Spontaneous Abortion and Molar Pregnancy Practice Flashcards

Definition: A spontaneous abortion, commonly referred to as a miscarriage, is defined as the termination of a pregnancy before the fetus reaches $20$ weeks of gestation.

Threatened Miscarriage: * Characterized by vaginal bleeding. * The cervix remains closed. * The pregnancy may still be viable; there is a possibility that the baby will be okay.
Inevitable Miscarriage: * The cervix is open. * Pregnancy loss is certain and cannot be stopped or prevented.
Incomplete Miscarriage: * Some pregnancy tissue has passed, but other components (placenta or fetal tissue) remain inside the uterus.
Complete Miscarriage: * All products of conception and pregnancy tissue have passed out of the uterus naturally.
Missed Miscarriage: * The fetus has died in utero, but the body has not yet expelled the tissue. The pregnancy remains inside the uterus.
Septic Miscarriage: * A miscarriage accompanied by the development of an infection in the uterus.

The memory trick "CABS" can be used to recall common symptoms: * C: Cramping. * A: Abdominal pain. * B: Bleeding (vaginal). * S: Passing of tissue from the vagina.

Expectant Management: This approach involves waiting patiently for the pregnancy tissue to pass out of moving through the body naturally without intervention.
Medication: The drug Misoprostol may be administered to help the uterus contract and expel the tissue.
Surgical Procedures: * Dilation and Curettage (D&C): Manual dilation of the cervix and scraping of the uterine lining. * Suction Curettage: Using a vacuum device to remove tissue from the uterus.

Clients with an Rh-negative blood type may require the administration of Rho(D) Immune Globulin (RhoGAM) to prevent alloimmunization in future pregnancies.

Nursing care should focus on three primary priorities: * B = Bleeding: Assessing the volume and frequency of blood loss. * I = Infection: Monitoring for signs of systemic or localized infection. * P = Pain: Managing the patient's discomfort and physical pain.

A molar pregnancy occurs when a fertilized egg grows abnormally into a non-viable mass instead of a normal fetus.
Memory Trick: "MOLE = Many Odd-Looking Enlargements".
Abnormal tissue growth replaces the development of a normal baby.

Vaginal bleeding.
Severe nausea and vomiting (hyperemesis).
Significantly high levels of hCG (human chorionic gonadotropin).
An enlarged uterus that is often larger than the expected size for gestational age.
Presence of "Grape-like" tissue passed through the vagina.
High blood pressure (hypertension) occurring before $20$ weeks of pregnancy may be an indicator.

Uterine Evacuation: Surgical removal of the abnormal tissue.
hCG Monitoring: Serial monitoring of hCG levels is required to ensure they return to zero and stay there.
Pregnancy Prevention: Patients must avoid becoming pregnant again until a medical provider confirms it is safe to do so.
Reliable Contraception: Education on effective birth control is essential.

Risk Factor: A previous history of molar pregnancy increases the risk of recurrence.
Major Complication: The development of Gestational Trophoblastic Neoplasia (a type of cancer/tumor growth).
Cancer Risk: Follow-up is critical because the abnormal tissue can become malignant.

Ultrasound: The primary tool used for diagnosing a molar pregnancy or confirming the type of miscarriage.
CBC (Complete Blood Count): Used specifically to check for anemia resulting from bleeding.
Severe Nausea: This is physiologically caused by the excessively high levels of hCG circulating in the body.
Bleeding Risks: Excessive bleeding can lead to Hypovolemia (low blood volume).

Emotional Needs: Nursing staff must provide robust emotional support and grief counseling for the loss of the pregnancy.
Nursing Priority: Bleeding remains the priority nursing concern in these cases.
Future Risks: Increased risk of recurrence exists for future pregnancies.
Goal Outcome: The patient should achieve stable (non-detectable) hCG levels and a full physical/emotional recovery.