Abortion (AB) describes the natural or artificial (through medical intervention) termination of a pregnancy. Abortions occur commonly in nature. Medically induced abortion remains a controversial issue. Certain religions oppose most medically initiated abortions for various reasons. Roman Catholic hospitals, for example, may not perform abortions unless specific criteria are met, such as a life-threatening situation for the mother. A healthcare professional may refuse to participate in an induced abortion based on religious or moral grounds.
If the aborting woman is Rh negative, a specific anti-Dimmune globulin, such as Rh immune globulin (RHOGAM), should be given as a precautionary measure against Rh sensitization.
The two major categories of abortion are (1) spontaneous (by natural cause or without medical intervention; often called a miscarriage by lay people); and (2) induced or therapeutic (with medical intervention by way of mechanical assistance or medical agents).
Types of Abortion
Spontaneous Abortion
It is estimated that approximately 10% to 20% of all pregnancies end in spontaneous abortion. Fetal abnormalities or defects are the most frequent causes of spontaneous abortion. Maternal alcohol use and cigarette smoking may contribute. Other causes include maternal disorders, trauma(e.g., a motor vehicle accident), dietary factors, and abnormalities of pregnancy.
Threatened Abortion
This condition exists any time bleeding or cramping occurs in the first 20 weeks of pregnancy without major cervical dilation. Many birth attendants will not take extreme measures to save such a pregnancy because a spontaneous abortion is often nature’s way of disposing of a malformed fetus. If bleeding is slight, however, hormones or muscle relaxants may be given. The client is put to bed with her feet elevated for 48 to 72 hours. If the bleeding stops, she may resume limited activities. If true uterine contractions occur, the prognosis is more guarded.
Complete Abortion
This occurs when the woman spontaneously expels all the products of conception (i.e., the placenta and fetus). The uterus then contracts toward normal size, and the cervix closes. The same care that routinely follows a normal delivery is given to the woman. Observe the client closely for signs of haemorrhage. Check her blood pressure to see that it remains stable. Note and report any changes in skin colour, especially pallor or cyanosis. Check her pulse (a weak, rapid pulse is a sign of shock). The birth attendant checks to make sure the uterus is contracted. Document the number of perineal pads the client uses and the amount of bleeding.
Septic Abortion
This is the term given when the contents of the uterus become infected before or during an abortion, or when the uterus becomes infected later. Septic (endotoxic) shock may occur and may cause maternal death.
Recurrent Spontaneous Abortion
Referred to in the past as habitual abortion, this term means that a woman has spontaneously lost three or more successive pregnancies. Recurrent spontaneous abortion is often caused by an incompetent cervix that dilates prematurely. In such a case, the birth attendant usually makes every possible effort to save the pregnancy. Attempts are made to determine the cause of the recurrent abortions and to correct the situation if possible.
Sometimes surgery may correct a problem causing the loss. Some habitual and spontaneous abortions are the result of premature cervical dilation, during the second or early third trimester of pregnancy. This situation is also called incompetent cervix. Premature cervical dilation simply means that the cervix is unable to support a pregnancy. The weight of the fetus is sufficient to force the cervix to dilate, causing a spontaneous abortion. Causes of this condition include cervical infections (e.g., chlamydia), cervical or vaginal cancer, previous cervical biopsies or conizations, and prior multiple dilation and curettage procedures. The cervical weakness may be congenital; one such cause is maternal exposure to diethylstilbestrol in utero.
Minor surgical procedures are often used for the pregnant woman with an incompetent cervix. A nonabsorbable suture called a cervical cerclage or cervical ring is placed around the cervix. This suture holds the cervix closed during the remainder of the pregnancy; when the woman begins labour, the suture or ring is removed. If the cerclage is permanent, the woman requires a cesarean delivery.
Inevitable Abortion
An abortion in which the loss of the products of conception cannot be prevented is known as an inevitable abortion. Increased cramping and blood loss, with progressive cervical dilation, characterize this type of abortion.
Incomplete Abortion
This type of abortion occurs when the uterus expels some products of conception but retains others. Extensive bleeding may occur. In this case, the physician may perform a dilation and curettage (D&C), which may also be called a dilation and evacuation, of the uterus. In a D&C, the surgeon dilates the cervix and then inserts instruments into the uterus. The uterine walls are scraped to remove any products of conception.
Missed Abortion
A missed abortion occurs when the fetus has died but remains in the uterus. If the fetus is not expelled spontaneously within 1 month, the pregnancy will be terminated and a D&C performed. For inevitable, incomplete, and missed abortions occurring between 16 and 20 weeks of pregnancy, a drug called dinoprostone (Prostin E2) may be administered to the mother. The drug causes the uterus to expel the fetus.
Induced Abortion
Therapeutic Abortion
A therapeutic abortion is the legal termination of pregnancy under a physician’s direction. Induced abortion before the 16th to 20th week of gestation is legal in the United States and in many other countries, although an abortion may be difficult to obtain in some areas. It may be done for medical or personal reasons.
Therapeutic abortion may be recommended for a woman whose life is in jeopardy due to the stress of pregnancy. Medical reasons for therapeutic abortion include severe maternal cardiac disease, severe renal or hypertensive disorder, or a fetus with a high probability of congenital anomaly. In some maternal psychiatric disorders or family crises, abortion is performed as an elective procedure.
Certain congenital disorders, which amniocentesis can determine at about the 14th week of gestation, are an indication for abortion to avoid the birth of a severely impaired child. If the woman has rubella (German measles) during pregnancy, especially during the first trimester, the likely hood of fetal defects is strong, and an abortion may be performed.
Criminal or Illegal Abortion
An intervention in pregnancy without medical or legal justification is a criminal or illegal abortion. Abortion is not legal in all situations. Because nonmedical people normally carry out illegal abortions in unsterile environments, the risks to the pregnant woman are great. Major risks include haemorrhage and infection.
Complications of Abortion
When the placenta separates from the uterus, large blood vessels are exposed, which can lead to severe infection or haemorrhage. During the time when most abortions were performed illegally and generally under unsanitary conditions, sepsis was a common concern.
Untreated, postabortion sepsis can be fatal. Sterility (the inability to conceive) is another common result. Therefore, maintaining surgical asepsis (sterile conditions) and removing all the products of conception from the uterus are vitally important.
Therapeutic abortions involve complex and difficult decisions. Regardless of the decision, depression, guilt, and anger are not uncommon psychological concerns.