Passage of an intact
gestational sac or contractions with scant uterine bleeding and diminishing
uterine cramps suggests that a complete abortion has occurred. Tissue that
passed should undergo pathological examination to confirm the presence of
products of conception. Complete
abortions do not require therapy, it is difficult to reliably distinguish them
clinically or sonographically from incomplete abortions. Although, it is clear
that surgery is necessary for women with excessive bleeding, unstable vital
signs, or obvious signs of infection, some clinicians recommend suction
curettage for all patients with complete abortions.
Ermination of pregnancy before the fetus is viable.
In the medical sense, this term and the term miscarriage both refer to the
termination of pregnancy before the fetus is capable of survival outside the
uterus. The term abortion is more commonly used as a synonym for induced
abortion, the deliberate interruption of pregnancy, as opposed to miscarriage,
which connotes a spontaneous or natural loss of the fetus. Because of this
distinction made by the average layperson, care should be exercised in the use of
the word abortion when speaking of a spontaneous loss of the fetus.
The technique chosen to terminate pregnancy depends
on the stage of pregnancy and the policies of the institution and patient
needs. It is rare for a fetus to survive if it weighs less than 500 g, or if
the pregnancy is terminated before 20 weeks of gestation. These factors are,
however, difficult to determine with a high degree of accuracy while the fetus
is still in utero; survival of the fetus delivered near the end of the second
trimester often depends to a great extent on the availability of personnel and
equipment capable of supporting life until the infant develops sufficiently.
Viability of the fetus outside the uterus is
frequently used as the determining factor in deciding the legality and morality
of induced abortion. Whether this is a valid criterion is essentially based on
whether one believes that the fetus is human from the moment of conception or
that it achieves humanity at some point during physical development. Those who
oppose abortion on moral grounds believe that the fetus is human or potentially
human and that destruction of the fetal body is tantamount to murder. Many
others have equally strong beliefs that abortion is a woman's right.
The liberalization of abortion laws has resulted in
a dramatic increase in the number of abortions performed in physicians'
offices, clinics, and hospitals. While this has diminished the occurrence of
septic abortions performed at the hands of unscrupulous abortionists and has
improved the possibility of safe and uneventful physical recovery from an induced
abortion, the issue remains controversial and charged with emotion. The health
care provider who strongly objects to abortion is legally and morally free to
choose not to participate in the procedure and is advised to avoid situations
involving responsibility for the care of patients who have chosen abortion as a
means of ending an unwanted pregnancy. Women who have made a decision to have
an abortion need a safe, non-judgmental environment to recover physically and
emotionally from the procedure.
The patient should know that other alternatives are
available and that an abortion after 20 weeks is inadvisable for medical and
other reasons. Preabortion counseling in the psychological, religious, and
legal aspects of abortion should be readily available, with immediate referral
to the proper resources. Although delay in carrying out the procedure may
increase the risk of complications, no patient should be encouraged to go
through with an abortion until she has had time and sufficient counseling to
reach a rational decision.
During postabortion counseling there should be a
discussion of various methods of contraception. The client will need
information on the advantages and disadvantages of each method, her
responsibilities in preventing future unwanted pregnancies, and available help
in initiating and following through on a program of effective contraception.
She should be informed that women who have had two or more abortions run a
greatly increased risk of miscarriage or spontaneous abortion in the first six
months of subsequent pregnancies.
Patient Care. The type of care required and the
complications to be avoided in abortion will depend on the stage of pregnancy
at the time of termination and whether the abortion is spontaneous, is induced
under sterile conditions, or is performed by an unskilled abortionist or the
patient herself. Many women who choose to have an abortion are anxious and
confused about the physical and psychological outcomes of the procedure.
Therefore both pre- and postabortion counseling are recommended.
In cases of spontaneous or habitual abortion,
patient care is directed toward emotional support of the patient and acceptance
of her feelings of bitterness, grief, guilt, relief, and other emotions
associated with the loss of the fetus. The patient should be able to express
her feelings in an open, nonjudgmental, and nonthreatening environment.
complete abortion complete expulsion of all the
products of conception.
criminal abortion termination of pregnancy by
illegal interference, usually undertaken when legal induced abortion is
unavailable. The most frequent complications are severe hemorrhage and sepsis,
and for those who delay seeking medical attention the mortality rate is high.
early abortion abortion within the first 12 weeks of
pregnancy.
elective abortion induced abortion done at the
request of the mother for other than therapeutic reasons.
habitual abortion spontaneous abortion in three or
more consecutive pregnancies before the 20th week of gestation.
incomplete abortion abortion in which parts of the
products of conception are retained in the uterus.
induced abortion abortion brought on intentionally
by medication or instrumentation.
inevitable abortion a condition in which vaginal
bleeding has been profuse, membranes usually show gross rupturing, the cervix
has become dilated, and abortion is
almost certain.
infected abortion abortion associated with infection
of the genital tract from retained material, with a febrile reaction.
missed abortion retention of dead products of conception
in utero for more than 8 weeks.
septic abortion abortion associated with serious
infection of the products of conception and endometrial lining of the uterus,
leading to generalized infection; it is usually caused by pathogenic organisms
of the bowel or vagina.
spontaneous abortion termination of pregnancy before
the fetus is sufficiently developed to survive; called miscarriage by
laypersons. In the United States this definition is confined to the termination
of pregnancy before 20 weeks' gestation (based upon the date of the first day
of the last normal menses).
