nursearchives: Pathophysiology - Spontaneous Abortion

SPONTANEOUS ABORTION

Is the unintended termination of pregnancy at any time before the fetus has attained viability (20 weeks gestation or fetal weight of <500g)
Cause frequently unknown, but 50% are due to chromosomal abnormalities
Exposure or contact with teratogenic agents
Poor maternal nutritional status
Maternal agents with virus such as rubella, cytomegalovirus, active herpes, and toxoplasmosis, or specific bacterial microorganisms that put the pregnancy at risk
History of diabetes, thyroid disease, anticardiolipin antibodies, or lupus erythematosus
Smoking or drug abuse of both
Immunologic factor by which the mother and father are genetically similar, with major antigens that cause the maternal immune system to reject the embryo
Abnormal uterine development or structural defect in the maternal reproductive system (including an incompetent cervix)
Environmental factors such as drugs, radiation, or trauma

CLINICAL MANIFESTATIONS

Uterine cramping
Low back pain
Vaginal bleeding usually begins as dark spotting, then progresses to frank bleeding as the embryo separates from the uterus
B-hCG levels may be elevated for as long as two weeks after loss of the embryo

DIAGNOSTIC EVALUATION

COMPLICATIONS

NURSING ASSESSMENT

Evaluate the amount of and color of blood that is present: determine the time the bleeding began and any precipitating factors.
Determine whether a positive pregnancy test has previously been obtained, also the date of the last menstrual period.
Monitor vital signs for indication of complications such as haemorrhage, infection
Evaluate any blood or clot tissue for the presence of fetal membranes, placenta or fetus

NURSING DIAGNOSES

Risk for fluid volume deficit related to maternal bleeding
Anticipatory grieving related to loss of pregnancy, cause of the abortion, future childbearing
Risk for infection related to dilated cervix and open uterine vessel
Pain related to uterine cramping

NURSING INTERVENTIONS

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