Abortion, Cervical Insufficiency, & Intrauterine Fetal Demise

What is the medical term for miscarriage

Spontaneous abortion

What is a spontaneous abortion

Pregnancy ends

Risk factors for spontaneous abortion

- Fetal chromosomal abnormalities

- Maternal endocrine disorders (hypothyroidism, uncontrolled diabetes)

- >35 yr age

- Substance abuse

Threatened abortion nursing interventions

- Assess blood loss (pad count, clots, foul odor)

- Hemorrhage s/s (↑ HR, ↓ BP, ↓ H/H)

- Assess viability

How to assess for viability (baby still alive) in spontaneous abortion

- Ultrasound for signs of pregnancy loss

- hCG level

↑ vs ↓ hCG level in spontaneous abortion

↑ = pregnancy progressing

↓ = abortion likely happened

Nonviable spontaneous abortion nursing interventions

- Uterine stimulant (Misoprostol and Oxytocin to get baby out)

- Surgery (IF ↑↑↑↑↑ INEFFECTIVE)

- Administer RhoGAM

What do AFTER spontaneous abortion surgery

Administer Oxytocin or Methylergonovine to prevent PPH

What is Cervical Insufficiency

Painless cervical dilation in 2nd trimester

Cervical Insufficiency s/s

- Cervical shortening/dilation without pain

- Pelvic pressure

- ↑ clear/pink-tinged discharge

Cervical Insufficiency tx **

Cervical cerclage IF <23 weeks gestation

When is the cervical cerclage stitches removed

At 36 weeks OR when labor begins

What med is given to ↓ risk of preterm cervical change

Progesterone

What is Intrauterine Fetal Demise :(

Fetus death ≥ 20 week gestation

Types of abortion

Threatened - pregnancy progressing, but miscarriage is likely
inevitable - cervix dilated; miscarriage is unavoidable
Missed - miscarriage, but all tissue remains
Incomplete - like missed, but some tissue has passed
complete - like missed, but all tissue has passed