You are on page 1of 11

Spontaneous Abortion HSCI 367 Term Paper

Abrantes Misty Abrego Ambar Castellanos Sandy Salcedo Victoria Truong Jennifer 14 November 2013

Spontaneous abortion is described as a loss of a fetus before the 20th week of pregnancy (Todd, 2012). Spontaneous abortion, otherwise known as a miscarriage, is when any pregnancy ends prematurely before the fetus can survive. As many as 50% of pregnancies end in miscarriage, usually before a missed period or before the woman knows that she is pregnant. Approximately 15% of recognized pregnancies will end in miscarriage (Todd, 2012). Miscarriages are typically unpreventable, and caused by an abnormal pregnancy; for instance, a genetic problem with the embryo or fetus, or problems with the mothers uterus or cervix. Women who have experienced a miscarriage may experience emotional factors attributed to the loss, such as grief. Women who have experienced a loss know the difficulty of the experience. Educating oneself on factors associated with miscarriage, as well as someone else who has had a miscarriage, may help women who have experienced one themselves History The medical term miscarriage is now used instead of instead of spontaneous abortion, this occurred after changes in legislation in the 1960s and developments in ultrasound technology in the early 1980s (about.com, n.d.). Ultrasound technology allowed doctors to help identify miscarriages in pregnant women. Before the 1980s, doctors and health professionals used the phrase spontaneous abortion for miscarriage. The primary reason for this change was miscarriage is a socially sensitive topic, and women disliked the term abortion for miscarriage (Damjanov, 2012). Professionals have changed their terminology when speaking to patients to be more

2 sensitive to womens feelings. In some cases doctors may still not distinguish between spontaneous and induced abortions in clinical practice (about.com, n.d.). Changes in terminology have allowed more women to be open to discussing their experiences with others. Etiology According to The Armenian Medical Network, Studies show that around 50 percent of all spontaneous abortions have an abnormal karyotype during the first three months of pregnancy (2006). The likelihood of a miscarriage decrease as the pregnancy progresses into the second and third trimesters. Toth (2013) says that, this decreases to 20 to 30 percent in the next 3 months along down to 5 to 10 percent in the last three months before actual birth takes place. Other causes of miscarriage can be from infections, defects in chromosomes, endocrine factors, immune system factors, and maternal diseases that are the result of heredity or activities that women participated in during the time of her pregnancy. However, the causes of a large percentage of miscarriages are unknown. Incidence The overall incidence of spontaneous abortion is estimated to be about 15-20% (Forbes, 1997). There are eight different stages or kinds of miscarriage, each has different incidence rate (American Pregnancy Association, 2013). They are as follows: 1. Threatened Miscarriage 15% (Steer, 2010) 2. Incomplete Miscarriage 2.4% (Early Options, 2010) 3. Missed Miscarriage 2% (Merz, 2009) 4. Complete Miscarriage 28% (Jurkovic, 2009)

3 5. Recurrent Miscarriage 1-3% (Alijotas-Reigh, n.d) 6. Ectopic Miscarriage 2% (Shoupe, 2011) 7. Molar Pregnancy 1.7% (Fisher, Foskett, Newlands, Rees, Sebire, & Secki, 2003) 8. Blighted Ovum 20% (Merz, 2009) Prevalence Prevalence of miscarriage is approximately 12% of all pregnancies. Twenty one percent of all pregnancies have bleeding before the twentieth week (Saravelos, Yan, Rehmani, & Li, 2011). Public Health Ramifications Public health has indirect effects when it comes to spontaneous abortion. The March of Dimes, a foundation dedicated to assisting mothers in having healthy full term pregnancies, conducts research to discover issues that threaten fetus lives (March of Dimes, 2013). Moreover, the March of Dimes foundation advocates the importance of access to quality health care for expecting mothers (March of Dimes, 2013). It is crucial to obtain quality prenatal care to assist in a healthy pregnancy. In addition, the mothers health and pre-existing health conditions have an impact on the chances a woman experiencing a miscarriage (March of Dimes, 2013). Therefore, having access to medical care and the resources needed to treat and detect certain health conditions can make a substantial difference in preventing a miscarriage. Having access to quality healthcare also gives women valuable information about maintaining a healthy pregnancy. Information concerning certain behaviors such as caffeine and alcohol consumption, as well as drug and tobacco use may need to be passed along by healthcare providers.

