Missed abortion

Missed abortion

1. Missed abortion Prepared by Jwan Kareem Salh Msc .Student

2. Definition Abortion  is the ending of a  pregnancy by removal or expulsion of an  embryo or  fetus An abortion that occurs without intervention is known as a  miscarriage or "spontaneous abortion" and occurs in approximately 30% to 40% of pregnancies. When deliberate steps are taken to end a pregnancy, it is called an  induced abortion .

3. Missed abortion Also known as a missed abortion or a silent miscarriage, occurs when a fetus is no longer alive, but the body does not recognize the  pregnancy loss  or expel the pregnancy tissue. As a result, the placenta may continue to release hormones, so may continue to experience signs of pregnancy.  About 80% of miscarriages occur in the first 12 weeks of  pregnancy  (the  first trimester ).

4. Clinical features Vaginal bleeding  Heavy cramping  Expulsion of fetal tissue  Subsidence of pregnancy symptoms Uterus becomes smaller in size

5. Cont … Cervix feels firm with closed internal os Non audibility of the fetal heart sound even with Doppler ultrasound Pregnancy test becomes negative

6. causes The causes of missed abortion are not fully known. About  50 percent  of miscarriages happen because the embryo has the wrong number of chromosomes. An endocrine or an  autoimmune disorder. A  heavy smoker. Physical trauma  .

7. Cont.. Anembryonic gestation (blighted ovum) Maternal disease Embryonic anomalies Placental abnormalities. Uterine anomalies.

8. When should woman see a doctor? should always see a doctor if suspect any kind of miscarriage. Call doctor if have any miscarriage symptoms, including: vaginal bleeding abdominal cramps or pain discharge of fluid or tissue

9. Risk factors being an older parent previous abortion exposure to  tobacco smoke obesity   diabetes thyroid problems   drug or alcohol use.

10. Diagnosis Ultrasound before 20 weeks’ gestation. Usually when they cannot detect a heartbeat at a prenatal checkup. Monitor the level of the pregnancy hormone hCG in blood over a couple days. C hecking to see if the  cervix  is open or closed.

11. Medical Management Prostaglandin E1 (Misoprostol) Sublingual misoprostol of 600 ug or vaginal misoprostol of 800 ug may be a good choice for the first dose Expulsion usually occurs within 48 hours 6th or 12th hourly misoprostol tablets given vaginally. Antibiotics are given

12. Surgical management Dilation and curettage  (D&C) surgery may be necessary to remove remaining tissue from the uterus. doctor may recommend a D&C immediately following diagnosis of a missed abortion, or they may recommend it later if the tissue doesn’t pass on its own or with the use of medication.

13. Complications Retaining the products for long time can lead to sepsis. DIC [disseminated intravascular coagulation] – (very rare) in gestations exceeding 16 week. Uterine hemorrhage Infection Uterine perforation 

14. Cont … Incomplete Miscarriage Asherman Syndrome Recurrent Miscarriages

15. Nursing Interventions 1.If bleeding is profuse, place the woman flat in bed on her side and monitor uterine contractions and fetal heart rate through an external monitor. 2.Also measure intake and output to establish renal function and assess the woman’s vital signs to establish maternal response to blood loss. 3.Measure the maternal blood loss by saving and weighing the used pads. 4.Save any tissue found in the pads because this might be a part of the products of conception.

16. Prevention Non-modifiable risk factors Preventing a miscarriage in subsequent pregnancies may be enhanced with assessments of: Immune status . Chemical and  occupational exposures Anatomical defects . Pre-existing   or acquired disease in pregnancy Polycystic ovary syndrome . Previous exposure to chemotherapy and radiation

17. Cont … Modifiable risk factors Maintaining a healthy weight and good pre-natal care can reduce the risk of miscarriage Some risk factors can be minimized by avoiding the following: Smoking Cocaine use Alcohol Poor nutrition Occupational exposure to agents that can cause miscarriage Medications associated with miscarriage Drug abuse