Threatened Abortion

Subject: Midwifery I (Theory)

Overview

It is clinical entity when a process of abortion has started but not processed to a state from which recovery is impossible. In threatened abortion, there is abdominal pain and bleeding from the womb but fetus is still alive. This means the cervix is not open and the products of conception have not been expelled but slight bleeding may occur.

Threatened Abortion

Threatened abortion is a clinical entity where the process of abortion is started but has not been progressed to a state from which recovery is impossible and there is a chance of pregnancy continuation. In this, the cervix is not open and the products of the conception aren’t expelled or displaced yet. Bleeding is sometimes accompanied by abdominal cramps. It is also called threatened abortion.

Causes

  1. The exact causes of threatened abortion aren't known.
  2. The other factors causing threatened abortion is:
  3. Infection
  4. Immune system response
  5. Physical problems in woman or mother
  6. Uterine abnormalities

Risk factor

  1. Obesity
  2. Bacterial and viral infection during pregnancy
  3. Uncontrolled diabetic Mellitus
  4. Trauma on abdomen
  5. Thyroid problems
  6. Advanced maternal age (over 35years)
  7. Exposure to certain types of medication

Signs and Symptoms

  1. History of amenorrhoea
  2. Slight, scanty and bright red or blood stained vaginal bleeding or discharge
  3. Painless bleeding, sharp and dull pain in the lower abdomen and back
  4. No any history of an expulsion of any fleshy lump.
  5. Uterus is soft during abdomen examination
  6. Blood in the external OS, the cervix is soft
  7. Fever, weakness

Investigation

  1. Hemoglobin to determine the severity of bleeding
  2. Blood grouping and cross match, complete blood count
  3. Ultrasonography
  4. Urine pregnancy test
  5. VDRL
  6. Serial HCG level to determine any abnormality in the doubling time which indicates the high risk of fetal loss.
  7. White blood cells, differential count
  8. Beta HCG
  9. Pelvic test exam

Complication

  1. Anemia
  2. Infection
  3. Miscarriage

Management

  1. Provide adequate bed rest and reassure the patient
  2. Advise the mother to avoid strenuous activity and sexual intercourse
  3. Advise the patient to wear a vulval pad.
  4. Check the total blood loss, amount color, and consistency, duration of bleeding and sign of pallor.
  5. Instruct the patient and her family to save anything that passed per vagina like pads and clothes for tidal blood loss
  6. No enema and vaginal examination.
  7. Check the patient overall vital signs and record.
  8. Follow up in an antenatal clinic after bleeding stops. Reassess if bleeding reoccurs.
  9. Swab the vulval twice with usual aseptic techniques
  10. Sedative (phenobarbitone, diazepam) is given as usually ordered doses to relief pain.
  11. Enema and per vaginal examination should not be performed.
  12. Monitor the overall vital signs and record properly.
  13. Ultrasound for fetal well-being.
  14. Women should encourage having light diet frequently and consuming high rich foods in protein, vitamin, and iron.
  15. Advice to avoid heavy lifting and hazardous task.

 

REFERENCE

 

HealthLine. 2005. 2017 http://www.healthline.com/health/miscarriage-threatened#Treatments5

Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/000907.htm

Web MD. 2005. 2017 http://www.webmd.boots.com/pregnancy/guide/threatened-miscarriage

Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu

BabyMed. 2001. 2017. http://www.babymed.com/medical-issues/bleeding-early-pregnancy-threatened-abortion
Things to remember
  • the cervix is not open and the products of the conception aren’t expelled or displaced yet
  • The exact causes of threatened abortion aren't known.
  • Serial HCG level to determine any abnormality in the doubling time which indicates the high risk of fetal loss.
  • Check the total blood loss, amount color, and consistency, duration of bleeding and sign of pallor
  • Enema and per vaginal examination should not be performed.
Questions and Answers

A clinical condition known as threatened abortion occurs when the abortion process has begun but has not yet proceeded to the point at which recovery is impossible and there is still a chance that the pregnancy will continue. The cervix is not yet open, and the fetal products have not yet been displaced or ejected. Abdominal pains might occasionally occur along with bleeding. Another name for it is threatening abortion.

Threatened Abortion

A clinical condition known as threatened abortion occurs when the abortion process has begun but has not yet progressed to the point at which recovery is impossible and there is still a chance that the pregnancy will continue. The cervix is not yet open, and the fetal products have not yet been displaced or expelled. Abdominal cramps can sometimes occur along with bleeding. Another name for it is threatened abortion.

Causes

  • The exact causes of threatened abortion aren't known.
  • The other factors causing threatened abortion is :
    • Infection.
    • Immune system response
    • Physical problems in woman or mother
    • Uterine abnormalities

Risk Factor

  • Obesity,
  • Bacterial and viral infection during pregnancy,
  • Uncontrolled diabetic mellitus,
  • Trauma on abdomen,
  • Thyroid problems,
  • Advanced maternal age (over 35years),
  • Exposure to certain types of medication.

Signs and Symptoms

  • History of amenorrhoea,
  • Slight, scanty and bright red or blood stained vaginal bleeding or discharge,
  • Painless bleeding, sharp and dull pain in the lower abdomen and back,
  • No any history of an expulsion of any fleshy lump.
  • Uterus is soft during abdomen examination,
  • Blood in the external OS, the cervix is soft,
  • Fever, weakness.

Investigation

  • Hemoglobin to determine the severity of bleeding,
  • Blood grouping and cross match, complete blood count,
  • Ultrasonography,
  • Urine pregnancy test,
  • VDRL,
  • Serial HCG level to determine any abnormality in the doubling time which indicates the high risk of fetal loss.
  • White blood cells, differential count,
  • Beta HCG,
  • Pelvic test exam.

Complication

  • Anemia,
  • Infection,
  • Miscarriage.

Management

  • Provide adequate bed rest and reassure the patient
  • Advise the mother to avoid strenuous activity and sexual intercourse
  • Advise the patient to wear a vulval pad.
  • Check the total blood loss, amount color, and consistency, duration of bleeding and sign of pallor.
  • Instruct the patient and her family to save anything that passed per vagina like pads and clothes for tidal blood loss
  • No enema and vaginal examination.
  • Check the patient overall vital signs and record.
  • Follow up in an antenatal clinic after bleeding stops. Reassess if bleeding reoccurs.
  • Swab the vulval twice with usual aseptic techniques
  • Sedative (phenobarbitone, diazepam) is given as usually ordered doses to relief pain.
  • Enema and per vaginal examination should not be performed.
  • Monitor the overall vital signs and record properly.
  • Ultrasound for fetal well-being.
  • Women should encourage having light diet frequently and consuming high rich foods in protein, vitamin, and iron.
  • Advice to avoid heavy lifting and hazardous task.

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