Spontaneous Miscarriages (Abortion) Flashcards
Refers to any interruption of a pregnancy before the age of viability which is usually 20 weeks gestation
Miscarriage / Abortion
Typer of miscarriages according to gestational age
1) Early miscarriage (1st trimester)
2) Late miscarriage (2nd trimester)
Refers to pregnancy loss before 13 completed weeks
Early miscarriage
Refers to pregnancy loss after 13 completed weeks but before 20 completed weeks.
Late miscarriage
Clinical types of miscarriage / abortion (based on symptoms & progression)
1) Treathened Abortion
2) Missed Abortion
3) Inevitable / Imminent Abortion
4) Incomplete Abortion
5) Complete Abortion
POC - products of conception
Can still be a viable fetus / POC not expelled
Threatened Miscarriage
Symptoms of a threatened miscarriage
1) scant, bright red bleeding
2) Cramping
3) No cervical dilation
4) Intact membranes
Threatened Miscarriage
Assessment procedures
1) P.E (physical exam)
2) FHT
3) UTZ
To assess fetal viability
Threatened Miscarriage
Management
1) Avoid strenuous physical activities
2) Bed rest is routinely recommended
3) Reduce stress
4) Strictly no coitus for 2 weeks
5) Follow-up with UTZ to monitor for fetal cardiac activity
6) RhIG (RhoGAM) for Rh-negative mothers at >12 weeks AOG
Threatened Miscarriage
Possible outcomes
- 50% women continue the pregnancy
- 50% of women changes progress to inevitable miscarriage
POC is not expelled, no FHT
Missed Miscarriage
Missed Miscarriage
Symptoms
- no immediate bleeding
- Not immediately recognized (missed)
- Closed cervix
- No FHT
Missed Miscarriage
Assessment
- No increase in fundal height
- Previously heard fetal heart sounds no longer audible
- Bleeding/cramping occurs later as the body tries to expel the POC
Missed Miscarriage
Procedures
- D&C or D&E: to evacuate POC
- If over 14 weeks AOG : Labor is produced by prostaglandin suppository or misoprostol administration
Missed Miscarriage
Drugs Given
1) Misoprostol - to cause cerival dilation +
2) Oxytocin - to cause uterine contractions to actively terminate pregnancy.
Missed Miscarriage
Nursing Interventions
1) Explain properly the term “Missed” as woman may be misled that if the pregnancy was missed, she can still continue with the pregnancy
2)Provide support in accepting the reality
3)Refer for counseling so they can begin a future pregnancy
Missed Miscarriage
Complication if allowed to expel POC naturally
Infection (endometritis, sepsis)
- RPOC whether fetal or placental can be a source of infection
- Necrotic tissues trigger inflammatory response which activates coagulation system to DIC
POC is not expelled, open cervix
Inevitable / Imminent Miscarriage
Inevitable / Imminent Miscarriage
Symptoms
- Scant, bright red vaginal bleeding
- Uterine contractions
- Cervical dilation
Inevitable / Imminent Miscarriage
Assessment procedures
Physical exam
- check for tissue fragments saved by the patient
- check for FHT to confirm
Inevitable / Imminent Miscarriage
Procedure
1) D&C or D&E : to ensure removal of all POC
2) Suction curettage : to clean the uterus
Inevitable / Imminent Miscarriage
Patient Education
Inform patient that:
- pregnancy was lost
- Suction & Curettage is done to clean the uterus & avoid infection not to end the pregnancy.
Some POC expelled but cervix is open
Incomplete Miscarriage
Incomplete Miscarriage
Symptoms
- Vaginal bleeding
- Uterine contractions
- Cervical dilation
Incomplete Miscarriage
Assessment
Part of the conceptus (usually the fetus) is expelled leaving the placenta or membranes retained in the uterus.
Incomplete Miscarriage
Procedures
D&C or Suction Curettage : to evacuate the retained tissues.
