A.1 Abortion

Republic of the Philippines
Camarines Sur Polytechnic Colleges

Nabua Camarines Sur
CARE OF MOTHER AND CHILD AT RISK

OR WITH PROBLEMS
(ACUTE AND CHRONIC)
NCM 109 – 2ND Semester
A. Nursing Care Of A Family

Experiencing A Sudden Pregnancy
Complication
CARMI RUSSEL T. CASYAO, RM, RN, MAN
Clinical Instructor
LEARNING OBJECTIVES
• Describe sudden complications of pregnancy that place a
pregnant woman and her fetus at high risk.
• Assess a woman who is experiencing a complication of
pregnancy.
• Formulate nursing diagnoses that address the needs of a
woman and her family experiencing a complication of
pregnancy.
• Identify expected outcomes to minimize the risks to a
pregnant woman and her fetus when a sudden complication
of pregnancy occurs as well as manage seamless transitions
across differing health care settings.
BLEEDING DISORDER DURING
PREGNANCY
• Hemorrhage – is defined as rapid loss of more than 1% of
body weight in blood. Rapid blood loss results in:
a. Inadequate tissue perfusion
b. Deprivation of glucose and oxygen in the
tissues
c. Build up of waste products
• Hypovolemic shock – occurs bleeding results in blood
loss amounting to 1.5 to 2 liters.
Signs and Symptoms of Hypovolemic
Shock
Assessment Significance
Increased pulse rate Heart attempts to circulate decreased blood volume
Decreased blood pressure Less peripheral resistance is present because of
decreased blood volume
Increased respiratory rate Respiratory system attempts to increase gas exchange
to better oxygenate decreased red blood cell volume
Cold, clammy skin Vasoconstriction occurs to maintain blood volume in
central body core
Decreased urine output Inadequate blood is entering kidneys because of
decreased blood volume.
Dizziness or decreased level of consciousness Inadequate blood is reaching cerebrum because of
decreased blood volume
Decreased central venous pressure Decreased blood is returning to heart because of
reduced blood volume
PRIMARY CAUSES OF BLEEDING
DURING PREGNANCY
FIRST & SECOND TRIMESTER SECOND TRIMESTER THIRD TRIMESTER
• Threatened spontaneous • Gestational trophoblastic • Placenta previa
miscarriage (early: under 16 disease (hydatidiform mole)
weeks; late: 16 to 24 weeks)
• Imminent (inevitable) • Premature cervical dilatation • Premature separation of the

miscarriage placenta (abruptio placentae)
• Missed miscarriage • Preterm labor

• Incomplete spontaneous
miscarriage
• Complete spontaneous
miscarriage
• Ectopic (tubal) pregnancy
A.1 ABORTION
ABORTION
• Is the most common bleeding disorder
of early pregnancy.
• Is the termination of pregnancy before
viability, that is, before 20 weeks
gestation from LMP or before the
fetus weighs 500 grams.
• it is better to speak of these early pregnancy losses as spontaneous miscarriages to avoid confusion
with intentional terminations of pregnancies.
• SPONTANEOUS MISCARRIAGE
- Occurs in 15-20% of recognized pregnancy.
• EARLY MISCARRIAGE
- Occurs before week 16 of pregnancy.
• LATE MISCARRIAGE
- Occurs between weeks 16 and 24.
DEFINITION OF TERMS
ABORTUS
- Is a fetus that is aborted weighing less than 500 grams.
OCCULT PREGNANCY
- Refers to those zygotes that were aborted before pregnancy is
diagnosed or recognized.
BLIGHTED OVUM
- A small macerated fetus, sometimes there is no fetus.
TYPES OF ABORTION:
1.Elective abortion or Therapeutic abortion
• Elective abortion- initiated by personal choice

• Therapeutic abortion – are those recommended by health
care provider to protect the mother’s physical or mental
health.
2. Spontaneous abortion
- the loss of a fetus during pregnancy due to natural causes.
CAUSES OF SPONTANEOUS ABORTION
Fetal causes:
1.Developmental anomalies in more than 60% of cases.
2.Chromosomal abnormalities
Maternal factors: Environmental factors:

