Case Study: Spontaneous Abortion

A. Description

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.

2. Types of spontaneous abortions

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

b. Imminent or inevitable abortion – is characterized by bleeding, cramping and cervical dilation. Termination cannot be prevented.

c. Incomplete abortion – is characterized by expulsion of only part of the products of conception (usually the fetus). Bleeding occurs with cervical dilation.

d. Complete abortion – is characterized by complete expulsion of all products of conception.

e. Missed abortion – 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. Recurrent (habitual) abortion – is spontaneous abortion of three or more consecutive pregnancies.

B. Etiology – 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

C. Pathophysiology – 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.

D. Assessment Findings

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. Clinical Manifestations – 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.

E. Implementation

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.