Incomplete Miscarriage
Patient Education
Tell the patient that pregnacy was already lost. She might be confused of the term “Incomplete”
Incomplete Miscarriage
Danger
Maternal Hemorrhage
POC entirely expelled and cervix is open
Complete Miscarriage
Complete Miscarriage
Symptoms
- Vaginal bleeding
- Uterine Contractions
- Cervical dilation
Complete Miscarriage
Assessment
Bleeding and Cramping
- Bleeding stops after all POC are expelled spontaneously without assictance.
Complete Miscarriage
Procedure/Therapy
None
- If heavy bleeding occurs, women needs to see HC provider
This refers to 3 or more spontaneous miscarriages in a row
Recurrent Miscarriage
Possible Cases of Recurrent Miscarriage
1) Abnormal fetal development either due to teratogenic factors
2) Genetic factors : defect sperm or egg / chromosomal abernations
3) Anatomical Abnormalities of the uterus : septate, bicornuiate; presence of fibroids ,leiomyomas
4) Uterine infection
5) Autoimmune disorders : rejection of fetal cells.
6) Implantation abnormalities : tubal implantation
7) Endocrine Factors
Refers to an insufficient production of progesterone or inadequare response of the endometrial lining to the progesterone produced which can lead to inability of the endometrium to sustain the pregnancy.
Luteal Phase Defect
Complications of Miscarriages
1) Hemorrhage : bleeding is not managed early.
2) Infection : d/t retained placental fragments.
3) Septic Abortion : r/t induced or illegal abortios done by untrained practitioner using non-sterile instruments
4) DIC : r/t missed abortion: necrotic tissue > inflammatary response > activate coagulation system.
5) Rh Incompatibility / Hemolytic Disease of the Newborn
6) Powerlessness : lack of control, helplesness
Describes another surface protein on the RBC. Named after the Rhesus monkey, where it was initially identified
Rh Factor
What happens in 1st pregnancy with Rh(+) fetus (under normal conditions
Mother is Rh (-)
- No mixing of blood; placenta serves as a barrier between maternal & fetal circulation
- No antibodies produced by mother’s immune system
- No Rh incompatibility tissue/
What happens to a 1st pregnancy Rh- mother during delivery of an Rh+ baby?
- Placenta detaches from the uterine wall, fetal blood vessels in the placenta may rupture, allowing Rh+ blood cells from the fetus to enter the maternal bloodstream.
- Mother produces antibodies against the “foreign” Rh+ blood (initial sensitization & memory)
- Baby not affected since baby is already out
What happens during 2nd pregnancy of an Rh- mother to a Rh+fetus?
- Mother’s immune system is already sensitized (produced antibodies & remembers the Rh antigen) making it capable of reacting more rapidly and aggressively to Rh+ cells of the fetus.
- Pre-existing antibodies cross the placenta andattack the fetal RBC causing hemolysis
What happens in Hemolytic Disease of the Newborn (HDN)
Breakdown of RBCs > releaseof hemoglobin > heme > bilivergin > bilirubin > jaundice
Nursing Responsibilities for Rh Incompatibility
- **RhoGAM **(Brand Name)
- RhIG Rh Immune Globulin (Generic Name)
Route of RhoGAM
Via IM to Rh- mothers to prevent Rh incompatibility
Standard administration schedule of RhoGAM
- Routine administation at 28 weeks gestation (prophylaxis)
- Within 72 hours after delivery
Why give RhoGAM at 28 weeks gestation as prophylaxis?
This prevents maternal sensitization during the third trimester, when small amounts of fetal blood may enter the maternal circulation
Why give RhoGAM 72 hrs after delivery?
If newborn is Rh+, RhoGAM is given to prevent the mother from developing anti-D antibodies for future pregnancies
Nursing Responsibilities for Spontaneous Abortion
1) Assess and Monitor the Patient
2) Provide Emotional and Psychological Support
3) Prepare patient for possible procedures
4) Adminster IV fluids as ordered to maintain hemodynamic stability
5) Administer prescribed medications
6) Prevent and monitor for complications
7) Educate the Patient and Family
8) Educate about Emotional Recovery
9) Discuss contraceptive options if the patient wants to delay future pregnancies.
