Abortion is the termination of pregnancy before 20 weeks of gestation, or the expulsion of a fetus weighing less than 500 grams. It can be spontaneous, commonly called a miscarriage, or induced through medical or surgical methods. Clinical classification helps guide prompt nursing actions and medical interventions in emergency wards across Nigeria.
Rapid evaluation of a patient presenting with vaginal bleeding during early pregnancy requires a systematic nursing approach. Begin by assessing vital signs to detect early signs of hypovolemic shock. Obtain a detailed obstetric history, noting the last menstrual period, duration of bleeding, and passage of tissue.
Abdominal and pelvic examinations help determine uterine size and cervical os status. A sterile speculum examination reveals the source of bleeding and identifies retained products of conception in the vaginal vault or os. Point-of-care pregnancy testing and pelvic ultrasound confirm the diagnosis, differentiating between viable intrauterine pregnancies, ectopic pregnancies, and various abortion types.
Unstable patients presenting with hemorrhage, severe sepsis, or uterine perforation require immediate resuscitation. Secure large-bore intravenous access immediately and infuse normal saline or Ringer's lactate rapidly to restore intravascular volume.
Draw blood samples concurrently for hemoglobin levels, blood typing, and crossmatching. Administer oxygen therapy via face mask if oxygen saturation drops. In cases of suspected sepsis, collect blood cultures and initiate broad-spectrum intravenous antibiotics promptly before surgical evacuation.
Medical management offers a non-surgical alternative for incomplete or missed abortions up to specific gestational limits. The regimen typically combines mifepristone and misoprostol, or uses misoprostol alone where mifepristone is unavailable.
Nurses must monitor pain levels, assess vaginal bleeding amounts, and watch for excessive hemorrhage or signs of incomplete expulsion requiring surgical backup.
Surgical evacuation is indicated for heavy bleeding, infected tissue, hemodynamic instability, or failed medical management. Manual Vacuum Aspiration (MVA) and Suction Curettage are the primary methods used in modern clinical practice.
| Feature | Manual Vacuum Aspiration (MVA) | Sharp Curettage (D&C) |
|---|---|---|
| Gestational age | First trimester (up to 12-14 weeks) | First trimester and diagnostic uses |
| Anesthesia | Local paracervical block or sedation | General anesthesia usually required |
| Equipment | Plastic cannula and handheld vacuum syringe | Metal curettes and ring forceps |
Nurses assist by providing emotional reassurance, monitoring vital signs, checking pain scores, and ensuring all evacuated tissue is sent for histological examination when required.
Post-Abortion Care is an essential emergency service package designed to treat abortion complications, provide family planning counseling, and link women to reproductive health services. Comprehensive PAC reduces repeat unwanted pregnancies and maternal morbidity.
Counseling should be non-judgmental, confidential, and tailored to the patient's physical and emotional state. Discuss return of fertility, as ovulation can resume as early as two weeks after an abortion. Offer a wide range of modern contraceptive methods before discharge, ensuring the patient makes an informed choice suited to her lifestyle.
Complications from abortion range from acute hemorrhage and uterine perforation to pelvic inflammatory disease and secondary infertility. Early recognition and aggressive intervention save lives.
Nurses must maintain high vigilance during the recovery phase, monitoring lochia discharge, tracking temperature charts, and assessing abdominal tenderness.
The legal status of abortion in Nigeria is highly restrictive, governed by the Criminal and Penal Codes. Induced abortion is illegal unless performed strictly to save the pregnant woman's life. Unsafe abortion remains a major contributor to maternal mortality across the country.
Ethically, nurses face dilemmas balancing personal beliefs with professional duties. Regardless of the legal or moral context, emergency life-saving care must never be withheld from a patient suffering from abortion complications. Maintain strict patient confidentiality and provide compassionate, non-punitive care at all times.