Nursing Care Plan for Abortion, Spontaneous Abortion, Miscarriage

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Pathophysiology

Abortion is the termination of a pregnancy before the fetus is able to live outside the womb, usually prior to 20 – 24 weeks. Abortion has many classifications. They may be spontaneous (miscarriage), in which there is no outside intervention that results in the loss of pregnancy, or induced, either electively or for therapeutic reasons. Early abortions occur prior to 12 weeks gestation, while late abortions are between 12 and 20 weeks. Complete abortion is when all tissues are completely passed. When an incomplete abortion occurs, some tissue remains in the uterus and can be parts of the fetus, placenta or other pregnancy tissue. Miscarriage is a common occurrence with approximately 10% – 20% of all known pregnancies ending in spontaneous abortion.

Etiology

In elective abortion, the pregnancy is intentionally terminated  through medical intervention. In cases of spontaneous abortion, the fetus often has genetic complications that are usually not related to the mother. Use of drugs or alcohol, smoking, and high doses of caffeine may Other causes of fetal demise may include infection (maternal or fetal), trauma, maternal medical complications like diabetes, hypertension or thyroid disorder, incompetent cervix or immune system issues. A woman may be at increased risk of spontaneous abortion if she is over the age of 35 years old or has had previous miscarriages.

Desired Outcome

Patient will experience minimal blood loss and be free from infection; patient will develop coping skills to effectively manage emotional loss of pregnancy

Abortion, Spontaneous Abortion, Miscarriage Nursing Care Plan

Subjective Data:

  • Pain in lower back
  • Abdominal cramping

Objective Data:

  • Vaginal bleeding or spotting
  • Fluid or tissue passing through the vagina

Nursing Interventions and Rationales

  • Obtain information about pregnancy from patient including estimated due date

 

  • Note any chronic health conditions, previous miscarriages or events and risk factors that may have led up to the onset of symptoms.
  • Note due date to determine gestational age and viability of fetus.

 

  • Assess patient for bleeding, amniotic fluid and passage of pregnancy tissue

 

  • Weigh or count number of saturated pads each hour
  • Note amniotic fluid or tissue being expelled from the vagina that indicates spontaneous abortion

 

  • Perform assessment of fundal height; note if abdomen is firm or rigid

 

  • Note any contractions that may indicate impending expulsion of fetus
  • Rigidity of the uterus may be a sign of infection

 

  • Assess for fetal heart rate

 

Determine if there is a viable fetus; determines course of treatment

 

  • Assist with ultrasound or amniocentesis

 

Helps to determine fetal maturity and viability in the presence of fetal heart rate

 

  • Initiate IV fluids and administer blood products  as appropriate

 

Replacement of fluid and blood loss

 

  • Assess and manage pain

 

  • Contractions, low back pain and cramping are symptoms that require management.
  • Assist with non-pharmacological interventions as necessary.

 

  • Place patient in lateral position on strict bed rest

 

  • This position helps relieve pressure on the vena cava and helps reduce bleeding
  • Bed rest is required to limit blood loss and help with pain management

 

  • Monitor vital signs

 

  • Excessive blood loss can result in hypovolemia, especially in the case of placenta abruption.
  • Monitor for hyper/hypotension, tachycardia and shortness of breath.
  • Note if fever is present which may indicate infection.

 

  • Assess patient’s psychological status and offer support and resources

 

  • Unexpected loss of pregnancy may cause emotional distress.
  • Offer emotional  support and provide resources for counseling, religious contacts and support groups to help develop coping techniques.

 


References

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