Chromosomal abnormalities cause at least half of
spontaneous abortions.
Therapeutic abortion abortion induced legally by a
qualified physician to safeguard the health of the mother.
Threatened abortion a condition in which vaginal
bleeding is less than in inevitable abortion, the cervix is not dilated, and
abortion may or may not occur; this is the presumed diagnosis when any bloody
vaginal discharge or vaginal bleeding occurs in the first half of pregnancy.
complete abortion
1. the complete expulsion or extraction from its
mother of a fetus or embryo
2. complete expulsion of any other product of
gestation. (for example, blighted ovum).
complete abortion
Etymology: L, complere,to fill up
termination of pregnancy in which the conceptus is
expelled or removed in its entirety. Because no products of conception remain
in the uterus, surgical evacuation is not necessary. Compare incomplete
abortion.
complete abortion Obstetrics An abortion or miscarriage
in which all tissues have been expulsed; an abortion may be completed by
curettage to eliminate necrotic decidual tissue in the uterus, which might act
as a nidus for infection. See Abortion.
abortion
premature expulsion from the uterus of the products
of conception; termination of pregnancy before the fetus is viable.
complete abortion
complete expulsion of all the products of
conception.
early abortion
abortion within the first third of pregnancy.
epizootic bovine abortion
characterized by serious fetal disease followed by
abortion. Endemic in California's coastal range and in the foothill region of
the Sierra Nevada, USA. Necropsy findings in the fetus are diagnostic; they
include profuse petechiation and severe granulomatous hepatitis. Cause appears
to be a novel deltaproteobacterium closely related to members of the order
Myxococcales. Transmitted by the tick, Ornithodoros coriaceus. Called also
foothill abortion.
habitual abortion
spontaneous abortion occurring in three or more
successive pregnancies.
incomplete abortion
abortion in which parts of the products of
conception are retained in the uterus.
induced abortion
abortion procured by the veterinarian to eliminate a
misalliance, to reduce wastage in animals in a feedlot, to encourage
commencement of lactation earlier than would otherwise occur. In cattle
manipulation through the rectal wall is a possible way of destroying the
viability of the fetus. Induction by the administration of prostaglandins or
corticosteroids is more usual. See also pregnancy termination.
infectious abortion
the common causes in the various species are:
cattle
Brucella abortus (brucellosis); Campylobacter fetus
subsp. venerealis (vibriosis); Campylobacter fetus subsp. fetus; Leptospira
pomona, L. hardjo (leptospirosis); Listeria monocytogenes (listeriosis);
Arcanobacterium pyogenes; Aspergillus, Absidia and Mucor spp. (fungal
abortion); bovine virus diarrhea virus; infectious bovine rhinotracheitis
herpesvirus; Chlamydophila abortus; a deltaproteobacterium (epizootic bovine
abortion); Coxiella burnetii (Q fever), Neospora caninum.
sheep and goats
Campylobacter fetus subsp. fetus (vibriosis);
Campylobacter jejuni; Chlamydophila abortus (enzootic abortion of ewes);
Listeria monocytogenes (listeriosis); Salmonella abortus-ovis; Brucella
melitensis; Toxoplasma gondii (toxoplasmosis); Brucella ovis (limited occurrence);
bluetongue virus; border disease.
horse
Streptococcus equi subsp zooepidemicus;
Actinobacillus equuli, A. equisimilis; Rhodococcus equi; leptospirosis, most
commonly the pomona serogroup and less frequently serovar grippotyphosa; equine
herpesvirus (EHV1); equine viral arteritis (EVA); equine arteritis; Potomac
horse fever; and in the USA the mare reproductive loss syndrome associated with
ingestion of the Eastern tent caterpillar Malacosoma americanum.
pig
Leptospira pomona, L. grippotyphosa, L. canicola, L.
icterohaemorrhagiae (leptospirosis); Erysipelothrix rhusiopathiae (erysipelas);
porcine reproductive respiratory syndrome (PRRS) virus; parvovirus; porcine
circovirus 2; Aujesky's disease; classical swine fever; and African swine
fever.
dog and cat
Brucella canis, feline leukemia virus, feline
herpesvirus.
missed abortion
retention of a dead embryo or fetus for more than 1
to 2 weeks.
pine needle abortion
a late-term abortion with retained fetal membranes
in cattle caused by ingestion of isocupressic acid in the needles of Pinus
spp., commonly P. ponderosa, but also P. jeffryi, P. contorta and Juniperus
scopulorum and J. communis. Nutrient deficiency and tree management practices
may promote ingestion off the ground as cattle graze through while eating early
growing spring grass.
abortion rate
number of abortions as a percentage of the cows in
the herd which were diagnosed pregnant in early pregnancy; the target is septic abortion
abortion associated with serious infection of the
uterus leading to generalized infection.
spontaneous abortion
abortion occurring naturally. See also spontaneous
abortion.
abortion storm
a cluster of abortions occurring at about the same
time or in rapid sequence within a group of pregnant females. See also equine
viral abortion.
therapeutic abortion
abortion induced by a veterinarian for medical or
other health reasons.
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