Abortion Types

Stefany Maldonado Rivera

M00506162
NURS2142 Practice of Maternal-Neonatal Care
Prof. Malika James,

DEFINITION
An abortion is the termination of a pregnancy before the fetus is
viable and capable of extrauterine existence, usually less than 20
weeks of gestation (or when the fetus weighs less than 500 g)
resulting in or caused by its death.

TYPES OF ABORTIONS
Abortion
Categories

Induced

Therapeutic

Spontaneous

Elective

Missed

Septic

Threatened

Continuing
Pregnancy

Inevitable

Complete

Incomplete

SPONTANEOUS ABORTION
This is commonly referred to as a miscarriage. A pregnancy that ends as a
result of natural causes before 20 weeks of gestation. Spontaneous
Abortion can be subdivided into:
Threatened Abortion
Inevitable Abortion:
Complete and Incomplete

Missed Abortion
Habitual or Recurrent Abortion

Threatened Abortion
The process of abortion has started but has not progressed to a state from which recovery is impossible.
Characteristics:
Occurring before the 20th week of gestation
Mild uterine cramping and vaginal bleeding with no cervical dilation.
It may subside or an incomplete abortion may follow.
Management:
Bedrest
No coitus up to 2 weeks after bleeding stopped
Repetitive transvaginal ultrasounds and assessment of human chorionic gonadotropin (hCG) and progesterone
levels determine if the fetus is still alive
and in the uterus.

Inevitable Abortion
An abortion is said to be inevitable if it can no longer continue.

Characteristics:
Membranes rupture and the cervix dilates
Lower abdominal cramping and moderate to heavy bleeding.
Tissue may be present with the bleeding
Passage of the products of conception will occur. It may be complete or incomplete.
Management:
Bed rest if no pain, fever, or bleeding.
Hospitalization
If rupture of membranes (ROM), bleeding, pain or fever is present, then prompt termination of pregnancy is accomplished usually by
dilation and curettage (D&C); Oxytocin after D & C
Understanding and emotional support

Incomplete

Complete

An abortion in which part of the

products of conception (usually the
foetus) is passed, while the placenta
and membranes are retained.

An abortion that happens when all the

products of conception (embryo, placenta
with intact membranes) are expelled
from the uterus

Characteristics:
Expulsion of only part of the
products of conception (usually
the fetus).
Severe uterine cramping
Bleeding occur with cervical
dilation.
Management:
D & C; Oxytocin after D & C
Understanding and emotional
support

Characteristics:
Complete expulsion of all products of
conception
Light bleeding
Mild uterine cramping
Passage of tissue
Closed cervix
Management:
There is no treatment other than rest
is usually needed.
Suction curettage may be performed
to ensure no retained fetal or maternal
tissue.
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

Missed Abortion
An abortion that occurs when the fetus dies and is retained in utero, together with the placenta and membranes
for up to several weeks. Also referred to as silent miscarriage.

Characteristics:
Intrauterine pregnancy is present but is no longer developing normally, may be diagnosed by ultrasonic examination after
uterus
stops increasing in size or even decreases in size.
Cervix closed, client may report dark brown vaginal discharge, but not necessarily have bleeding or cramping present
Pregnancy test findings are negative.

Management:
If spontaneous evacuation of the uterus does not occur within 1 month, pregnancy is terminated by method appropriate to
duration of pregnancy.
Blood clotting factors are monitored until uterus is empty.
Disseminated intravascular coagulation (DIC) and incoagulability of blood with uncontrolled hemorrhage may develop in cases

Recurrent or Habitual Abortion

Recurrent early (habitual) miscarriage is three or more spontaneous pregnancy losses before 20 weeks of gestation.

Characteristics:
Spontaneous abortion of three or more consecutive pregnancies
Parental chromosomal abnormalities can be a cause. The evaluation of couples experiencing recurrent pregnancy
loss usually includes karyotyping of both partners and evaluating the womans uterine cavity and testing for
antiphospholipid antibody syndrome.

Management:
Varies; depends on type.
Trace the cause of recurrent abortion
Prophylactic cerclage may be performed if premature cervical dilation is the cause.
Tests of value include: parental cytogenetic analysis and lupus anticoagulant and anticardiolipin antibodies assays

Septic/Infected Abortion
Loss of pregnancy in which there is an infection of the products of conception and the uterine endometrial lining, usually
resulting from attempted termination of early pregnancy.
Characteristics:
Abortion complicated by infection
Foul smelling vaginal discharge
Uterine cramping
Fever and abdominal tenderness
Slight to heavy bleeding is usually malodorous
Management:
Immediate termination of pregnancy by method appropriate to duration of pregnancy.
Cervical culture and sensitivity studies are performed, and broad-spectrum antibiotic therapy (e.g., ampicillin) is started.
Treatment for septic shock is initiated if necessary.

