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Abortion..
ABORTION

 termination of a pregnancy by the removal

or expulsion from the uterus of a fetus or
embryo, resulting in or caused by its
death.
- before the fetus is sufficiently
developed to survive
- before 20 weeks AOG based on LMP
- delivery of a fetus -neonate that
weighs <500 g.
ABORTION

 occurs in 15-20% of recognized

pregnancies

 1% of women experience 3/more

spontaneous abortion before the 1st live
birth
ABORTION

 2 categories:

 1. Spontaneous Abortion
 2. Induced Abortion
A.SPONTANEOUS ABORTION

 abortion that occurs w/o medical or

mechanical means to empty the uterus

 “miscarriage”
SPONTANEOUS ABORTION

Pathology:

 hemorrhage into the decidua basalis and

necrotic changes in tissues adjacent to the
bleeding
 blighted ovum
 blood or carneous mole
 fetal maceration
SPONTANEOUS ABORTION

Etiology:

 Fetal factor
- abnormal zygote dev’t.
- aneuploid abortion (abn. # of Ch)
- euploid abortion (abn. Ch dev’t)
SPONTANEOUS ABORTION

Etiology:

 Maternal factor
- age
- timing of prev. pregnancy
- infections (Herpes simplex)
- chronic debilitating diseases (SLE)
- endocrine abnormalities (DM)
- nutrition
SPONTANEOUS ABORTION

Etiology:

 Drugs and Environmental factor

- tobacco-smoking
- alcohol
- caffeine (>4 cups/d)
SPONTANEOUS ABORTION

Etiology:

 Physical factor
- radiation
- anesthetic gases
SPONTANEOUS ABORTION

Etiology:
 immunologic factor
 inherited thrombophilia
 laparotomy
 trauma
 uterine defects (leiomyoma)
 incompetent cervix
 paternal factor
SPONTANEOUS ABORTION

Categories:
1. threatened abortion
2. inevitable abortion
3. incomplete abortion
4. missed abortion
5. recurrent (habitual) abortion
6. septic abortion
1.Threatened Abortion

 bleeding begins first and cramping

abdominal pain, anterior and clearly
rhythmic
 simulating mild labor, persistent low back
pain and pelvic pressure
 dull, midline, supersymphyseal discomfort
 cervix closed, uterine size compatible w/
AOG
2.Inevitable Abortion

 there is gross rupture of the membranes

in the presence of cervical dilatation
3.Incomplete Abortion

 profuse heavy bleeding so as to cause

hypovolemia

 history of passage of meaty tissue

 cervix is dilated, part of placenta may be

protruding
4.Missed Abortion

 dead products of conception retained

inside the uterus for 8 weeks or more

 abortus consists of shriveled sac

containing a macerated fetus
5.Habitual Abortion

 3/more consecutive spontaneous abortion

 Due to aneuploidic chromosomal

abnormalities and euploidic conceptus

 incompetent cervix
6.Septic Abortion

 termination of pregnancy w/in the first 20

weeks of gestation w/ infection of the
products of conception, uterus and
adnexae, or w/ the presence of
microorganism or their products in the
systemic circulation
 Uterine bleeding Cervical Uterine size BOW Other Management
contrac dilatation vs. findings
tion Gestation

Threat- + +/- +/- Compatible INTACT (+) FHT Bed rest

ened

Imminent + + + Compatible INTACT (+) FHT Watchful

expectancy
Oxytocin

Inevitable ++- ++ + Incompatible RUPTURED (+) FHT Curettage,

oxytocin

Complete - +/- + Incompatible/ NA Absent Observation

appreciated

Missed - Spotting/- - Incompatible/ NA (-) FHT Prostaglandins

appreciated D&C

Habitual +/- + + compatible (+)/(-) fast (+) FHT Cerclage

course of probable
labor cause
Incompete
nt cervix
B.INDUCED ABORTION

 medical or surgical termination of

pregnancy before the time of fetal viability

 legal aspect:
Therapeutic abortion, to save the life of
the mother.
INDUCED ABORTION

 Indications:

- persistent heart disease after previous

cardiac decompensation

- invasive carcinoma of the cervix

INDUCED ABORTION
 Guidelines for Therapeutic Abortion:
- continuation of pregnancy may threaten the life
of the woman or seriously impair her health

- pregnancy has resulted from rape or incest

- continuation of pregnancy is likely to result in

the birth of a child w/ severe physical deformities
or mental retardation
Elective Abortion

 voluntary abortion

 interruption of pregnancy before viability

at the request of the woman but not for
reasons of impaired maternal health or
fetal disease
ABORTION TECHNIQUES

 Surgical Techniques
 Medical Techniques
Surgical Techniques
 Dilatation and Curettage
cervical dilatation followed by evacuation of
pregnancy

Sharp curettage – mechanically scraping out the

contents
Suction curettage - vacuum aspiration
Dilatation and Evacuation – wide cervical dilatation
followed by mechanical destruction and evacuation of
fetal parts
Dilatation and Extraction - part of the fetus is first
extracted through the dilated cervix
Surgical Techniques
 Dilatation and Curettage

Hygroscopic dilators – insertion of laminaria prior

to D & C
- draws water from proteoglycan
complexes causing them to
dissociate and allowing the cervix to
soften and dilate
Prostaglandins – softens cervix prior to
mechanical dilatation
surgical
Surgical Techniques
 Dilatation and Curettage

Complications:
- uterine perforation
- cervical laceration
- hemorrhage
- incomplete removal of the fetus and placenta
- infection
Surgical Techniques
 Menstrual Aspiration
- Aspiration of the endometrial cavity using a
flexible 5- or 6-mm Karman cannula and syringe
within 1-3 weeks after a missed menstrual
period

 Laparotomy
Abdominal hysterotomy or hysterectomy
Uterine disease
Medical Techniques

 Oxytocin
- induction of abortion by uterine
contraction

 Intra-amnionic Hyperosmotic Solutions

- 20% saline or 30% urea injected into the
amniotic sac to stimulate uterine
contractions and cervical dilatation
Medical Techniques

 Prostaglandins
- for cervical ripening
- dissolution of collagen bundles and increase in
submucosal water content
 Mifepristone
- oral antiprogesterone
- high receptor affinity for progesterone-binding sites
 Epostane
- block the synthesis of endogenous progesterone
Consequences of Elective abortion

 maternal mortality
- safe during1st 2 mos.
- relative risk of dying doubled for each 2
weeks of delay after 8 weeks’ gestation

 impact on future pregnancies

- fertility is not altered
Septic Abortion

 anaerobic bacteria
 coliforms

 Haemophilus influenzae
 Campylobacter jejuni
 group A streptococcus
Nursing Interventions:

 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

Abortion Debate (USA)

 Pro-life-
Complete prohibition of abortion/ with legal
restrictions
 Pro-Choice-
Against legal restrictions
Public Opinion
 December of 2001-North America, asked
Canadian on Abortion
-32%, be legal in all circumstances
-52%, legal in certain circumstances and
-14% be legal in no circumstance
 May of 2005- 10 European Countries,
asked this question; “If a woman doesn’t
want children, should she be allowed to
have an abortion?”
Highest approval- 81%
Lowest -47%
 A similar poll in April 2009 (U.S.)
-18%, be legal in all cases
-28%, be legal in most cases
-28%, be illegal in most cases
-16%, be illegal in all cases
Abortion in the Philippines

 The basic status of Abortion in the

Philippines is that it is illegal or banned by
rule of law.
Thank you
By: jhong antonio RN,
MSN