Abortion

Definition of Terms:

Abortion 
    Early abortion – termination of pregnancy before 12 weeks
    Late abortion – occurs between 12 to 20 weeks

Types of Abortion:

1. Elective or Therapeutic Abortion

    - Elective abortion 
    - Therapeutic abortions
2. Spontaneous Abortion

Divided into 4 stages:

    - Threatened abortion
    - Inevitable abortion
    - Incomplete abortion
    - Complete abortion
    - Others (missed, habitual, infected, & septic abortion)

Complications:
1. Hemorrhage
2. Infection or septic abortion 
3. Disseminated Intravascular Coagulation (DIC)

THREATENED ABORTION
 Refers to possible loss of the products of conception
Signs & Symptoms:
1. Light vaginal bleeding
2. None to mild uterine cramping
 More severe cramps may lead to inevitable
abortion
Management:
1. Assess for
 LMP
 Ask for presence of clots
 Pain 
2. Conservative Management
 Usually no medical therapy
 Bedrest until 3 days after bleeding has stopped (usually w/in
24 hrs bleeding will stop)
 If bleeding persist, cramps worsen & there is passage of
tissue, advise client to go to the hospital
 No coitus up to 2 weeks after bleeding has stopped
 Hormonal Therapy – may cause congenital anomaly
3. Provide reassurance, showing normal pregnancy ultrasound

INEVITABLE OR IMMINENT ABORTION

 Refers to loss of the product of conception that cannot be prevented
Signs & Symptoms:
1. Moderate to profuse bleeding
2. Moderate to severe uterine cramping
 3. Open cervix or dilatation of cervix
4. Rupture of membranes
5. No tissue has passed yet
Management:
1. Hospitalization
2. E&C
3. Oxytocin after E & C
4. Sympathetic understanding & emotional support

COMPLETE ABORTION
 Refers to the spontaneous expulsion of the products of
conception after the fetus has died in the utero.
Management
1. C.A usually needs no further surgical/medical treatment
2. Observe closely for continued bleeding or signs of infection
 Indicates that not all fetal tissue was expelled
3. Advice to eat high iron foods
4. Advice rest for few days to 2 weeks 
 No douching & coitus for 2 weeks
5. Tell patient that she may experience intermittent menstrual-like flow & cramps during the
following week
 Next menstrual period usually occurs in 4-5 weeks
6. Expelled product of conception should be confirmed by a physician/pathologist to be intact
& truly product of conception (not clot)
7. Reassure woman that next pregnancy is likely to last to term if she is young & no other risk
factors.
8. Aside from CBC & HCG level, determine too the Rh factor
9. Advise patient to return if any of the following occur:
 Profuse vaginal bleeding
 Severe pelvic pain
 Temperature greater than 100 degree F

INCOMPLETE ABORTION
 Expulsion of some parts & retention of other parts of conceptus in utero.
Signs & Symptoms:
1. Heavy vaginal bleeding
2. Severe uterine cramping
3. Open cervix
4. Passage of tissue
5. Ultrasound shows that some of the products of conception are still inside
the uterus
Management: 
1. E & C
2. Monitor blood loss
3. Monitor I & O
4. Sympathetic understanding & moral support

MISSED ABORTION
 Retention of all products of conception after the death of fetus in the
uterus.
Signs & Symptoms:
1. Absence of FHT
2. Signs of pregnancy disappear
Management:
 1. Remove product of conception to prevent DIC
2. Up to 28 wk gestation, M.A is frequently manage by inserting 20mg
dinoprostone (prostaglandin E2) suppository into the vagina q 3 or 4 hrs
as necessary to produce contractions.
              3. Dilute IV infusion of oxytocin to expel conceptus

HABITUAL ABORTION
 Occurring in 3 or more successive pregnancies 
 Identify cause to determine the most effective treatment
INFECTED ABORTION
 Infection involving the products of conception & the maternal reproductive
organ
SEPTIC ABORTION
 Dissemination of bacteria (&/or their toxins) into the maternal circulatory &
organ system.
Signs & Symptoms:
1. Foul smelling vaginal discharge
2. Uterine cramping
3. Fever, chills & peritonitis
4. Leukocytosis – WBC count, 16,00 to 22,000/uL
5. Critically ill patients may evidence septic or endotoxic shock w/ vasomotor
collapse, hypothermia, hypotension, oliguria or anuria, & respiratory
distress
Management:
1. Treat abortion
2. High dose of antibiotic therapy
 PCN for gram (-) microorganisms
 Clindamycin & tobramycin for gram (+)
3. E & C if accompanied by incomplete abortion
Note: Infertility may occur after recovery due to scarring of uterus & fallopian tubes.
 Scarring can interfere w/ fertilization & proper implantation