Abortion in Nursing: Spontaneous, Induced, and Missed
Included In This Lesson
Study Tools For Abortion in Nursing: Spontaneous, Induced, and Missed
Outline
Overview
- Definition – A pregnancy that ends before the fetus would be able to survive independently outside the womb
- Spontaneous abortion = “Miscarriage”
- Elective (Induced) Abortion
- Legal nationwide in U.S. with each state having its own restrictions
- Generally speaking, early term abortions are legal
Nursing Points
General
- Types of abortions
- Spontaneous – body does it on its own
- Induced – medically initiated
- Methotrexate
- Prostaglandins (misoprostol-cytotec)
- Methylergonovine (methergine)
- Threatened – spotting and cramping with NO cervical changes
- Inevitable – spotting, cramping, dilation and effacement of cervix
- Incomplete – portions of embryo or fetus or placenta retained in the uterus
- Complete – bleeding cervical dilation, loss of all tissue and conception products
- Missed – fetal or embryonic demise, but no outward signs and all components remain in the uterus
- Habitual – spontaneous abortion (miscarriage) for 3 or more pregnancies in a row
Assessment
- Vaginal spotting
- Abdominal pain or cramping
- Cervical os – open or closed
- Fluid or tissue passing from the vagina
- Ultrasound to visualize
- Bleeding may signify another issue, doesn’t always indicate miscarriage
Therapeutic Management
- If any parts of the embryo/fetus are still present, prepare client for a D&C (dilation and curettage) to remove contents of the uterus
- Must be performed because of risk of infection
- Evaluate blood loss
- Count perineal pads
- Save expelled contents
- Replace IVF per orders
- Check blood type of mom
- Give RhoGAM if Rh-negative
Nursing Concepts
- Reproduction
- Comfort
- Grief & Loss
Patient Education
- Signs to report post D&C
- When to call for an induced abortion
ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Abortion in Nursing: Spontaneous, Induced, and Missed
Transcript
I am going to explain the details of the different types of abortions and your role in caring for this patient.
So what is an abortion. Most think of someone being pregnant and not wanting to keep the pregnancy so they go to a clinic and have an abortion. Yes, this true but medically any pregnancy that ends before the fetus would be able to survive on its own outside of the womb is an abortion. Because of this they are labeled either as a spontaneous abortion or a miscarriage or elective which is either an abortion that is chosen by the patient because ether they do not want the pregnancy which could even be someone that does want a child but has learned that they are carrying a fetus that has genetic problems or one that won’t be compatible with life.
There are several types of abortions. There are spontaneous abortions and this is where body does it on its own. These are usually caused by genetic anomalies. That is important to know. Abortions can also be induced which means it is medically initiated. These are induced with medications like methotrexate, this is usually used for ectopic pregnancies because Methotrexate attacks the rapidly dividing cells which is what an embryo is. In this picture you can see the ectopic pregnancy in the fallopian tube. So this could be medically managed to save the fallopian tube.Other medications are prostaglandina (misoprostol-cytotec) and Methylergonovine (methergine)
With a threatened abortion there is spotting and cramping with NO cervical changes. It is just threatened but doesn’t occur, it is just a sign that there is a chance. Inevitable is spotting, cramping, dilation and effacement of cervix. It is inevitable, it is going to happen. Incomplete is where portions of embryo or fetus or placenta retained in the uterus but there is loss of some of the pregnancy. This is where surgical management will be needed to remove the retained pieces. Complete abortions is going to have bleeding present and cervical dilation. There will be loss of all tissue and conception products. If there is going to be an abortion this is the type we want to see because the body takes care of removing everything the way it should without complication. A missed abortion is where there is fetal or embryonic demise, but no outward signs of a loss. All products of conception will remain in the uterus and this will require either surgical intervention or medications to help the body release the products.
So what do we need to be assessing? We want to assess the vaginal spotting and see how much there is. Bleeding could signify something else going on. We also want to know if there has been any fluid or tissue loss so asking these questions and assessing will help. We need to assess what she is feeling is it pain or cramping or both? Is the cervix dilating? So looking at the cervical os and assessing. An ultrasound can be done to better visualize what is really going on. Do we have a fetal heart rate? Is it an ectopic pregnancy?