3.Advancing maternal age 35 y/o & above
4.Structural abnormalities of reproductive tract ( cervical incompetence)
5.Inadequate progesterone production
6.Maternal infection
7.Chronic & systemic maternal diseases
8.Exogenous factors ( tobacco, alcohol & cocaine)
COMPLICATION OF ABORTION:
1.Hemorrhage (incomplete abortion) – continued

heavy bleeding indicates retained tissue.
2.Infection or Septic abortion –
3.Disseminated Intravascular Coagulation (DIC)
may occur if missed abortion is retained beyond
one month.
TYPES OF SPONTANEOUS ABORTION:
1. Threatened
2. Imminent (Inevitable)
3. Complete
4. Incomplete
5. Missed
TYPES OF SPONTANEOUS ABORTION:
I. THREATENED ABORTION - Refers to the possible loss
of the products of conception. All vaginal bleeding in
early pregnancy without cervical changes is
considered a threatened abortion.
SIGNS & SYMPTOMS:

a. Light vaginal bleeding
b. None to mild uterine cramping. More severe
cramps may lead to an inevitable abortion.
Management:
1. Assess for:
• Ask LMP as management for pregnancy bleeding will
vary according to the age of gestation.
• Instruct the patient to save all pads for examination.
• Ask for the presence of clots.
• Abdominal pain is the next common complaint of
women suffering from abortion next to vaginal bleeding.
(suprapubic area; one or both lower quadrants, pain
may radiate to the lower back, buttocks genitalia and
perineum.)
2. Conservative Management: usually, no other
medical therapy is needed for patients who
experienced threatened abortion.
• Instruct the patient to have bedrest until the
three days after bleeding has stopped. In majority
cases, bleeding usually stops within 48 hours. If
bleeding persists, tissue passed and cramps
worsen, tell the patient to the hospital
immediately.
• Advise the couple not to engage in coitus up to 2
weeks after bleeding stopped.
• There is no evidence that hormones save
pregnancies except in a very few instances and
hormonal therapy may cause congenital
anomalies. And also vaginal cancer and other
genital abnormalities in female offspring have
been associated with the use of estrogen for
threatened abortion.
3. However parents usually worry that they might
have lost the baby or may lose the baby anytime
soon after a bleeding episode.
• Nurses are in a position to provide these patients
with reassurance.
• It is also important to be honest to the patient
that it is possible to loss the baby but treatment
is available to try to save the pregnancy if
bleeding continues.
II. INEVITABLE OR IMMINENT
ABORTION
- Refers to the loss of the products of
conception that cannot be prevented.
SIGNS & SYMPTOMS:
a. Moderate to profuse bleeding
b. Moderate to severe uterine cramping
c. Open cervix or dilatation of cervix
d. Rupture of membranes
e. No tissue has passed yet
Management:
1. Hospitalization
2. D&C
3. Oxytocin after D & C
4. Emotional support
III. COMPLETE ABORTION
-refers to the spontaneous expulsion of the
products of conception after the fetus has
died in utero.
-the entire products of conception (fetus,
membranes, and placenta) are expelled
spontaneously without any assistance.
-The bleeding usually slows within 2 hours
and then ceases within a few days after
passage of the products of conception.
SIGNS & SYMPTOMS:
a. Vaginal Spotting
b. Cramping
c. Cervical dilatation
d. Complete expulsion of uterine contents
Management:
1. A complete abortion usually needs no further medical

or surgical treatment.
2. The patient must still be observed closely for
continued bleeding or signs of infection.
3. Regular diet. Advice to eat high iron foods as the
woman lost a lot of blood.
4. Instruct patient to rest for a few days to 2 weeks
after a complete abortion. Patient may resume regular
activities when able, but they should refrain from
intercourse and douching for approximately 2weeks.
5. Tell patient that she may experience intermittent

menstrual-like flow and cramps during the following
week. The next menstrual period usually occurs 4-
5weeks.
6. It is important that the expelled products of conception
are evaluated by physician and confirmed to be intact and
truly products of conception. (Ultrasound)
7. Reassure patient that her next pregnancy is likely to last

to term if she is young and has no other risk factor.
(Family planning & pregnancy is discouraged next 3
months after abortion)
8. Aside from testing for CBC and HCG level Rh factor must
also be determined.
9. Advise the patient to return to the emergency

department if any of the following symptoms occur:
• Profuse vaginal bleeding

• Severe pelvic pain
• Temperature greater than 100 F
IV. INCOMPLETE ABORTION
- Expulsion of some parts and retention of other parts
of concepts in utero.
SIGNS & SYMPTOMS:
1.Heavy vaginal bleeding
2.Severe uterine cramping
3.Open cervix
4.Passage of tissue
5.Ultrasound shows that some of the products of
conception are still inside the uterus
Management:
1.D & C
2.Monitor blood loss in patient’s who have
inevitable and incomplete abortion.
3. Emotional support.
V. MISSED ABORTION
- Retention of all products of conception after the death of fetus in the
uterus.
- also commonly referred to as early pregnancy failure
SIGNS AND SYMPTOMS:
1.Absence FHT
2.Signs of pregnancy disappear. Missed abortion should be suspected
when the:
• Uterus fails to enlarge
• Fetal heart sounds are not heard at the appropriate time or
disappears after it has been initially heard.
• A serum or urine test for the submit of human chorionic
gonadotropin (HCG) becomes negative earlier than expected or does
not double within 48-72 hours.
• Ultrasound showing no cardiac activity provides the earliest
diagnosis.
Management:
1. Depending on the age of gestation or size of
conceptus, the products of conception has to be
removed from the uterus to prevent DIC.
2. Up to 28 weeks gestation, missed abortion is
frequently managed.
3. Late missed abortion may be completed with a
dilute IV infusion of oxytocin, which causes
contraction of the uterus and delivery of the
products of conception. After the uterus has
contracted following delivery of the fetus,
curettage may be needed to remove fragments of
RECURRENT PREGNANCY LOSS OR
HABITUAL ABORTION
- Abortion occurring in 3 or more successive pregnancies.
- requires extensive diagnostic investigation, including
genetic and chromosomal studies.
- The cause of the abortion must be identified in order to
determine the most effective treatment to achieve a
successful pregnancy.
POSSIBLE CAUSES:
• Defective spermatozoa or ova
• Endocrine factors such as lowered levels of protein-
bound iodine (PBI), butanol-extractable iodine (BEI),
and globulin-bound iodine (GBI); poor thyroid function;
or a luteal phase defect
• Deviations of the uterus, such as septate or bicornuate
uterus
• Resistance to uterine artery blood flow
• Chorioamnionitis or uterine infection
• Autoimmune disorders such as those involving lupus
anticoagulant and antiphospholipid antibodies.
MANAGEMENT:
1.Treating the cause.
2.Specific treatment according to the cause
of abortion include:
a.) Cervical cerclage
b.) Fertility drugs
c.) Aspirin or Mini-Heparin: the first tissue
changes that occur in the placenta before the
loss of pregnancy is the formation of hyaline
fibrinogen blood clots within the small blood
vessels.
d.) Luteal Phase Progesterone Support: Fertilization and
implantation occurs during the luteal phase of the
menstrual cycle.
e.) Uterine abnormalities
f.) treatment of medical illness such as SLE, DM,
hypothyroidism, hyperthyroidism, sexually transmitted
diseases before and during pregnancy to ensure
successful gestation.
INFECTED ABORTION
- infection involving the products of
conception and the maternal reproductive
organs.
SEPTIC ABORTION
- Dissemination of bacteria (and/their toxins) into the
maternal circulatory and organ system. With a septic
abortion, the patient is acutely ill experiencing signs and
symptoms of infection and threatened or incomplete
abortion. Septic abortions were often associated with
induced abortions performed by untrained persons using
nonsterile techniques or criminal abortions.
CAUSATIVE ORGANISMS:
• Escherichia coli
• Hemolytic streptococci
• Enterobacter aerogenes
• Staphylococci
SIGNS & SYMPTOMS:
1. Foul smelling vaginal discharge
2. Uterine cramping
3. Fever, chills and peritonitis
4. Leukocytosis-WBC count
5. Critically ill patients may evidence septic or endotoxic shock with
vasomotor collapse, hypothermia, hypotension, oliguria or anuria
and respiratory distress.
MANAGEMENT:
1. Treat abortion
2. High dose IV antibiotic therapy: penicillin for gram negative
microorganism.
3. D & C if accompanied by incomplete abortion
4. Infertility may occur after recovery due to scarring of uterus
and fallopian tubes, scarring can interfere with fertilization
and proper implantation.
Reference Book: Maternal
and Child Health Nursing
(Care of the Childbearing
and
Childrearing Family) 9th
Edition Volume 1 JoAnne
Silbert-Flagg

A.1 Abortion

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Republic of the Philippines

Camarines Sur Polytechnic Colleges

CARE OF MOTHER AND CHILD AT RISK

A. Nursing Care Of A Family

• Imminent (inevitable) • Premature cervical dilatation • Premature separation of the

• Missed miscarriage • Preterm labor

1.Elective abortion or Therapeutic abortion

• Elective abortion- initiated by personal choice

Maternal factors: Environmental factors:

1.Hemorrhage (incomplete abortion) – continued

SIGNS & SYMPTOMS:

1. A complete abortion usually needs no further medical

5. Tell patient that she may experience intermittent

7. Reassure patient that her next pregnancy is likely to last

9. Advise the patient to return to the emergency

• Profuse vaginal bleeding

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