MCN (ABN) - A

ROMUROS, Ashary M.
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 & GENOGRAM

 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.

1. Spontaneous
 Threatened abortion
 Inevitable/Imminent abortion
 Complete abortion
 Incomplete abortion
 Missed abortion
 Recurrent/Habitual abortion

2. Therapeutic/Voluntary

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 her 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.
RESOURCES:

 Belleza (R.N.), M. (2017). Abortion. Nurselabs. Retrieved March 26, 2022, from
https://nurseslabs.com/abortion/#:~:text=bleeding%20during%20pregnancy-,Nursing
%20Interventions,maternal%20response%20to%20blood%20loss.

 BPAS. (2015). What is abortion? British Pregnancy Advisory. Retrieved March 27, 2022 from
https://www.bpas.org/abortion-care/considering-abortion/what-is-abortion/