If any parts of the embryo/fetus are found to still be present we need to prepare for a D&C (dilation and curettage) to remove contents of pregnancy. As you see in this image dilation is done mechanically and then products are removed. This has to be done because if the body is not passing the conception products on it’s own then there is a risk of infection. These patients are usually bleeding because the body is trying so hard to shed the products so we evaluate blood loss and if it is too much then we can address that. Counting perineal pads is a good way to assess the loss. We also must, must must, check the blood type of the mom and give RhoGAM if she is Rh-negative.
Reproduction is a concept because abortion deals with reproduction. Comfort because we need to keep her comfortable during procedures and post procedure and grief and loss is a big one because it is a huge loss to a family and they are going to be going through a hard time after.
Abortions can be elective/therapeutic and this is a choice, whether a pregnancy they do not want or therapeutic because of a choice made from something found through testing. Spontaneous (miscarriages) are another type, which most of the time are caused by genetic abnormalities. The body causes it and it just happens. Bleeding needs to be monitored. And remember an incomplete abortion needs surgical intervention.
Make sure you check out the resources attached to this lesson and review the different types of abortions with considerations to if there is tissue loss and if the cervix opens. Now, go out and be your best selves today. And, as always, happy nursing.
Monalisa’s Study Plan
Concepts Covered:
- Community Health Overview
- Circulatory System
- Urinary System
- Communication
- Prenatal Concepts
- Test Taking Strategies
- Respiratory Disorders
- EENT Disorders
- Developmental Theories
- Legal and Ethical Issues
- Prefixes
- Suffixes
- Acute & Chronic Renal Disorders
- Disorders of the Adrenal Gland
- Preoperative Nursing
- Integumentary Disorders
- Integumentary Disorders
- Prioritization
- Bipolar Disorders
- Disorders of the Posterior Pituitary Gland
- Hematologic Disorders
- Immunological Disorders
- Renal Disorders
- Childhood Growth and Development
- Labor Complications
- Upper GI Disorders
- Medication Administration
- Developmental Considerations
- Adulthood Growth and Development
- Disorders of Pancreas
- Musculoskeletal Disorders
- Musculoskeletal Trauma
- Disorders of the Thyroid & Parathyroid Glands
- Integumentary Important Points
- Pregnancy Risks
- Urinary Disorders
- Cardiac Disorders
- Learning Pharmacology
- Documentation and Communication
- Anxiety Disorders
- Basic
- Factors Influencing Community Health
- Prenatal and Neonatal Growth and Development
- Lower GI Disorders
- Eating Disorders
- Trauma-Stress Disorders
- Microbiology
- Oncology Disorders
- Somatoform Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Concepts of Population Health
- Understanding Society
- Depressive Disorders
- Personality Disorders
- Cognitive Disorders
- Substance Abuse Disorders
- Psychological Emergencies
- Hematologic Disorders
- Liver & Gallbladder Disorders
- Emergency Care of the Cardiac Patient
- Female Reproductive Disorders
- Delegation
- Vascular Disorders
- Oncologic Disorders
- Postpartum Complications
- Fetal Development
- Endocrine and Metabolic Disorders
- Basics of NCLEX
- Shock
- Studying
- Concepts of Mental Health
- Labor and Delivery
- Gastrointestinal Disorders
- Health & Stress
- Neurological Emergencies
- EENT Disorders
- Emotions and Motivation
- Intraoperative Nursing
- Digestive System
- Central Nervous System Disorders – Brain
- Tissues and Glands
- Postpartum Care
- Cardiovascular Disorders
- Newborn Care
- Renal and Urinary Disorders
- Newborn Complications
- Neurologic and Cognitive Disorders
- Musculoskeletal Disorders
- Infectious Disease Disorders
- Nervous System
- Respiratory System
- Behavior
- Terminology
- Respiratory Emergencies
- Peripheral Nervous System Disorders
- Proteins
- Noninfectious Respiratory Disorder
- Basics of Human Biology
- Neurological Trauma
- Concepts of Pharmacology
- Statistics
- Emergency Care of the Neurological Patient
- Basics of Sociology
- Central Nervous System Disorders – Spinal Cord
- Infectious Respiratory Disorder
- Psychotic Disorders
- Emergency Care of the Trauma Patient