INDUCED ABORTION
Is the purposeful interruption of a pregnancy before 20 weeks of gestation. Many factors
contribute to a womans decision to have an abortion. Indications include:
Preservation of the life or health of the mother
Genetic disorders of the fetus
Rape or incest
The pregnant womans request
Elective Abortion: Performed at the womans request
Therapeutic Abortion: Performed for reasons of maternal or fetal health or disease, the term
therapeutic abortion applies.

LEGALITY
Abortion is regulated in most countries, including the United States. Before 1970, legal abortion was not widely
available in the United States. However, in January 1973, the U.S. Supreme Court set aside previous antiabortion laws
and legalized abortion. This decision established a trimester approach to abortion.
1st Trimester: abortion is permissible, the decision is between the woman and her health care provider, and a state
has little right to interfere
2nd Trimester: abortion is left to the discretion of the individual states to regulate procedures as long as they are
reasonably related to the womans health
3rd Trimester: abortions may be limited or even prohibited by state regulation unless the restriction interferes with
the life or health of the pregnant woman

In 1992, the U.S. Supreme Court ruled to allow states to restrict early abortion services as long as the restrictions did
not place an undue burden on the womans ability to choose abortion. Since then many bills have been introduced
to limit access and funds for women seeking abortion.

METHODS
Surgical Abortion: These are abortions that involve an invasive procedure. Major
types of surgical abortions include:
Suction Aspiration
Dilation and curettage (D & C)
Dilation and Evacuation (D & E)

Medical/Chemical Abortion: These are abortions that involve the administration of

drug specifically intended to abort the child. Common drugs used for medical
abortions include:
Mifepristone (RU-486)
Methotrexate
Salt Poisoning

Surgical Abortion
1st Trimester: Aspiration (suction) Dilation and Curettage (D&C)

Risk and Adverse Effects

Injury to Uterus or Cervix, Hemorrhage, Infection, Maternal Death, Future Pregnancy Complications

Surgical Abortion
2nd Trimester: Dilation and Evacuation (D & E)

Risk and Adverse Effects

Uterine Perforation, Cervical Laceration, Infection, Hemorrhage, Maternal Death, Future Pregnancy

Surgical Abortion
3rd Trimester: Induction Abortion Injection and Stillbirth

Risk and Adverse Effects

Medical/Chemical Abortion
1st Trimester: Abortion Pills

Risk and Adverse Effects

NURSING PROCESS
Assessment

Diagnosis

Outcome

Interventions

History
Pregnancy history: last

menstrual period, previous

pregnancies, pregnancy losses
Interview
Pain (type, location)

Bleeding (quantity,

appearance)
Allergies

Emotional status

Physical examination
Vital signs

Speculum vaginal examination

Ultrasonography

Laboratory tests
-hCG and progesterone levels

(pregnancy)
Hemoglobin level (anemia)

White blood cell count

(infection)

Anxiety or Fear related to:

unknown outcome and

unfamiliarity with medical

procedures
Deficient Fluid Volume related
to:
excessive bleeding secondary

to miscarriage
Acute Pain related to:
uterine contractions

Anticipatory Grieving related

to:
unexpected pregnancy

outcome
Situational Low Self-esteem
related to:
inability to successfully carry a

pregnancy to term gestation

Risk for Infection related to:
surgical treatment

dilated cervix

Discuss the effect of the loss on

her and her family.
Identify and use available
support systems.
Develop no physiologic or
psychologic complications (e.g.,
hemorrhage, infection,
depression).
Verbalize relief from pain.

Physiologic stabilization:
Initiate an intravenous
line.
Initial laboratory tests:
blood type and Rh,
hemoglobin, hematocrit.
Administer medications as
ordered (antiemetics,
uterotonics, antibiotics,
analgesics).
Prepare woman for manual or
surgical evacuation of uterus if
products of conception have not
passed.
Explain procedures.
Offer the option of seeing the
products of conception.
Provide education on recognition
of grief responses and how to
manage these responses.
Provide discharge teaching
(medications, need for rest,
normal physical findings,
resumption of sexual activity,
family planning).

REFERENCES
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https://nurseslabs.com/

abortion/

Lowdermilk, D. L., Perry, S. E., Cashion, Y., & Alden, K. R. (2012). Chapter 28: Antepartum
Hemorrhagic

Disorder. In Maternity & Women's Health Care (10th ed.). St. Louis , MO:

Mosby.
Methods. (n.d.). American Life League, Inc. Retrieved January, 2017, from
http://www.all.org/learn/

abortion/methods/

Types of Abortion. (2014, July 06). Retrieved January, 2017, from

http://nursingcrib.com/nursing-notes- reviewer/types-of-abortion/
Wenting, Y. (2011, March 31). What are the Types of Abortion?. wMedicine. Retrieved