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.
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.
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
- Pain in lower back
- Abdominal cramping
- 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.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell