Chapter 11: Spontaneous Abortion

Question 1

What is a Spontaneous Abortion (SAB)?

Answer 1

or miscarriage

-pregnancy that ends before 20 weeks gestation

Question 2

Classifications Associated with Spontaneous Abortions (SAB)

Answer 2

• Abortus
• Complete abortion
• Incomplete abortion
• Inevitable abortion
• Threatened abortion
• Missed abortion
• Septic abortion
• Recurrent abortion

Question 3

Abortus

Answer 3

fetus lost before 20 weeks gestation

-less than 17.5 oz, or less than 9.8 in (25 cm) in size

Question 4

Complete Abortion

Answer 4

complete expulsion of all products of conception (POC) before 20 weeks of gestation

Question 5

Incomplete Abortion

Answer 5

partial expulsion of some but not all POC before 20 weeks of gestation

Question 6

POC

Answer 6

products of conception
-a medical term used to identify any tissues that develop from a pregnancy. It is commonly used by doctors to include not only the fetus but also the placenta and any other tissues that may result from a fertilized egg

Question 7

Inevitable Abortion

Answer 7

no expulsion of products, but bleeding and dilation of the cervix such that continuation of a pregnancy is unlikely

Question 8

Threatened Abortion

Answer 8

any intrauterine bleeding before 20 weeks of gestation, without dilation of the cervix or expulsion of any POC

Question 9

Missed Abortion

Answer 9

death of the embryo or fetus before 20 weeks of gestation with complete retention of the POC; these often proceed to a complete abortion within 1 to 3 weeks, but occasionally retained much longer

Question 10

Septic Abortion

Answer 10

POC become infected during the abortion process

Question 11

Recurrent Abortion

Answer 11

two or more successive pregnancies have ended in spontaneous abortion

Question 12

Etiology: For first trimester spontaneous abortions

Answer 12

associated with chromosomal abnormalities
-also from infections (e.g. bacteriuria and C trachomatis), maternal anatomical defects, and immunological and endocrine factors

Question 13

Etiology: for Second trimester spontaneous abortions

Answer 13

(12 to 20 weeks)
-chronic infections, recreational drug use, maternal uterine or cervical anatomical defects, maternal systemic disease, exposure to fetotoxic agents, and trauma

Question 14

Signs and Symptoms

Answer 14

• bleeding
• cramping, abdominal pain
• decreased symptoms of pregnancy
• cervical changes (dilation) may be present on vaginal examination

Question 15

Diagnostic Tests

Answer 15

Ultrasound

-performed for placental evaluation and to determine fetal viability

Question 16

Laboratory Tests

Answer 16

• Quantitative level of (beta) B-hCG: which should show a lower value (when normal = higher value)
• Hemoglobin and Hematocrit
• Blood type and Rh status determination
• indirect Coomb’s screen

Question 17

Indirect Coomb’s Test

Answer 17

can be used to determine whether there are antibodies to the Rh factor in the mother’s blood
-It checks the mother’s blood to see if there are antibodies that could pass to and harm their unborn baby
>In this case: A normal (negative) result means that the mother has not developed antibodies against the fetus’s blood
>an unsensitized, Rh(D)-negative woman should be given Rho(D) immune globulin (RhoGAM) to prevent antibody formation

Question 18

Management

Answer 18

-D and C (dilation and curettage); the cervix is dilated and a curette is inserted and used to scrape the uterine walls and remove the uterine contents
>in an incomplete cervix, an emerging cerclage (placement of ligature to close the cervix) may be performed
>An unsensitized, Rh(D)-negative woman should be given Rho(D) immune globulin (RhoGAM) to prevent antibody formation

Question 19

what happens if indirect coombs test is positive?

Answer 19

An abnormal (positive) indirect Coombs test means you have antibodies that will act against red blood cells that your body views as foreign. This may suggest: Erythroblastosis fetalis. Incompatible blood match (when used in blood banks)
-the mother has developed antibodies to the fetal red blood cells and is sensitized