Abortion

abortion

medically - loss of pregnancy before fetus is “viable”

• capable of living outside of uterus

• maternal mortality seldom results from safe abortions

viability

> 20wks gest or weighing more than 500mg

spontaneous abortion

miscarriage, occur most in 1st trimester

spontaneous abortion risk factors

• chromosomal abnormalities (trisomy 16)

• endometrial defects

• advanced maternal age

• obesity

• black ethnicity

• smoking

• hx previous miscarriage

• environmental risk factors

• maternal infections (syphilis, rubella, etc)

• maternal endocrine disorders (thyroid, diabetes)

• placental abnormalities

• chronic maternal diseases (autoimmune, kidney)

• abnormalities in maternal reproductive tract

• teratogenic drugs

spontaneous abortion manifestations

• vaginal spotting, bleeding, or passing of clots

• pelvic cramping & dull backache

• falling hCG levels

• U/S to observe for lack of fetal sac or heartbeat

nursing considerations

• assess for amount & character of blood loss (monitor for shock)

  • H&H to assess blood loss

  • T&C for possible transfusion & RhoGam

• speculum exam of cervix

• monitor for signs of infection

• U/S for FHR & presence of IUP

• serial beta-hCG levels q2-3days

  • determine rise, plateau, or decrease in levels

  • healthy pregnancy: levels rise by 50% min q48hrs

• emotional & spiritual support for client & family

induced abortion

elected by pt

common reasons for elective abortion

• preservation of mental health

• fetal anomalies or genetic conditions

• pregnancy resulting from rpe or incest

• socioeconomic or personal circumstances

medical elective abortions

• non-surgical abortions that use drugs

• combined regimen: Methotrexate or mifepristone PO (antiprogesterone drug) then Cytotec (prostaglandin to induce ctx)

  • when used w/i 49 days of gest, 92% undergo medical abortion w/o surgery

• misoprostol (Cytotec) can be used alone

  • lower efficacy rate than combo

• offered through 1st trimester

• failure → surgical management w/ D&C and/or suction

surgical elective abortions

• manual vacuum aspiration

• D&C second most common method

• after 12wks gest, dilation & evacuation or induction of labor by IV oxytocin & intra-amniotic/intravaginal prostaglandin or misoprostol may be required

manual vacuum aspiration

removing POC by suction using a manual syringe

electric vacuum aspiration

removing POC by suction using an electric pump

patient prep & teaching for elective abortion

• normal activity may be resumed, but rest for a few days

• bleeding/cramping may occur for 1-2wks, light spotting up to 1mo

• pelvic rest for 1wk

• use of BC right away

• menses usually resumes w/i 4-6wks

• temp taken at home BID

• follow up appt in 2wks

• after surgical abortion

  • cramping 20-30min after procedure

  • complications: uterine perforation, hemorrhage, cervical lacerations, adverse reaction to anesthetics