAVENOUS FLUIDS. As with
Lactated Ringer's, the nurse should
prepare for IV therapy and
administer oxygen at a rate of 6 to
10 liters per minute using a face
mask in order to replenish
intravascular fluid loss and ensure
appropriate fetal oxygenation.
 AVOID VAGINAL EXAMINATIONS.
The physician would also avoid
further vaginal examinations to avoid
disturbing the products of conception
or triggering cervical dilatation.
SURGICAL MANAGEMENT
 DILATATION AND EVACUATION.
This is to make sure that all products
of conception would be removed
from the uterus.
 DILATION AND CURETTAGE. This
is most commonly performed for
incomplete abortions to remove the
remainder of the products of
conception from the uterus.
NURSING MANAGEMENT:
Nurses must also have their own
independent functions to ensure the
safety and wellbeing 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 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.
NURSING DIAGNOSIS:
 Knowledge deficit related to signs
and symptoms of possible
complications
 Anticipatory grieving related to loss
of pregnancy, cause of abortion,
future childbearing
 Acute pain related to uterine
cramping and possible procedures 
Risk for infection related to dilated
cervix and open uterine vessels. 
Risk for deficient fluid volume
 HEALTH TEACHINGS:
 Educate the patient on proper
contraceptive measures as a means
of birth control, to avoid unwanted
pregnancies. The patient should be
urged to remain compliant with
antibiotic therapy if the abortion was
septic.
 Educate the patient to pay more
attention to nutrition (iron-containing
diet) to prevent anemia.
 Suggest avoiding intercourse until
after the next menses or using
condoms when engaging in
intercourse.
 Encourage adequate fluid intake to
maintain fluid and electrolyte
balance in the body.
 Avoid exertion and heavy exercises
and promote rest for 2 weeks.
 Avoid long travels.
 Avoid drinking alcohol for at least 48
hours as it may increase the risk of
heavy bleeding
 Address emotional and
psychological needs