ABORTION

ECTOPIC PREGNANCY
ABORTION
is a medical term for any interruption of a pregnancy
before a fetus is viable
Age of viability
a fetus of more than 20 to 24 weeks of gestation or one that weighs at least 500 grams

Miscarriage
Early miscarriage - before 16 weeks
Late miscarriage - 26 - 24 weeks
Causes
● Abnormal fetal development
○ Teratogenic factor or chromosomal aberration

● Presence of immunologic factors or rejection of embryo

○ Immune response

● Implantation abnormalities
○ Inadequate endometrial formation
○ Inappropriate site of implantation
Causes
● Inadequate production of progesterone by corpus luteum

● Systemic infection
○ Rubella
○ Syphilis
○ Poliomyelitis
○ Cytomegalovirus
○ Toxoplasmosis
■ (readily cross placenta causing fetal death)
Causes
● Urinary Tract Infection (UTI)

● Ingestion of teratogenic drug

○ Isotretinoin / Accutane
○ Alcoholic beverages
Signs and symptoms
● Vaginal spotting
○ Report immediately to HCP
○ Ensure not self abort
○ Polyps
● Abdominal cramps
● Backache
Types of spontaneous miscarriage
● Threatened miscarriage
● Imminent / Inevitable miscarriage
● Complete miscarriage
● Incomplete miscarriage
● Missed miscarriage
Threatened miscarriage
50% of women with threatened miscarriage continue pregnancy
50% imminent / inevitable miscarriage
Imminent / Inevitable miscarriage
● (+) uterine contractions
● (+) cervical dilatation
○ The loss of products of conception cannot be halted
Complete miscarriage
Entire products of conception are expelled without any assistance
● Fetus
● Membranes
● Placenta

S / Sx:
Bleeding usually slows within 2 hours to within a few days
Incomplete miscarriage
● Part of the fetus is expelled but membrane or the placenta is retained in the
uterus

● Cervix dilates slightly

● Dilatation curettage or suction curettage

○ To evacuate the remainder of pregnancy from the uterus
Missed miscarriage / Early pregnancy failure
● Fetus dies in utero but it is not expelled
○ UTZ: embryo died 4-6 weeks before onset of miscarriage symptoms
○ D&E
● Prenatal examination
○ No increasing in size of fundal height
○ No previously heard FHT
● S/Sx:
○ (+) painless brownish vaginal bleeding
Complications of miscarriage
● Hemorrhage
● Infection
● Septic Abortion
● Isoimmunisation
● Powerlessness / Anxiety
Possible Nursing Diagnosis
◻ Powerlessness or anxiety r/t early loss of pregnancy
secondary to miscarriage
◻ Deficient fluid volume r/t excessive bleeding secondary to
spontaneous abortion
◻ Acute pain r/t abdominal cramping secondary to threatened
abortion
◻ Grieving r/t expected loss of unborn child
ECTOPIC PREGNANCY
Ectopic Pregnancy
●
implantation occurs OUTSIDE the uterine cavity
● 2% of pregnancies are ectopic
● 2nd most frequent cause of bleeding early in pregnancy
● 6% of all maternal deaths in the US

● most common site:

● Fallopian tube (95%)
■ Ampullar
■ Isthmus

■ Interstitial / Fimbrial
 Risk Factors:
● Pelvic inflammatory disease (eg. Salpingitis)
● Women who smoke
● Women with IUD
● Previous ectopic pregnancy
● In-vitro fertilization
● Uterus exposed to DES

* Oral contraceptives
Signs and Symptoms:
* X unusual symptoms (implantation)
● X menstrual flow
● N and V (early pregnancy)
● Breast tenderness
● (+) hCG (pregnancy test) (53%)

●Dx:
○Early pregnancy UTZ
○MRI
Nursing Management:
● Possible
Nursing Diagnosis:
○ Powerlessness related to early loss of pregnancy
secondary to ectopic pregnancy
○ Acute pain related to abdominal bleeding secondary
to tubal rupture
○ Deficientfluid volume related to hypovolemia
secondary to maternal blood loss
○ Grieving related to loss of the pregnancy