ABORTION
Presented By:
Ms. Fazeelat Tahira
Faculty: LSN (UOL)
Unit-2
ABORTION
The spontaneous or artificially induced expulsion of
an embryo or fetus before 28 wks of pregnency.
The term "abortion" actually refers to any premature
expulsion of a human fetus, whether naturally
spontaneous, as in a miscarriage, or artificially
induced, as in a surgical or chemical abortion. Today,
the most common usage of the term "abortion"
applies to artificially induced abortion, which is the
subject of this pamphlet.
Types of abortion
Spontaneous Abortion:
Theinvoluntary loss of the products of
conception prior to 24 weeks’ gestation
Threatened Abortion
Cervix is closed & no tissue is passed
Inevitable Abortion
Increased bleeding & cervix dilates
Incomplete Abortion
Bleeding dilation of cervix & passage of tissue
Abortion
Cont….
Abortion
Complete
Passage of all products of conception, cervix
closes and bleeding stops
Missed
Fetus dies in uterus but is not expelled,
uterine growth stops and sepsis is possible
Recurrent
2 or more consecutive spontaneous
abortions
Induced Abortions
Therapeutic Abortion
Intentional termination of pregnancy
before age of viability to preserve the
health of the mother
Elective Abortion
Intentional termination of pregnancy for
reasons unrelated to mothers health
Nursing Care of abortion
Document amount and character of
bleeding
Save anything that looks like clots or tissue
for evaluation by a pathologist
Monitor vital signs
If actively bleeding, woman should be kept
NPO in case surgical intervention is needed
Cont....
1. Maintaining fluid volume :
1. Report tachycardia ,hypotention,pallor,indicating
hemorrhage and shock.
2. Draw blood for CBC as well as type and screen for
possible blood administration .
3. Establish and maintain an I.V with large bore
catheter for possible transfusion and large quantities
of fluid replacement.
2. Preventing infection:
1. Evaluate temperature every 4 hours if normal ,and
every 1 to 2 hours if elevated .
Cont....
2. Check vaginal drainage for increased amount and
odor,which may indicate infection .
3. Instruct on and encourage perineal care after each
urination and defecation to prevent contamination.
3. Promoting comfort:
1. Instruct patient on the cause of pain to decrease
anxiety .
2. Instruct and encourage the use of relaxation
techniques to augment analgesics.
3. Administer pain medications as needed and as
prescribed.
Post-Abortion Teaching
Report increased bleeding
Take temperature every 8 hours for 3 days
Take an oral iron supplement if prescribed
Resume sexual activity as recommended by the
health care provider
Return to health care provider at the
recommended time for a checkup and
contraception information
Pregnancy can occur before the first menstrual
period returns after the abortion procedure
Emotional Care
Spiritual support from someone of the
family’s choice and community
support groups may help the family
work through the grief of any
pregnancy loss
Review effective and ineffective
communication techniques
Effective Communication
Ectopic Pregnancy
An ectopic pregnancy is one in which the fertilized egg
implants in tissue outside of the uterus and the
placenta and fetus begin to develop there. The most
common site is within a Fallopian tube(96% of ectopic
pregnancies occur in fallopian tube), the term (tubal)
pregnancy is commonly used, however, ectopic
pregnancies can occur in the ovary, the abdomen, and
in the lower portion of the uterus (the cervix)
Ectopic Pregnancy
95% occur in fallopian tube
Scarring or tubal deformity may result from:
Hormonal abnormalities
Inflammation
Infection
Congenital defects
Causes of Ectopic pregnancy
The fertilized ovum implants outside the uterus
Most tubal pregnancies occur in the distal (ampullary)
two –thirds of the tube .
Some are located in the proximal portion of the
extrauterine part of the tube (isthmic)
Rarely , intrauterine and extrauterine gestation can exist
as the same time .(heterotopic pregnancy)
Structural factors that prevent or delay the passage of
the fertilized ovum include adhesions of the tube,
congenital and developmental anomalies of the fallopian
or uterine tube .
Cont...
Previous ectopic pregnancy.
Use of an intrauterine device for more than 2 years .
Multiple induced elective abortions .
Functional factors include menstrual reflux and
decrease tubal motility.
Maternal age and race , previous tubal surgery, history
of pelvic inflammatory disease ,surgical correction of
fallopian tube occlusions.
Cont....
Ectopic Pregnancies
(Continued)
Manifestations
Lower abdominal pain, may have light
vaginal bleeding
If tube ruptures:
May have sudden severe lower abdominal
pain
Vaginal bleeding
Signs of hypovolemic shock
Ectopic Pregnancies
(Continued)
Treatment
Pregnancy test
Transvaginal ultrasound
Laparoscopic examination
Priority is to control bleeding
Actions can be taken:
Using medications
Or by surgery to remove pregnancy from the
tube
Nursing Management:
Preventing infection:
Evaluate temperature every 4 hours if normal ,and every
1 to 2 hours if elevated .
Give emotional support
Nursing consideration-EP = fetal loss
Promoting comfort:
Assess for abdominal pain and missed menses
Instruct patient on the cause of pain to decrease anxiety .
Instruct and encourage the use of relaxation techniques
to augment analgesics.
Administer pain medications as needed and as prescribed.
Reference:
James AH, Kouides PA, Abdul-Kadir R, Edlund M,
Federici AB, Halimeh S, et al. Von Willebrand disease
and other bleeding disorders in women: Consensus on
diagnosis and management from an international
expert panel. Am J Obstet Gynecol. May 28 2009;
[Medline].
Hickey M, Higham JM, Fraser I. Progestogens with or
without oestrogen for irregular uterine bleeding
associated with anovulation. Cochrane Database Syst
Rev. Sep 12 2012;9:CD001895. [Medline].
