The term abortion
can be refer to as the expulsion of the fetus, prior to viability, which is considered to be between 20 weeks gestation or
weight of less than 500g. according to state reporting laws, 9cunning ham
leveno, Bloom et al 2005. abortion are either spontaneous or naturally or
included occurring as the result of medical or surgical means. The term
abortion may have negative connotation, spontaneous abortion is often called
miscarriage.
There
are other complication that can cause bleeding in the first half of pregnancy,
this include
entopic pregnancy and gestational
tropho blastic diseases. In the second third trimester, the two major cause of
bleeding are placenta prairie and abruption placenta. Regardless of the cause of bleeding however
the nurse has certain general responsibilities in providing nursing care.
GENERAL PRINCIPLES OF NURSING OTER- RENTION
(a) Sporting is relatively common during pregnancy and usually
occurs following intercourse or exercise because of trauma of the highly vascular
cervix however, the woman is advised to report any spotting or bleeding that
occur during pregnancy, so that it can be evaluated. It is often the nurses
responsibility to make the initial assessment of bleeding.
In
general the following nursing measures are indicated:-
1.
Monitor blood pressure and pulse frequently
2.
observe the woman for behavior indicative of shock,
such as pollar claming, skin perspiration, dysperea or restlessness
3.
counts and weigh pads to asses amount of bleeding over
a given time period save any tissue odots expelled.
4.
if pregnancy is of 12 weeks gestation or beyond, assess
fetal heart tones with a Doppler
5.
prepare for intravenous (therapy there may be standing
orders to begin the therapy on client who are bleeding.
6.
prepare equipment for examination and have oxygen
availably
7.
collect and organize all data including auto parental history
onset of bleeding episode and laboratory studies hemoglobin hematocrit.
Hormonal assays) for analyzing.
8.
notify other members of the health care team including
the physician or nurse, midwife, operating room staff if a surgical procedure
is to be performed.
9.
obtain an order to type and cross match for blood
evidence of significant blood loss exists.
10.
access coping mechanisms of the women in crisis, give
emotional support to enhance her coping abities by continues sustained pressure
and by communing her status to her family. Prepare the woman for possible fetal
loss. Assess her, expression of anger, denial silence quit, depression or self
blame
11.
assess the family response to the situation
SPONTANEOUS ABORTION (MISCARRIAGE)
The incidence of
first trimester spontaneous abortion is about 10% to 12% for clinical recognized pregnancies but the member may be
hiyber over all. The likehood of recurrent miscarriage is through to be 25% to
50% (Simpson 2002). A majority of early miscarriages are related to chromosomal
abnormalities. Other causes include teratogenic drugs, faulty implantation due
to abnormalities of the females reproductive tracts; a weakened cervix,
placental abnormalities, chronic maternal disease, endocrine imbalance and
maternal infections research does not support the believe that accidents and
psychic trauma are primary causes of spontaneous abortion.
CLASSIFICATIONS
Spontaneous abortion
is subdivided into the following categories:-
i. THREATENED
ABORTION:- The embryo fetus is jeopardized by unexplained bleeding,
cramping and backache. The cervix is closed, the bleeding may persist for days.
It may be followed by partial or complete expulsion of the embryo or fetus
placenta and membranes (sometime called the products of conception)
ii. IMMINENT ABORTION:- Bleeding and
cramping crease. The internal cervical as dilates, membranes may rapture. The
term inevitable abortion also appears.
iii. COMPLETE ABORTION:- All the products of
conception are expelled.
iv. INCOMPLETE
ABORTION:- Abortion some of the products of conception are retained most
often the placenta. The internal cervical is diluted slightly.
v. MISSED
ABORTION:- The fetus dies in utero, but is not expelled. uterine growth
ceases, breast changes, regress and the woman report a brownish vaginal
discharge. The cervix is closed. If the fetus is retained beyond 6 weeks
breakdown of fetal tissue results in the release of thromboplastin and disseminated intravascular capitulation may
develop.
vi. Recurrent (habitual) abortion. Abortion
occurs consecutively in three or more pregnancies.
SEPTIC ABORTION:- Infection is present, it may occur with prolonged
unrecognized rapture of the membrane pregnancy with an infraurine device
CLINICAL THERAPY
The pelvic
cramping and backache are reliable indicators of potential spontaneous
abortion. There symptoms are usually absent in bleeding caused by polyps,
ruptured cervical blood vessels or cervical erosion. Ultrasound scanning may be
used to detect presence of a gestational sac or fetal heartbeat, if the cause
of bleeding is unclear.
Result
of human chronic gonadoropin level are not particularly helpful because the
level fall slowly after fetal death and therefore cannot confirm or live
emproyo or fetus. Heamoglobin and hematocrit are obtained to assess blood loss.
Blood is typed and corss matched for possible replacement needs.
The
therapy prescribed for the pregnant woman with bleeding is rest, abstinence
from sex, and perhaps sedation, if bleeding persists and abortion is immanent
or incomplete. The woman may be hospitalized therapy or blood transfusions may
be started to replace fluid and dilation and curettage (D&C) or suction evacuation
is performed to remove the remainder of
the products of conception. In missed abortions the products of conception
usually are expelled, spontaneously. Diagnosis is based on history pelvic
examination and may be confirm by ultrasound if necessary. If this does not
occur within 4 to 6 weeks after embrayo or fetas death hospitalization is
necessary. If in the first trimester D&C or suction evacuation is done in
the second trimester, labour is induced or elevation and evacuation D&E be
used.