ABORTION

• Unexpected deviations or complications from the course of normal pregnancy occurs, which we now term as high-risk
• High-risk pregnancy is one in which the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to pregnancy
• Categories of high-risk pregnancy

  • Maternal age parity factors and maternal illness
  • Fetal factors
  • Placental factors
• Maternal age parity factors and maternal illnesses

  • Age 16 years or under
  • Nullipara 35 or over
  • Multipara 40 or over
  • Interval of 8 years or more since the last pregnancy
  • High parity (5 or more)
  • Pregnancy occurring after 3 months or less after the last delivery
  • Hypertension
  • Diabetes
  • Cancer
  • Kidney disease
  • Anemia
  • Issues in clotting and bleeding factors
• Maternal age parity factors and maternal illnesses

  • Tuberculosis
  • Malnutrition and obesity
  • Heart diseases
  • STI and TORCH (toxoplasmosis, others, rubella, cytomegalovirus, herpes simplex)
  • Alcoholism and drug addiction
  • Psychiatric issues
  • Mental retardation
  • History of prolonged labor and delivery
  • Previous cesarean delivery
  • Cephalopelvic disproportion
  • Problems with the 5p's
• Fetal factors

  • Congenital anomalies
  • History of previous birth defects
  • One or more still birth at term
  • Two or more consecutive spontaneous abortions
  • Two or more premature deliveries
• Placental factors

  • Position
  • Development
• What trimester does abortion occur?

  First trimester
• Abortion

  pregnancy that ends in less than 20 weeks gestation, either spontaneously or therapeutic (induced/medical/elective/intention/criminal)
• Abortion

  termination of pregnancy before the fetus is viable (20 weeks or weight of less or 500 grams)
• Miscarriage

  is becoming an accepted medical term to denotr spontaneous abortion
• Spontaneous abortion


  • is a termination of pregnancy without action taken by the woman or another person. Without medical or mechanical interventions
  • ends of natural cause
  • Without elective medical procedure
• Etiology of spontaneous abortion (fetal factors)

  • defective embryologic development or abnormal fetal formation due to teratogenic factor or chromosomal aberration
  • faulty ovum implantation
  • rejection of the ovum by the endometrium
• Etiology of spontaneous abortion (maternal factors)


  • infection
  • severe malnutrition
  • reproductive system abnormalities (incompetent cervix)
  • endocrine problems (thyroid dysfunction)
  • trauma
  • drug ingestion - teratogenic substances
  • illness ( cancer, TB, hypertension, GDM)
• Etiology of spontaneous abortion (placental factors)


  • premature separation of the normally implanted placenta
  • abnormal placental separation
  • abnormal placental function
• Pathophysiology

  The fetal, placental, defect or maternal condition results in the disruption of blood flow, containing oxygen and nutrients to the developing fetus. The fetus is compromised and subsequently expelled from the uterus.
• Clinical signs of abortion

  • Vaginal bleeding or spotting
  • Uterine or abdominal cramps
  • Passages of tissues or products of conception
  • Signs related to blood loss = hypovolemic shock = maternal and fetal death
• Different types of spontaneous abortion classified as MIITCHS

  • Missed abortion
  • Inevitable abortion
  • Incomplete abortion
  • Threatened abortion
  • Complete abortion
  • Habitual abortion
  • Septic abortion
• Threatened abortion


  • under 16 weeks, late 16 to 14 weeks
  • Bleeding: first bright red. Slight/spotting
  • Abdominal cramps: may or may not be present. Backache
  • Cervical dilation: closed
  • Tissue passage: none
  • Fever: none
• Inevitable or imminent abortion

  • Bleeding: Moderate
  • Abdominal cramps: Persistent cramping
  • Cervical dilation: Open. Rupture of membranes and all products of conception
  • Tissue passage: All products of conception
  • Fever: None
• Complete abortion

  • Bleeding: Minimal to severe
  • Abdominal cramps: Moderate to severe
  • Cervical dilation: Open
  • Tissue passage: All products of conception
  • Fever: None
• Incomplete abortion

  • Bleeding: Severe bleeding
  • Abdominal cramps: Severe
  • Cervical dilation: Open
  • Tissue passage: Fetal or incomplete placental tissues
  • Fever: None
• Missed / Fetal Demise / Death in utero abortion

  • Bleeding: None. Mild to moderate to severe
  • Abdominal cramps: None. No FHT with ultraosund
  • Cervical dilation: Closed
  • Tissue passage: None
  • Fever: None
• Habitual or Recurrent abortion

  • 3 or more consecutive abortions
  • Bleeding: Intermittent fetal discharge
  • Abdominal cramps: Mild to moderate to severe
  • Cervical dilation: Closed or open
  • Tissue passage: Depends upon the type of abortion
  • Fever: None
• Septic (infection) abortion

  • Bleeding: Mild to severe
  • Abdominal cramps: Severe
  • Cervical dilation: Closed or open with or without tissue
  • Tissue passage: Possibly, foul discharge
  • Fever: There is fever
• Nursing diagnosis

  • Anticipatory grieving related to loss of pregnancy, cause of abortion, future childbearing
• Nursing interventions

  • Assess the reaction of patient and support person, and provide information regarding current status, as needed
  • Encourage the patients to discuss feelings, about the loss of the baby. Include effects on relationship with the father
  • Do not minimize the loss by focusing on future childbearing, rather acknowledge the loss and allow grieving
  • Providing time along for the couple to discuss their feelings
• Therapeutic / Induce / Medical / Intentional / Elective abortion


  • can be induced up to approximately 20 weeks gestation
  • is the interruption of a pregnancy before the 20th week of gestation at the woman's request for reasons other than the maternal health or fetal disease
• Therapeutic abortion


  • are those induced to safeguard the health of the mother and in cases of genetic disease and anomalies in the fetus that could endanger the life of the mother
• Nontherapeutic abortion


  • desire to terminate the pregnancy
• Surgical management of abortion

  • Dilation and evacuation
  • Dilation and curettage
  • Hysterectomy
• Dilation and evacuation


  • all products of conception from the uterus are expelled
• Dilation and curettage 


  performed for incomplete abortion to remove the remaining products of conception from the uterus
• Dilation and curettage


  • Is a procedure to remove tissue from inside your uterus. Health care providers perform dilation and curettage to diagnose and treat certain uterine conditions - such as heavy bleeding - or to clear the uterine lining after a miscarriage or abortion
  • Small instruments or medication to open (dilate) the lower, narrow part of the uterus (cervix). Your provider then uses a surgical instrument called a curette, which can be a sharp instrument or suction device, to remove uterine tissue