Abortion Information - Types of Abortion, Causes, Sign & Symptoms And Treatment of Abortion
Abortion is the spontaneous or induced (therapeutic) expulsion of the products of conception from the uterus before fetal viability (fetal weight < 500 g [17 5/8 oz] or gestation < 20 weeks). Up to 15% of all pregnancies and approximately 30% of all first pregnancies end in spontaneous abortion (miscarriage). At least 75% of miscarriages occur during the first trimester.
Causes of abortion
Spontaneous abortion may result from fetal, placental, or maternal factors. Fetal factors, which usually cause such abortions between the 9th and 12th week of gestation, include the following:
Placental factors usually cause abortion around the 14th week of gestation, when the placenta takes over the hormone production necessary to maintain the pregnancy. These factors include:
TYPES OF SPONTANEOUS ABORTION
Signs and symptoms of abortion
Prodromal signs of spontaneous abortion may include a pink discharge for several days or a scant brown discharge for several weeks before the onset of cramps and increased vaginal bleeding. For a few hours, the cramps intensify and occur more frequently; then the cervix dilates to expel uterine contents. If the entire contents are expelled, cramps and bleeding subside. However, if any contents remain, cramps and bleeding continue.
Diagnosis of abortion
Diagnosis of spontaneous abortion is based on clinical evidence of expulsion of uterine contents, pelvic examination, and laboratory studies. Human chorionic gonadotropin (HCG) in the blood or urine confirms pregnancy; decreased HCG levels suggest spontaneous abortion.
CLINICAL TIP Spontaneous abortion may result from a decrease in serum progesterone. Levels should be checked every 7 to 10 days. HCG levels should be checked every 48 hours and should be double in comparison with the previous level
Pelvic examination determines the size of the uterus and whether this size is consistent with the length of the pregnancy. Tissue cytology indicates evidence of products of conception. Laboratory tests reflect decreased hemoglobin levels and hematocrit due to blood loss
Treatment and cure of abortion
An accurate evaluation of uterine contents is necessary before a plan of treatment can be formulated. The progression of spontaneous abortion can't be prevented, except in cases caused by an incompetent cervix. The patient must be hospitalized to control severe hemorrhage. If bleeding is severe, a transfusion with packed red blood cells or whole blood is required. Initially, I. V. administration of oxytocin stimulates uterine contractions. If any remnants remain in the uterus, dilatation and curettage or dilatation and evacuation (D&E) should be performed.
D&E is also performed in first and second-trimester therapeutic abortions. In second-trimester therapeutic abortions, the insertion of a prostaglandin vaginal suppository induces labor and the expulsion of uterine contents.
After an abortion, spontaneous or induced, an Rhnegative female with a negative indirect Coombs' test should receive Rho(D) immune globulin (human) to prevent further Rh isoimmunization.
In a habitual aborter, spontaneous abortion can result from an incompetent cervix. Treatment involves surgical reinforcement of the cervix (McDonald or Shirodkar-Barter procedure) 12 to 14 weeks after the last menses. A few weeks before the estimated delivery date, the sutures are removed and the patient awaits the onset of labor. An alternative procedure, especially for the woman who wants to have more children, is to leave the sutures in place and to deliver the infant by cesarean section.
Before possible abortion:
After spontaneous or elective abortion:
Care of the patient who has had a spontaneous abortion includes emotional support and counseling during the grieving process. Encourage the patient and her partner to express their feelings. Some couples may want to talk to a member of the clergy or, depending on their religion, may wish to have the fetus baptized.
The patient who has had a therapeutic abortion also benefits from support. Encourage her to verbalize her feelings. Remember, she may feel ambivalent about the procedure; intellectual and emotional acceptance of abortion aren't the same. Refer her for counseling if necessary.
To prepare the patient for discharge:
To minimize the risk of future spontaneous abortions, emphasize to the pregnant woman the importance of good nutrition and the need to avoid alcohol, cigarettes, and drugs. Most clinicians recommend that the couple wait two or three normal menstrual cycles after a spontaneous abortion has occurred before attempting conception. If the patient has a history of spontaneous abortions, suggest that she and her partner have thorough examinations. For the woman, this includes premenstrual endometrial biopsy, a hormone assessment (estrogen, progesterone, and thyroid, follicle-stimulating, and luteinizing hormones), and hysterosalpingography and laparoscopy to detect anatomic abnormalities. Genetic counseling may also be indicated.
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