Types of Abortion An abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus or embryo, resulting in or caused by its death. Causes of Abortion Abortion may be occur due to various factors such as fetal, placental, or maternal. Fetal Causes – The most common cause of early spontaneous abortion is abnormal development of the zygote, embryo or fetus. These abnormalities are incompatible with life and would have resulted in severe congenital anomalies had pregnancy not been aborted spontaneously. Maternal Factors – These are congenital or acquired conditions of the mother and environmental factors that had adversely affected pregnancy outcome and led to abortion. Such conditions include diabetes mellitus, incomplete cervix, exposure to radiation and infection. Placental Factors – Placental factors usually cause abortion around the 14th week of gestation. These factors includes premature separation of the normally implanted placenta and abnormal placental implantation. Abortion Types
Characteristics
Management
occurring before the 20th week of gestation characterized by cramping and vaginal bleeding with no cervical dilation. it may subside or an incomplete abortion may follow.
Bedrest No coitus up to 2 weeks after bleeding stopped
Imminent or Inevitable Abortion
membranes rupture and the cervix dilates characterized by lower abdominal cramping and bleeding.
Hospitalization D and C Oxytocin after D and C Sympathetic Understanding and emotional support
Incomplete Abortion
is characterized by expulsion of only part of the products of c onception (usually the fetus). severe uterine cramping bleeding occur with c ervical dilation.
D and C Oxytocin after D and C Sympathetic Understanding and emotional support
characterized by complete expulsion of all products of conception light bleeding mild uterine cramping passage of tissue closed cervix
There is no treatment other than rest is usually needed. All of the tissues that came out should be saved for examination by a doctor to make sure that the abortion is complete. The laboratory examination of the saved tissue may determine the cause of abortion.
Threatened Abortion
Complete Abortion
Missed Abortion
intrauterine pregnancy is present but is no Usually treated by induction of labor by dilation (or dilatation) and curettage (D & C). longer developing normally the cervix is closed, and the client may report dark brown vaginal discharge. pregnancy test findings are negative.
Recurrent or Habitual Abortion
characterized by spontaneous abortion of Trace the cause of recurrent abortion three or more consecutive pregnancies
Septic Abortion
abortion complicated by infection foul smelling vaginal discharge uterine cramping fever
Antibiotics Antibiotics as prescribed by your Obstetrician
Spontaneous Abortion 1. Spontaneous abortion is the expulsion of the fetus and other products of conception from the uterus before the fetus is capable of living outside of the uterus. 2. Types of spontaneous a bortions a. Threatened abortion - is characterized by cramping and vaginal bleeding in early pregnancy with no cervical dilation. It may subside or an incomplete abortion may follow. b. Imminent or inevitable abortion – is characterized by bleeding, cramping and cervical dilation. Termination cannot be prevented. c. Incomplete abortion – is characterized by expulsion of only part of the products of c onception (usually the fetus). Bleeding occurs with cervical dilation. d. Complete abortion – is c haracterized by complete expulsion of all products of conception. e. Missed abortion – is characterized by early fetal intrauterine death without expulsion of the products of conception. The cervix is closed, and the client may report dark brown vaginal discharge. Pregnancy test findings are negative. f. Recurrent (habitual) abortion – is spontaneous abortion of three or more consecutive pregnancies. B. Etiology – Spontaneous abortion may result from unidentified natural causes or from fetal, placental or maternal factors. 1. Fetal Factors a. Defective embryologic development b. Faulty ovum implantation c. Rejection of the ovum by the endometrium d. Chromosomal abnormalities 2. Placental Factors
a. Premature separation of the normally implanted placenta b. Abnormal placental implantation c. Abnormal placental function 3. Maternal Factors a. Infection b. Severe malnutrition c. Reproductive system abnormalities (eg, incompetent cervix) d. Endocrine problems (eg, thyroid dysfunction) e. Trauma f. Drug ingestion C. Pathophysiology – The fetal or placental defect or the maternal condition results in the disruption of blood flow, containing oxygen and nutrients, to the developing fetus. The fetus is compromised and subsequently expelled from the uterus. D. Assessment Findings 1. Associated findings – The client and family may exhibit a grief reaction at the loss of pregnancy, including: a. Crying b. Depression c. Sustained or prolonged social isolation d. Withdrawal 2. Clinical Manifestations – include common signs and symptoms of spontaneous abortion. a. Vaginal bleeding in the first 20 weeks of pregnancy b. Complaints of cramping in the lower abdomen c. Fever, malaise or other symptoms of infection 3. Laboratory and diagnostic study findings a. Serum beta hCG levels are quantitatively low b. Ultrasound reveals the absence of a viable fetus. E. Implementation 1. Provide appropriate management and prevent complications a. Assess and record vital signs, bleeding and cramping of pain. b. Measure and record intravenous fluids and laboratory test results. In instances of heavy vaginal bleeding; prepare for surgical intevention (D & C) if indicated. c. Prepare for PhoGAM administration to an Rh-negative mother, as prescribed. Whenever the placenta is dislodged (birth, D & C, abruptio) some of the fetal blood may enter maternal circulation. If the woman is Rh negative, enough Rh-positive blood cells may enter her circulation to cause isoimminization, the production of antibodies against Rh-positive blood, thus endangering the well-being of future pregnancies. Because the blood type of the conceptus is not known, all women with Rh-negative blood should receive RhoGAM after an abortion. d. Recommended iron supplements and increased dietary iron as indicated to help prevent anemia. 2. Provide client and family teaching a. Offer anticipatory guidance relative to expected recovery, the need for rest and delay of another pregnancy until the client fully recovers. b. Suggest avoiding intercourse until after the next menses or using condoms when engaging in intercourse. c. Explain that in many cases, no cause for the spontaneous abortion is ever identified. 3. Address emotional and psychosocial needs.
