c





1. Spontaneous abortion is the expulsion of the fetus and other products of conception
from the uterus before the fetus is capable of living outside of the uterus.
 



 


 

a.  


 
 - is
characterized
by cramping
and vaginal
bleeding in
early
pregnancy
with no
cervical
dilation. It
may subside
or an
incomplete
abortion may
follow.
b. 



 

 
 ± is characterized by bleeding, cramping and
cervical dilation. Termination cannot be prevented.
c. 
 

 
 ± is characterized by expulsion of only part of the
products of conception (usually the fetus). Bleeding occurs with cervical
dilation.
d. 
 

 
 ± is characterized by complete expulsion of all
products of conception.
e. 

 

± is characterized by early fetal intrauterine death
without expulsion of the products of conception. The cervix is closed,
and the client may report dark brown vaginal discharge. Pregnancy
test findings are negative.
f. 
 

 

± is spontaneous abortion of three or more
consecutive pregnancies.

 

 ± Spontaneous abortion may result from unidentified natural causes or from fetal,
placental or maternal factors.
1. Fetal Factors
a. Defective embryologic development
b. Faulty ovum implantation
c. Rejection of the ovum by the endometrium
d. Chromosomal abnormalities
2. Placental Factors
a. Premature separation of the normally implanted placenta
b. Abnormal placental implantation
c. Abnormal placental function
3. Maternal Factors
 a. Infection
b. Severe malnutrition
c. Reproductive system abnormalities (eg, incompetent cervix)
d. Endocrine problems (eg, thyroid dysfunction)
e. Trauma
f. Drug ingestion

! 



± The fetal or placental defect or the maternal condition results in the
disruption of blood flow, containing oxygen and nutrients, to the developing fetus. The fetus is
compromised and subsequently expelled from the uterus.

c
" 
1. Associated findings ± The client and family may exhibit a grief reaction at the loss
of pregnancy, including:
a. Crying
b. Depression
c. Sustained or prolonged social isolation
d. Withdrawal
2. 
  
 ± include common signs and symptoms of spontaneous
abortion.
a. Vaginal bleeding in the first 20 weeks of pregnancy
b. Complaints of cramping in the lower abdomen
c. Fever, malaise or other symptoms of infection
3. Laboratory and diagnostic study findings
a. Serum beta hCG levels are quantitatively low
b. Ultrasound reveals the absence of a viable fetus.

  

1. Provide appropriate management and prevent complications
a. Assess and record vital signs, bleeding and cramping of pain.
b. Measure and record intravenous fluids and laboratory test results. In
instances of heavy vaginal bleeding; prepare for surgical intevention (D
& C) if indicated.
c. Prepare for PhoGAM administration to an Rh-negative mother, as
prescribed. Whenever the placenta is dislodged (birth, D & C, abruptio)
some of the fetal blood may enter maternal circulation. If the woman is
Rh negative, enough Rh-positive blood cells may enter her circulation to
cause isoimminization, the production of antibodies against Rh-positive
blood, thus endangering the well-being of future pregnancies. Because
the blood type of the conceptus is not known, all women with Rh-
negative blood should receive RhoGAM after an abortion.
d. Recommended iron supplements and increased dietary iron as indicated to
help prevent anemia.
2. Provide client and family teaching
a. Offer anticipatory guidance relative to expected recovery, the need for rest
and delay of another pregnancy until the client fully recovers.
b. Suggest avoiding intercourse until after the next menses or using condoms
when engaging in intercourse.
 c. Explain that in many cases, no cause for the spontaneous abortion is ever
identified.
3. Address emotional and psychosocial needs.
s


   



An 
 is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus or embryo,
resulting in or caused by its death.
  


 may be occur due to various factors such as fetal, placental, or maternal.
1.     ± The most common cause of early spontaneous abortion is abnormaldevelopment of the zygote,
embryo or fetus. These abnormalities are incompatible with life and would have resulted in severe congenital
anomalies had pregnancy not been aborted spontaneously.
2. 

 ± These are congenital or acquired conditions of the mother andenvironmental factors that had
adversely affected pregnancy outcome and led to abortion. Such conditions include diabetes mellitus, incomplete
cervix, exposure to radiation and infection.
3.
 
 ± Placental factors usually cause abortion around the 14th week of gestation. These factors
includes premature separation of the normally implanted placenta and abnormal placental implantation.
c
 

     
 å occurring before the 1. Bedrest

 20th week of gestation 2. No coitus up to 2 weeks


 å characterized by after bleeding stopped
cramping and vaginal
bleeding with no
cervical dilation.
å it may subside or an
incomplete abortion
may follow.
ë 
 å membranes rupture and 1. Hospitalization
ë  the cervix dilates 2. D and C


 å characterized by lower 3. Oxytocin after D and C
abdominal cramping and 4. Sympathetic
bleeding. 5. Understanding and
emotional support
ë

 å is characterized by 1. D and C


 expulsion of only part of 2. Oxytocin after D and C
the products of 3. Sympathetic
conception (usually the 4. Understanding and
fetus). emotional support
å severe uterine cramping
å bleeding occur with
cervical dilation.
 å characterized by 1. There is


 complete expulsion of no treatment other than


 all products of rest is usually needed.
 conception 2. All of the tissues that
å light bleeding came out should be
å mild uterine cramping saved
å passage of tissue forexamination by a
å closed cervix doctor to make sure that
the abortion is
complete.
3. The
laboratory examinationo
f the saved tissue may
determine the cause of
abortion.


 å intrauterine pregnancy is 1. Usually treated by
present but is no longer induction of labor by
developing normally dilation (or dilatation)
å the cervix is closed, and and curettage (D & C).
the client
may report dark brown
vaginal discharge.
å pregnancy test findings
are negative.
Recurrent å characterized by 1. Trace the cause of
orü   spontaneous abortion of recurrent abortion


 three or more
consecutive pregnancies
a


 å abortion complicated by 1. Antibiotics as
infection prescribed by
å foul smelling vaginal your Obstetrician
discharge
å uterine cramping
å fever