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Abortion | 마이메르시 MyMerci
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Abortion

NCLEX Review Guide: Abortion - Risk Conditions Related to Pregnancy

Types of Abortion

Spontaneous Abortion (Miscarriage)

  • Threatened abortion: Vaginal bleeding with closed cervix and no passage of products of conception before 20 weeks gestation.
  • Inevitable abortion: Vaginal bleeding with open cervix, indicating abortion will occur but products haven't passed yet.
  • Incomplete abortion: Partial passage of products of conception with open cervix and continued bleeding.
  • Complete abortion: All products of conception have passed, cervix closes, and bleeding stops.
  • Missed abortion: Fetal death before 20 weeks with retained products and closed cervix.
  • Septic abortion: Infection of uterine contents, typically following unsafe abortion procedures.

Quick Comparison: Cervix Status & Bleeding

TypeCervixBleedingProducts Passed
ThreatenedClosedLightNo
InevitableOpenModerateNo
IncompleteOpenHeavyPartial
CompleteClosedMinimalComplete

Key Points

  • Cervical status is the key differentiator between abortion types
  • Bleeding patterns vary significantly and guide nursing interventions
  • Products of conception passage determines completeness of abortion

Nursing Assessment & Interventions

Priority Assessments

  1. Vital signs - Monitor for signs of hemorrhage (hypotension, tachycardia)
  2. Amount and characteristics of vaginal bleeding - Count pads, assess clots
  3. Pain level and location - Cramping vs. sharp pain patterns
  4. Cervical examination - Only by physician to determine dilation
  5. Emotional status - Assess grief response and coping mechanisms

Clinical Scenario

A 28-year-old woman at 12 weeks gestation presents with moderate vaginal bleeding and cramping. Cervical exam reveals 2cm dilation. This indicates inevitable abortion - prepare for D&C procedure and provide emotional support.

Memory Aid: "BLEEDS"

  • Blood loss assessment
  • Location of pain
  • Emotional support
  • Education about process
  • Discharge planning
  • Signs of infection

Key Points

  • Never perform vaginal exams on bleeding pregnant patients - physician only
  • Save all passed tissue for pathological examination
  • Monitor for signs of hemorrhage and infection

Therapeutic Management

Medical Interventions

  • Dilation and Curettage (D&C): Surgical removal of uterine contents for incomplete or missed abortion.
  • Expectant management: Watchful waiting for complete spontaneous passage in threatened abortion.
  • Medical management: Misoprostol to promote uterine contractions and expulsion of products.
  • RhoGAM administration: Given to Rh-negative mothers within 72 hours to prevent sensitization.

Critical Nursing Actions

  • Establish IV access for potential fluid/blood replacement
  • Type and crossmatch blood for potential transfusion
  • Administer RhoGAM if mother is Rh-negative
  • Provide grief counseling and emotional support

Key Points

  • RhoGAM must be given within 72 hours to Rh-negative mothers
  • D&C is indicated for incomplete, missed, or septic abortion
  • Expectant management appropriate only for threatened abortion with stable vitals

Complications & Risk Factors

High-Risk Factors

  • Maternal age: Risk increases significantly after age 35 due to chromosomal abnormalities.
  • Previous pregnancy losses: History of recurrent abortion increases risk for future pregnancies.
  • Uterine abnormalities: Structural defects like septate uterus or fibroids increase abortion risk.
  • Chronic medical conditions: Diabetes, thyroid disorders, and autoimmune diseases elevate risk.
  • Lifestyle factors: Smoking, alcohol use, and illicit drug use significantly increase risk.

Memory Aid: "CAUSES"

  • Chromosomal abnormalities
  • Age (advanced maternal)
  • Uterine defects
  • Systemic diseases
  • Environmental factors
  • Substance abuse

Key Points

  • Most first-trimester abortions result from chromosomal abnormalities
  • Recurrent abortion (≥3 losses) requires comprehensive evaluation
  • Lifestyle modifications can reduce risk in future pregnancies

Patient Education & Discharge Planning

Discharge Instructions

  1. Pelvic rest for 2 weeks - no tampons, douching, or sexual intercourse
  2. Monitor for signs of infection: fever, foul-smelling discharge, severe cramping
  3. Return to normal activities gradually as tolerated
  4. Follow-up appointment in 1-2 weeks for physical and emotional assessment
  5. Contraception counseling if pregnancy not desired immediately

Teaching Priority

Emphasize that most early pregnancy losses are not preventable and result from chromosomal abnormalities. Provide resources for grief counseling and support groups.

Key Points

  • Emotional support is as important as physical care
  • Future pregnancy planning should wait until physical and emotional healing
  • Warning signs require immediate medical attention

Quick Check: When to Call Provider

  • Temperature >100.4°F (38°C)
  • Heavy bleeding (>1 pad/hour)
  • Severe abdominal pain
  • Foul-smelling discharge
  • Signs of depression

Remember: You're preparing to provide compassionate, evidence-based care during one of the most difficult experiences a woman can face. Your knowledge and empathy will make a significant difference in your patients' healing journey. Keep studying - you've got this!

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