Chapter 11: Spontaneous Abortion Flashcards
What is a Spontaneous Abortion (SAB)?
or miscarriage
-pregnancy that ends before 20 weeks gestation
Classifications Associated with Spontaneous Abortions (SAB)
- Abortus
- Complete abortion
- Incomplete abortion
- Inevitable abortion
- Threatened abortion
- Missed abortion
- Septic abortion
- Recurrent abortion
Abortus
fetus lost before 20 weeks gestation
-less than 17.5 oz, or less than 9.8 in (25 cm) in size
Complete Abortion
complete expulsion of all products of conception (POC) before 20 weeks of gestation
Incomplete Abortion
partial expulsion of some but not all POC before 20 weeks of gestation
POC
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
Inevitable Abortion
no expulsion of products, but bleeding and dilation of the cervix such that continuation of a pregnancy is unlikely
Threatened Abortion
any intrauterine bleeding before 20 weeks of gestation, without dilation of the cervix or expulsion of any POC
Missed Abortion
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
Septic Abortion
POC become infected during the abortion process
Recurrent Abortion
two or more successive pregnancies have ended in spontaneous abortion
Etiology: For first trimester spontaneous abortions
associated with chromosomal abnormalities
-also from infections (e.g. bacteriuria and C trachomatis), maternal anatomical defects, and immunological and endocrine factors
Etiology: for Second trimester spontaneous abortions
(12 to 20 weeks)
-chronic infections, recreational drug use, maternal uterine or cervical anatomical defects, maternal systemic disease, exposure to fetotoxic agents, and trauma
Signs and Symptoms
- bleeding
- cramping, abdominal pain
- decreased symptoms of pregnancy
- cervical changes (dilation) may be present on vaginal examination
Diagnostic Tests
Ultrasound
-performed for placental evaluation and to determine fetal viability
Laboratory Tests
- 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
Indirect Coomb’s Test
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
Management
-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
what happens if indirect coombs test is positive?
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
