04.01 Abortion

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Overview

  1. Definition – A pregnancy that ends before the fetus would be able to survive independently outside the womb
    1. Spontaneous abortion = “Miscarriage”
    2. Elective (Induced) Abortion
      1. Legal nationwide in U.S. with each state having its own restrictions
      2. Generally speaking, early term abortions are legal

Nursing Points

General

  1. Types of abortions
    1. Spontaneous – body does it on its own
    2. Induced – medically initiated
      1. Methotrexate
      2. Prostaglandins (misoprostol-cytotec)
      3. Methylergonovine (methergine)
    3. Threatened – spotting and cramping with NO cervical changes
    4. Inevitable – spotting, cramping, dilation and effacement of cervix
    5. Incomplete – portions of embryo or fetus or placenta retained in the uterus
    6. Complete – bleeding cervical dilation, loss of all tissue and conception products
    7. Missed – fetal or embryonic demise, but no outward signs and all components remain in the uterus
    8. Habitual – spontaneous abortion (miscarriage) for 3 or more pregnancies in a row

Assessment

  1. Vaginal spotting
  2. Abdominal pain or cramping
  3. Cervical os – open or closed
  4. Fluid or tissue passing from the vagina
  5. Ultrasound to visualize
  6. Bleeding may signify another issue, doesn’t always indicate miscarriage

Therapeutic Management

  1. 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
    1. Must be performed because of risk of infection
    2. Evaluate blood loss
    3. Count perineal pads
    4. Save expelled contents
    5. Replace IVF per orders
  2. Check blood type of mom
    1. Give RhoGAM if Rh-negative

Nursing Concepts

  1. Reproduction
  2. Comfort
  3. Grief & Loss

Patient Education

  1. Signs to report post D&C
  2. When to call for an induced abortion

Reference Links

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Video 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.

Read more

  • Question 1 of 6

A client who has been diagnosed with an inevitable miscarriage at 16 weeks wants to try and miscarry at home instead of having a D&C. The nurse should instruct the client to call immediately for which scenario?

  • Question 2 of 6

A pregnant client presents to the emergency room with vaginal bleeding and states that she is 11 weeks. On ultrasound the embryo is visualized and the fetal heart rate is 142. What diagnosis should the nurse anticipate?

  • Question 3 of 6

A client who is 13 weeks pregnant comes to the clinic. During the ultrasound, no heart tones are detected. The client denies having had any bleeding. The nurse would be correct in explaining this to the client as what type of abortion/miscarriage?

  • Question 4 of 6

A client is upset about a miscarriage that she had and wants to know why it happened. What is the best response by the nurse?

  • Question 5 of 6

A nurse is caring for a client who has had a missed abortion at 9 weeks gestation. Which of the following treatments should the nurse prepare the client for?

  • Question 6 of 6

A nurse is caring for a 33-year-old client who is 10 weeks pregnant who presented at the healthcare clinic with complaints of vaginal bleeding and slight uterine cramping. The provider performs an ultrasound and diagnoses the client with a threatened abortion. Which of the following instructions would the nurse give to this client?

Module 0 – OB Course Introduction

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