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spontaneous abortion

Pregnancy abnormalities, such as spontaneous abortion, which refers to the termination of pregnancy before the embryo and fetus are viable; premature rupture of membranes: the natural rupture of fetal membranes before delivery, including term premature rupture of membranes and preterm premature rupture of membranes.

Edited at 2023-10-30 10:59:19

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spontaneous abortion

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Outline

Care for women during pregnancy
- 34
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pregnancy abnormalities

spontaneous abortion

Overview

Definition: Abortion is the termination of pregnancy before the embryo and fetus are viable.

Estimation of expected delivery date: The expected delivery date is calculated from the first day of the last menstrual period, and the entire pregnancy period is 280 days in total.

nursing assessment

Physiological assessment

Causes: embryonic factors (the most common cause), maternal factors, paternal factors and environmental factors.

Pathology: Miscarriage before 8 weeks of pregnancy: often presents with vaginal bleeding first, then abdominal pain, complete miscarriage often occurs, and the bleeding is not much. Incomplete abortion often occurs between 8 and 12 weeks of pregnancy, with heavy bleeding. After 12 weeks of pregnancy, the placenta has been completely formed, and the abortion process is the complete delivery process: abdominal pain first, and then the fetus and placenta are expelled.

health history

Common types and clinical manifestations

The main symptoms are vaginal bleeding and abdominal pain after menopause.

type

threatened abortion

Symptoms include a small amount of vaginal bleeding before 28 weeks of pregnancy without discharge of pregnancy products, and then mild lower abdominal pain, low back pain and a sinking feeling.

Gynecological examination: the cervix is not dilated, the fetal membranes are not ruptured, the size of the uterus is consistent with the pregnancy month, and the urine pregnancy test is positive.

Miscarriage is inevitable

Miscarriage is unavoidable and often develops from threatened abortion, manifested by increased vaginal bleeding or discharge, and worsening paroxysmal lower abdominal pain.

Gynecological examination: The cervix has been dilated, and the size of the uterus is consistent with the month of pregnancy or slightly smaller.

incomplete abortion

It shows that some of the products of pregnancy have been excreted from the body, but some remain in the uterine cavity. This is the inevitable result of the continued development of miscarriage, which often leads to heavy bleeding and even shock.

Gynecological examination: the cervix has been dilated and the uterus is smaller than the month of pregnancy.

complete miscarriage

All the pregnancy products have been discharged, vaginal bleeding gradually stopped, and abdominal pain gradually disappeared.

Gynecological examination: the cervix is closed, the uterus is close to normal size, and the urine pregnancy test is negative.

missed abortion

Also known as "expired abortion", the embryo or fetus has died in the uterine cavity but has not been expelled in time.

The symptoms of early pregnancy disappear, the uterus does not increase with the pregnancy month but shrinks, and if it reaches the second trimester, the fetal movement may disappear.

Gynecological examination: the cervix is not opened or the cervix is closed, the fetal heartbeat cannot be heard, and the urine pregnancy test is negative.

Recurrent miscarriage (habitual miscarriage): refers to three or more consecutive spontaneous miscarriages with the same sex partner

Miscarriage combined with infection

Related inspections

Processing principles

Threatened miscarriage: identify the cause and actively treat miscarriage

Miscarriage is unavoidable: promote the complete discharge of the embryo and pregnancy products as early as possible to prevent bleeding and infection, and timely evacuation of the uterus

Incomplete abortion: uterine evacuation, prompt fluid replacement, and blood transfusion if necessary. If bleeding lasts for a long time, antibiotic prophylaxis should be given

Complete miscarriage: generally no special treatment is required

Missed abortion: handle it promptly after diagnosis, prevent DIC, and check coagulation function before treatment

Recurrent miscarriage: focus on prevention

Miscarriage complicated by infection: While controlling the infection, remove the residue in the uterine cavity

psychosocial assessment

Common nursing diagnoses

Nursing measures

Nursing care for pregnant women with threatened abortion

general care

psychological care

Take medication as directed by your doctor

For patients with luteal insufficiency, intramuscular injection of progesterone 20mg

For patients with hypothyroidism, when taking oral low-dose thyroxine tablets, pay attention to monitoring the patient's fall during medication.

Take medication as directed by your doctor

For patients with luteal insufficiency, intramuscular injection of progesterone 20mg

For patients with hypothyroidism, when taking oral low-dose thyroxine tablets, pay attention to monitoring the patient's fall during medication.

health education

Pregnant women with loose cervical os should undergo internal cervical os repair surgery before pregnancy or internal cervical cerclage at 12-14 weeks of pregnancy.

Care for those who cannot continue the pregnancy

General care: closely monitor the amount of vaginal bleeding

psychological care

Care before and after surgery

health education

premature rupture of membranes

Natural rupture of fetal membranes before labor, including premature rupture of membranes at term and premature rupture of membranes before term

nursing assessment

Physiological assessment

Cause

Reproductive tract infections: important causes

Increased amniotic pressure, uneven stress on fetal membranes, trauma, and nutritional factors

Pathology, health history

clinical manifestations

Symptoms: Pregnant women suddenly experience uncontrollable vaginal discharge, which starts in large quantities and then gradually decreases, with intermittent discharge.

Signs: During anal examination, the posterior vaginal fornix is pulled up or the presenting part of the fetus is pushed up, and the amount of vaginal fluid (thin and may be mixed with vernix or meconium) is increased.

Mother and child influence

Pregnant women: intrauterine infection, puerperal infection

Fetus: premature birth, perinatal death, pneumonia, umbilical cord prolapse, etc.

Related inspections

Vaginal smear test, amnioscopic examination

Vaginal fluid pH test (the most important auxiliary test method)

Treatment principles: Prevent umbilical cord prolapse and infection; terminate pregnancy if it is <24 weeks or ≥36 weeks of pregnancy

psychosocial assessment

Common nursing diagnoses

Nursing measures

Expectant care for pregnant women

Prevent umbilical cord prolapse

Absolute bed rest, lie on the left side, and raise the buttocks to prevent umbilical cord prolapse or umbilical cord compression, which may cause fetal hypoxia or intrauterine distress.

Early detection and early treatment through fetal heart rate monitoring

Umbilical cord prolapse can be treated under strict disinfection and the umbilical cord can be retracted. End labor within minutes if necessary

Prevent infection

Closely observe the amniotic fluid properties, color, smell, and vital signs

Use antiseptic cotton balls to scrub the perineum twice a day

If the membranes are ruptured for more than 12 hours, use prophylactic antibiotics as directed by your doctor.

Reduce irritation: prohibit enemas and avoid unnecessary anal and vaginal examinations

Closely observe the condition of the fetus: follow the doctor’s advice and use tocolytics to prevent premature birth

Monitor contractions

Nursing care and health education for patients with termination of pregnancy