MATERNAL AND CHILD HEALTH NURSING

LECTURE / NCM 109

SPONTANEOUS MISCARRIAGE THREATENED MISCARRIAGE

SYMPTOMS
1. Vaginal bleeding
TERMS • Initially scant, bright red
ABORTION 2. Slight cramping
• A medical term for any interruption of 3. No cervical dilation
a pregnancy before a fetus is viable DIAGNOSTIC TESTS
(20-24 wks. AOG or at least 500 g). 1. Ultrasound
MISCARRIAGE 2. Blood test for hCG and is repeated in
• Interruption of pregnancy occurs 48 hrs.
spontaneously. • ↑hCG means the placenta is still
intact.
CAUSES
INTERVENTIONS
1. ABNORMAL FETAL DEVELOPMENT
1. Avoid strenuous activity for 24 – 48
• Teratogenic Factors
hrs.
• Chromosomal aberrations
2. Restrict coitus for 2 wks.
2. IMPLANTATION ABNORMALITIES
3. LACK OF PROGESTERONE PRODUCTION IMMINENT / INEVITABLE MISCARRIAGE
• Failure of the corpus luteum to SYMPTOMS
produce enough progesterone to 1. Uterine contractions
maintain the decidua basalis 2. Cervical dilation
4. SYSTEMIC INFECTION DIAGNOSTIC TESTS
• Rubella, syphilis, poliomyelitis, 1. Check for FHT
cytomegalovirus, toxoplasmosis, UTI 2. Ultrasound
5. INGESTION OF TERATOGENIC DRUG INTERVENTIONS
• isotretinoin (Accutane) 1. D & E (dilation & evacuation)
6. ALCOHOL INGESTION 2. After discharge following D & E, assess
for bleeding by recording no. of pads
ASSESSMENT used.
1. CONFIRMATION OF PREGNANCY
2. PREGNANCY LENGTH COMPLETE MISCARRIAGE
3. DURATION OF BLEEDING • Entire products of conception (fetus,
4. INTENSITY/AMOUNT OF BLOOD LOSS membranes, and placenta) are expelled
5. DESCRIPTION spontaneously without any assistance.
6. FREQUENCY • Bleeding usually slows within 2 hrs and
7. ASSOCIATED SYMPTOM then stops after a few days after passage
8. ACTION of the products of conception.
9. BLOOD TYPE OF THE WOMAN
INCOMPLETE MISCARRIAGE
DIAGNOSIS • Part of the conceptus (usually the fetus) is
A. THREATENED expelled, but the membrane or placenta is
B. IMMINENT retained in the uterus.
C. COMPLETE INTERVENTIONS
D. MISSED 1. D & C
E. INCOMPLETE 2. Suction curettage

RICCI D. CASTRO / BSN 2

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MATERNAL AND CHILD HEALTH NURSING
LECTURE / NCM 109

MISSED MISCARRIAGE 6. Use good handwashing techniques

• Fetus dies in utero but is not expelled. before & after handling the
SYMPTOMS contaminated pads.
1. No increase in fundal height C. SEPTIC ABORTION
2. FHS cannot be heard • Abortion that is complicated by an
3. May have had symptoms of infection.
threatened miscarriage • Occurs in women who tried self-
DIAGNOSTIC TESTS abortion or were aborted illegally
1. D & E using a non-sterile instrument.
2. If the pregnancy is ↑14 wks. Labor may Therapeutic Management
be induced by: 1. Monitor urine output/hr. to assess
• Prostaglandin suppository or kidney function.
misoprostol to dilate the cervix 2. IVF is started to restore fluid volume
• Oxytocin is administered to 3. Broad spectrum antibiotic is started
stimulate uterine contraction • Penicillin (gm+)
• Gentamicin (gm-aerobic)
COMPLICATIONS
• Clindamycin (gm-anerobic)
A. HEMORRHAGE
4. TT and TIG is ordered for prophylaxis
Therapeutic Management
of tetanus
1. Monitor V/S
5. D & C will be performed.
2. Position the woman flat and massage
the uterine fundus to aid in
contraction if there is excessive
bleeding.
3. D & C may be needed to empty the
uterus.
4. Blood transfusion may be necessary to
replace blood loss
B. INFECTION (ENDOMETRITIS)
Signs
1. Fever
2. Abdominal pain or tenderness
3. Foul vaginal discharge
Causative organism
• Escherichia coli (spread from the
rectum into the vagina).
Therapeutic Management
1. Antibiotic (Clindamycin)
2. Oxytocic agent (methylergonovine)
To encourage uterine contraction
3. Analgesic for abdominal discomfort.
4. Sitting in a Fowler’s position or
walking
Encourages lochia drainage by gravity.
5. Wear gloves when helping the woman
change her perineal pads.

RICCI D. CASTRO / BSN 2

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