[L. abortio, premature delivery, miscarriage]
The spontaneous or induced termination of pregnancy before the fetus reaches a viable age. The legal definition of viability (usually 20 to 24 weeks’ gestation) differs from state to state. Some premature neonates of less than 24 weeks’ gestation or 500 g are viable. Symptoms of spontaneous abortion include abdominal cramps and vaginal bleeding, sometimes with the passage of clots or bits of tissue.
The most common spontaneous causes are faulty development of the embryo resulting from chromosomal anomalies, abnormalities of the placenta, endocrine disturbances, acute infectious diseases, severe trauma, and shock. Other causes include problems related to the uterus, immunologic factors, and use of certain drugs.
Assessment includes monitoring vital signs, fluid balance, and abortion status and progress. Historical data must include duration of pregnancy; Rh status; and time of onset, type, and intensity of abortion symptoms. Character and amount of vaginal bleeding are noted, and any passed tissue (embryonic or fetal) is preserved for laboratory examination. The patient is evaluated for shock, sepsis, and disseminated intravascular coagulation.
A health care professional remains with the patient as much as possible to help allay anxiety, is aware of the patient's coping mechanisms, and is alert for responses such as grief, anger, guilt, sadness, depression, relief, or happiness.
If an elective abortion or surgical completion of the abortion is needed, the procedure and expected sensations are explained, and general perioperative care is provided. If the patient is Rh negative and Coombs test negative (not isoimmune), and if the pregnancy exceeded 8 weeks’ gestation, Rho(D) is administered as prescribed within 72 hr of the abortion. Prescribed fluids, oxytocics, antibiotics, and transfusions are administered as required.
After abortion, the patient is instructed to report excessive bleeding (clots greater than dime-size), pain, inflammation, or fever and to avoid intercourse, tampon use, douching, or placing anything else in the vagina until after a follow-up examination.
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