Early Pregnancy Loss (Spontaneous Abortion Sheet)

Question 1

What is the medical term for pregnancy loss before 20 weeks ?

Answer 1

Abortion

• regardless of elective or spontaneous.

Question 2

What is considered fetal viability ?

Answer 2

20 weeks gestation and or fetus weight 500 g or greater.

Question 3

What are the classifications of spontaneous abortion and assessment : (7)

Answer 3

• threatened
• inevitable
• incomplete
• complete
• septic
• missed
• habitual or recurrent

Question 4

What is threatened abortion :

Answer 4

Vaginal spotting early in gestation. No passage or embryonic or fetal tissue. Abdominal cramping. Cervix is closed.

Question 5

What is the management and treatment of threatened abortion :

Answer 5

Possible mild activity restriction with bedrest 24-48 hours, sedation. Instructed to avoid stimulation of sexual intercourse and orgasm for 2 weeks.

Question 6

What is inevitable abortion :

Answer 6

Pregnancy loss that cannot be prevented. Bleeding may be moderate/heavy.Cervix is dilated with tissue in cervix.

Question 7

What is the management and treatment of inevitable abortion :

Answer 7

If products of conception are not passed spontaneously, vacuum curettage or administration of prostaglandin analog to evacuate the uterus. A D&C may be performed.

Question 8

What is incomplete abortion:

Answer 8

Passage of some of the products of conception. Ultrasound reveals retained material in the uterus. Cervix is open

Question 9

What is the management and treatment for incomplete abortion:

Answer 9

Cervix is open but may require additional dilation before curettage.

Question 10

What is complete abortion:

Answer 10

All fetal tissue and products of conception passed in bleeding. Ultrasound reveals an empty uterus.

Question 11

What is the management and treatment of complete abortion:

Answer 11

No further intervention may be needed if uterine contractions adequate to prevent hemorrhage and there is no infection. No need for treatment but follow up care to discuss related issues.

Question 12

What is septic abortion:

Answer 12

Fever, abdominal pain and tenderness. Bleeding from scant to heavy, usually malodorous. Cervix usually dilated.

Question 13

What is the management and treatment of SEPTIC abortion:

Answer 13

Care includes termination of pregnancy; culture and sensitivity studies to initiate appropriate antibiotic therapy.

Question 14

What is MISSED abortion :

Answer 14

Retained nonviable embryo or fetus for 6 weeks or more. Fetus has died and placenta atrophied but products of conception retained. Cervix is closed.

Question 15

What is the treatment and management of MISSED abortion:

Answer 15

If spontaneous evacuation of the uterus does not occur within one month, uterus is evacuated by method appropriate to duration of the pregnancy. Blood clotting factors are monitored. DIC with uncontrolled hemorrhage may develop in cases of fetal death after week 12.

Question 16

What is HABITUAL or RECURRENT abortion:

Answer 16

three or more consecutive losses before 20 weeks of gestation. Cervix open.

Question 17

What is the management and treatment of HABITUAL or RECURRENT abortion:

Answer 17

Identification and treatment of underlying cause if possible. Prophylactic cerclage if r/t cervical insufficiency.

Question 18

Nursing assessment with any time of abortion:

Answer 18

Less than 20 weeks gestation fetus is nonviable. Greater than 20 weeks or 500 g, funeral arrangements are needed
Symptoms include uterine cramping, backache and pelvic pressure
If bleeding is noted count of perineal pads/hour
Be aware of S/S of shock
• HR elevated; Weak thready pulse
• Skin: Pallor. Cool, clammy
• Hypotension

Question 19

Nursing interventions with abortions:

Answer 19

Id type of abortion and management
Monitor UC if necessary
Monitor VS , LOC until stable
Start IV with large bore (over 18)
Administer RhoGAM to Rh negative clients with Rh+ baby. 
Teach client to notify nurse if:
•	Temp > 100.4
•	Foul odor to vaginal discharge
•	Bright red bleeding
•	Bleeding with any tissue fragments