Maternal > Spontaneous Miscarriages > Flashcards

Spontaneous Miscarriages Flashcards

(44 cards)

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1
Q

What is Miscarriage or Abortion?

A

Any interruption of a pregnancy before the age of viability (20 weeks gestation)

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2
Q

Types of Miscarriages According to Gestational Age

A
  1. Early Miscarriage (1st Trimester) - called early pregnancy loss (ACOG)
  2. Late Miscarriage (2nd Trimester) - loss after 13 weeks but before 20 completed weeks

Threatened Abortion, Missed Abortion, Inevitable / Imminent Abortion, Incomplete Abortion, Complete Abortion

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3
Q

Threatened Miscarriage Symtpoms

A

Scant, bright red bleeding, cramping, no cervical dilation, intact membranes

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4
Q

Threatened Miscarriage Assessment Procedure

A

P.E, FHT & UTZ to assess fetal viability

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5
Q

Threatened Abortion Management

A
  • Avoid strenuous physical activites
  • Bed rest is routinely recommended
  • Reduce stress
  • Strictly no coitus for 2 weeks
  • Follow-up with UTZ to monitor for fetal cardiac activity
  • RhIG (RhoGAM) for Rh-negative mothers at >12 weeks AOG
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6
Q

Threatened Abortion Outcome

A

50% of women continue the pregnancy
50% changes progress to inevitable miscarriage

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7
Q

Threatened Miscarriage

A

Can still be a viable fetus / products of conception (POC) not expelled

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8
Q

Missed Miscarriage

A

POC is not expelled, no FHT

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9
Q

Missed Miscarriage Symptoms

A

No immediate bleeding, not immediately recognized, closed cervix, no fetal heart tone

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10
Q

Missed Miscarriage Assessment

A

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

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11
Q

Missed Miscarriage Procedures

A

D & C (dilation and curettage) or D & E to (dilation and evacuation) evaluate POC
If over 14 weeks age of gestation (AOG) - labor is induced by prostaglandin suppository or misoprostol (Cytotec) administration

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12
Q

Missed Miscarriage Drugs Given

A

Misoprostol - inserted into vagina to cause cervical dilation followed by
Oxytocin - administered to cause uterine contractions to actively terminate pregnancy

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13
Q

Missed Miscarriage Nursing Intervention

A
  • Explain properly the term “missed” as the woman may be misled that if the pregnancy was missed, she can still continue with the pregnancy
  • Provide supporting in accepting the reality
  • Refer for counseling so they can begin a future pregnancy
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14
Q

Missed Miscarriage Complication if Allowed to Expel POC Naturally

A

Infection (endometritis, sepsis)
- RPOC whether fetal or placental can be a source of infection
- Necrotic tissues trigger inflammatory response to active coagulation system DIC

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15
Q

Inevitable / Imminent Miscarriage

A

POC is not expelled, open cervix

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16
Q

Inevitable / Imminent Miscarriage Symptoms

A

Scant, bright red vaginal bleeding, uterine contractions, and cervical dilations

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17
Q

Inevitable / Imminent Miscarriage Assessment Procedures

A

Physical exam: Check for tissue fragments saved by the patient check for FHT to confirm

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18
Q

Inevitable / Imminent Miscarriage Procedure

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A

D & C or D & E to ensure removal of all POC. Suction curettage to clean the uterus

19
Q

Inevitable / Imminent Miscarriage Patient Education

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A

Inform patient that pregnancy was lost and that suction and curettage is done to clean the uterus and avoid infection and not to end the pregnancy

20
Q

Incomplete Miscarriage

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A

Some POC expelled; cervix open

21
Q

Incomplete Miscarriage Symtpoms

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A

Vaginal bleeding, uterine contractions and cervical dilation

22
Q

Incomplete Miscarriage Assessment

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A

Part of the conceptus (usually the fetus) is expelled leaving the placenta or membranes are retained in the uterus

23
Q

Incomplete Miscarriage Procedures

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A

D & C or Suction Curettage to evacuate the retained tissues

24
Q

Incomplete Miscarriage Patient Education

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A

Tell the patient that pregnancy was already lost, she might be confused of the term “incomplete”