What to assess and monitor in patients with spontaneous abortion?
- Vital signs
- signs of shock or infection (fever, chills, foul-smelling vaginal discharge)
- presence of clots & frequency
- Bleeding ( amount, color, presence of clots/tissue)
- Evaluate pain (location, intensity, characteristics
When is Dilation and Curettage done?
If miscarriage is incomplete, for 1st tri miscarriage
When is Dilation & Evacuation done?
For 2nd tri miscarriages when pregnancy tissue is larger and requires more extensive removal.
This procedure is chosen when the body is allowed to naturally expel the pregnancy tissue withouth medical or surgical intervention
Expectant Management
This procedure uses a suction device instead of a sharp curet to remove pregnancy tissue. Done in early pregnancy (Less than or equal to 10-12 weeks)
Manual Vacuum Aspiration
Prescribed medications used for spontaneous miscarriages
1) Oxytocin - to contract the uterus & prevent hemorrhage.
2) Misoprostol - expel retained products if needed.
3) Analgesics - for pain relief
What is the gestational age limit for a pregnancy loss to be considered a miscarriage?
A. 12 weeks
B. 20 weeks
C. 24 weeks
D. 28 weeks
B. 20 weeks
Which term is preferred to avoid confusion with intentional termination of pregnancy?
A. Abortion
B. Miscarriage
C. Stillbirth
D. Ectopic pregnancy
B.Miscarriage
What is the primary cause of a luteal phase defect?
A. Excess estrogen production
B. Insufficient progesterone production
C. High levels of hCG
D. Overproduction of FSH
B. Insufficient progesterone production
Nurse Parker is evaluating a patient in early pregnancy who presents with bleeding and cramping. The cervix is closed, and the membranes are intact. What is the most appropriate term for this condition?
a) Inevitable
b) Complete
c) Habitual
d) Missed
e) Threatened
e) Threatened
Nurse Collins is reviewing a case where the embryo or fetus has died but has not been expelled. This condition is often detected when no fetal heart tones (FHT) are present, and it must be managed within 6 weeks to prevent complications like DIC or infections. What is the term for this condition?
a) Threatened
b) Incomplete
c) Missed
d) Inevitable
e) Habitual
c) Missed
Nurse Adams is caring for a patient who has experienced a miscarriage, and she notes that all the products of conception have been expelled. What term best describes this situation?
a) Habitual
b) Inevitable
c) Threatened
d) Missed
e) Complete
e) Complete
Nurse Harris is providing instructions to a patient in her first trimester who reports vaginal bleeding, suspecting a threatened abortion. After the teaching session, which statement made by the patient would suggest that she needs further clarification?
a) “I will refrain from sexual activity until the bleeding stops and for 2 weeks after the last sign of bleeding”
b) “ I will maintain strict bed rest for the remainder of the pregnancy”
c) “ I will keep track of the perineal pads I use each day, noting the amount and color of the blood”
d) “I will monitor for any signs of tissue passage”
b) “ I will maintain strict bed rest for the remainder of the pregnancy”
Nurse Evans is assessing a 39-year-old patient who is 37 weeks pregnant and has been admitted to the hospital due to vaginal bleeding after using cocaine an hour ago. What is the most likely cause of this bleeding?
a) Ectopic pregnancy
b) Placenta previa
c) Spontaneous abortion
d) Abruptio placentae (Placental abruption)
d) Abruptio placentae (Placental abruption)
Nurse Thompson is reviewing the medical history of a patient who has experienced spontaneous abortions in three consecutive pregnancies. These losses, occurring in the second trimester due to a weakened cervix that dilates prematurely, are referred to by what term?
a) Complete
b) Missed
c) Incomplete
d) Habitual
e) Threatened
D) Habitual
Nurse Lee is assessing a patient who has experienced heavy bleeding and cramping. She notes that some of the pregnancy tissue has been expelled, but the placenta remains attached, and the symptoms persist until the entire placenta is removed. What term best describes this condition?
a) Complete
b) Missed
c) Incomplete
d) Habitual
e) Threatened
c) Incomplete
