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

Signs 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
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.

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

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 Diagnosis

● Risk for deficient fluid volume related to bleeding during pregnancy

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.

Evaluation

● The aim for evaluation is inclined towards restoring the maternal blood volume and
stopping the source of the bleeding.
● The client’s blood pressure must be maintained above 100/60 mmHg.
● The pulse rate should be below 100 beats per minute and the fetal heart rate must be at
a normal level of 120-160 beats per minute.
● The client’s urine output should be more than 30 mL/hr, and only minimal bleeding
should be apparent for not more than 24 hours.