25
Incomplete Miscarriage Danger
Maternal hemorrhage
26
Complete Miscarriage
POC entirely expelled; cervix open
27
Complete Miscarriage Symptoms
Vaginal bleeding, uterine contractions and cervical dilation
28
Complete Miscarriage Assessment
Bleeding and cramping Bleeding stops after all POC (fetus, placenta, membranes) are expelled spontaneously without assistance
29
Complete Miscarriage Procedure / Therapy
None; but if heavy bleeding occurs, the woman needs to see her HC provider
30
Recurrent Miscarriage
Three or more spontaneous miscarriages in a row
31
Recurrent Miscarriage Incidence
1 - 2% of women
32
Recurrent Miscarriage Possible Causes
- Abnormal fetal development due to teratogenic factors - Genetic factors - Anatomical abnormalities of the uterus - Uterine infections - Autoimmune disorders - Implantation abnormalities - Endocrine factors
33
Luteal Phase Defect
An insufficient production of progesterone or inadequate response of the endometrial lining to the progesterone produced which can lead to inability of the endometrium to sustain the pregnancy
34
Complications of Miscarriages
- Hemorrhage - Infection - Septic Abortion - DIC - Rh incompatibility / Hemolytic Disease of the Newborn - Powerlessness
35
Rh Incompatibility
The Rh factor describes another surface protein on the RBC. If your blood does contain the Rh protein, your blood is said to be RH+, if not, then your blood is Rh-.
36
1st Pregnancy with Rh+ Fetus (Under Normal Conditions)
No mixing of blood; placenta serves as a barrier between maternal and fetal circulation No antibodies produced by mother’s immune system No Rh compatibility issue
37
2nd Pregnancy with Rh+ Fetus
Mother’s immune system is already sensitized (produced antibodies and 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 and attack fetal RBCs causing hemolytic disease in newborn (HDN)
38
Nursing Responsibilities: Rh Incompatibility
RhIG (RhoGAM) given IM to Rh- mothers to prevent Rh incompatibility Standard Administration Schedule: - Routine administration at 28 weeks gestation (as prophylaxis) prevents maternal sensitization during the 3rd trimester when small amounts of fetal blood may enter the maternal circulation - Within 72 hours after delivery if the newborn is Rh+, RhoGAM prevents the mother from developing antibodies for future pregnancies
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Nursing Responsibilities: Spontaneous Abortion
1. Assess and Monitor the Patient 2. Provide Emotional and Psychological Support 3. Prepare Patient for Possible Procedures 4. Administer 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
40
Assess and Monitor the Patient
Monitor vital signs, signs of shock or infection (fever, chills, foul smelling discharge), presence of clots, frequency and assess bleeding (amount and color), evaluate pain, assess emotional and psychological status
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Provide Emotional and Psychological Support
Establish therapeutic communication and provide emotional reassurance, encourage patient to express feelings about loss, offer counseling and support group referrals, involve the parter or family members for support, respect cultural and religious beliefs regarding pregnancy loss
42
Prepare Patient for Possible Procedures
- D&C - incomplete miscarriage for 1st trimester - D&E - for 2nd trimester miscarriages when pregnancy tissue is larger and requires more extensive removal - Expectant management - when body is allowed to naturally expel the pregnancy tissue without medical or surgical intervention - Manual vacuum aspiration (MVA) - suction device instead of sharp curet to remove pregnancy tissue done in early pregnancy (<10-12 weeks)
43
Administer Prescribed Medications
- Oxytocin: uterine contractions and prevent hemorrhage - Misoprostol: expel retained products of needed - Analgesics (NSAIDS, acetaminophen): pain relief - Antibiotics: infection - Tetanus toxoid: prophylaxis against tetanus - septic abortion
44
Educate the Patient and Family
Explain what to expect in terms of bleeding and recovery, avoid coitus and tampons for at least 2 weeks, monitor for signs of infection or excessive bleeding (soaking >2 pads/hr), teach about proper perineal hygiene
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