1. What is Spontaneous Miscarriage?
Answer: It is an interruption of pregnancy due to natural causes.
There are two types:
1. Early miscarriage- occurs before week 16 of pregnancy
2. Late miscarriage- occurs between weeks 16-24
2. Why is it important to establish the week of pregnancy in spontaneous miscarriage?
Answer: It determines the degree of bleeding expected for example:
Weeks 1-6 of pregnancy- placenta tentatively attached to decidua of uterus so bleeding is hardly severe
Weeks 6-12 of pregnancy- moderate degree of attachment to myometrium, can lead to the most severe bleeding and threat to lives of pregnant women who have a miscarriage during this time
Week 12 and onwards- attachment is penetrating and deep, can also lead to severe/profuse bleeding due to deep implantation, however in this scenario the fetus is expelled just as it is expelled in natural childbirth before the placenta separates, the uterine contraction can then help control postpartal bleeding
3. What are the causes of spontaneous miscarriage?
a. abnormal fetal formation secondary to a teratogenic factor or a chromosomal aberration,
b. immunologic factors which might be “rejecting” the embryo,
c. implantation abnormalities ( 50%) of zygotes are not implanted, inadequate implantation leads to inadequate fetal nutrition. Causes: inadequate endometrial formation or inappropriate site of implantation
d. failure of corpus luteum to produce enough progesterone to maintain deciduas basalis
e. Infection- rubella, syphilis,poliomyelitis, cytomegalovirus,toxoplasmosis, urinary tract infection
f. ingestion of teratogenic drug like isotretinoin if taken within the first 16 weeks of pregnancy
4. What will be my assessment priority?
Answer: Assess for vaginal spotting and history of the bleeding. You need to ask in a non-judgmental manner if the woman has tried to self-abort or if she has done any intervention to stop the bleeding.
5. How is it managed?
Answer: It depends on the symptoms and the amount of bleeding. If it is a late miscarriage it might end up just like natural childbirth with the fetus and later the placenta being expelled. The products of conception may completely expel but if not a D& C will be done to remove all remaining products of conception.
1. Flickr photograph of 6 week fetus by jdatoy
2. Maternal & Child Health Nursing- Adele Pillitteri