4 Signs and symptoms Signs and symptoms of miscarriages are: bleeding which progresses from light to heavy, severe cramps, abdominal pain, fever, weakness, and back pain. Heavy bleeding, fever, chills, and severe pain may be signs of infection, and patients are advised to contact their healthcare providers immediately (Todd, 2012). Diagnosis Spontaneous abortion is the most common complication seen in distressed pregnancies. Seen in 30 percent of biochemical pregnancies, it is only clinically recognized between 11-20% (Bottomley and Bourne, 2009). A correct assessment is best made by using a trans-vaginal ultrasound assessment (TVS). Indication based standards for a complete miscarriage requires a TVS and serial biochemical confirmation only if there is no visible intrauterine gestation sac. Incomplete miscarriage only requires trans-vaginal ultrasound to make a diagnosis. Maternal Rh incompatibility involves Rh antigen D, which causes neonatal hemolytic disease and other syndromes such as hydrops fetalis. During the womens first pregnancy, the unborn chi ld which is Rh+ would not be affected by its mothers Rh- blood. At this time the mothers body has not yet made antibodies to the Rh antigen D. Maternal fetal Rh incompatibility, which include hydrops fetalis, occurs when the blood of fetus and mother mix during the delivery. By exposing the Rh- mother to the dominant D antigen fetal red blood cells this will immunize the mother and her body will begin to produce IgG-type anti-Rh antibodies. The dominant D will cross the placenta affecting the fetal Rh+ red blood cells causing hemolysis and the fetus may die in utero displaying signs of hydrops fetalis. Hemolysis will follow in the fetal circulation resulting in anemia, hypoxia, and

5 eventually congestive heart failure in the fetus (Damjanov, 2011). Treatment Miscarriages can usually take their natural course without medical assistance (Marquardt, 2011). Protecting the abdomen area, taking the right medications, avoiding those medications that may cause complications and also consuming adequate amounts of vitamins will help with the pregnancy and help narrow the chances of a miscarriage. If a miscarriage does take place there are different types of treatment to help the women emotionally and medically depending on the type of their miscarriage. The first type of miscarriage is when mother has Rhesus (Rh) factor of Rh negative and the fetus is Rh positive, in order to protect the mother and the fetus a shot of anti-D immunoglobulin can be given to prevent miscarriage. If the mother knows that she has this risk factor, she can take action to prevent a miscarriage before she becomes pregnant by getting the shot in advance to conception. This is only works if a threatened miscarriage is diagnosed before the 12th week of gestation (Marquardt, 2011). Additionally, medication can be prescribed after the miscarriage to prevent additional bleeding and infections. When a miscarriage occurs it is important that the women have the material removed surgically and management for shock should be taken right away. Many pregnant women and their partners feel guilty after a miscarriage. Doctors should reassure women that it is nothing that they did, rather it was something chromosomally abnormal and the parents of the fetus are unlikely at fault for the miscarriage (Marquardt, 2011). Women should talk to their doctors and family since opening up the lines of communication to the family will help tremendously in the healing process. There are multiple organizations that specialize in miscarriages and

6 who can talk to them and have their questions answered. Among these, there are a few that deserve recognition: Mommies Enduring Neonatal Death www.mend.org, and A Place to Remember www.aplacetoremember.com (American Pregnancy Association, 2013). These organizations can be helpful to the women who suffer a miscarriage, by aiding with the grief of the loss and giving helpful tools to learn adequate coping mechanisms. Not all miscarriages can be prevented medically, but there are steps to help manage a healthy pregnancy in hopes of avoiding the likeliness of having a miscarriage. One of the steps to preventing a miscarriage is for expectant mothers to provide themselves with a healthy atmosphere. The others steps are staying healthy with regular exercise, eating healthy, managing stress, keeping weight within healthy limits, taking folic acid daily, and not smoking (American Pregnancy Association, 2013). Besides maintaining a healthy environment, it is important to keep your abdomen safe from trauma, not being around smoke, not drinking alcohol, checking with your doctor before taking any over the counter medication, and limiting or avoiding caffeine consumption altogether. Also, pregnant mothers should avoid environmental hazards, xrays, and contact sports or activities that may result in injury (American Pregnancy Association, 2013). These steps help ensure a healthy pregnancy and prevent miscarriages. Prognosis After the 12th week of pregnancy, ninety percent of the women will experience vaginal bleeding. Women should be attentive to their symptoms as vaginal bleeding poses an increased risk of complications throughout the rest of pregnancy. Epocrates Online

7 article states that, follow-up and counseling should be part of the overall management plan. The patients primary care physician should be promptly informed of the loss of pregnancy to avoid upsetting inquiries about a presumed on-going pregnancy. (Babarinsa, 2012) To prevent this, the woman would attend regularly scheduled followup appointments with her doctor, as well as, schedule counseling so that they can prevent the opperception of fault or any added stress to the woman who was expected to deliver (Babarinsa, 2012). In long term expectancy of spontaneous abortion, there are many severity levels in regards to how psychologically upsetting the miscarriage is to the expectant mother. MDGuidelines calls this phase The Anniversary Syndrome. This is when the patient may be upset, sad, or in a mood of grief of variable intensity, on the anniversary of the loss of pregnancy (MDGuidelines, 2013). Another syndrome that may be caused by spontaneous abortion is called Ashermans Syndrome. This is a rare condition where the cavity of the uterus develops scar tissue. The symptoms of this vary during the first 12 weeks of pregnancy. Half of women that are pregnant can undergo normal bleeding. After these three months however, women should stop bleeding. Some women with first trimester bleeding may experience an overall healthy pregnancy. While others may undergo symptoms such as cramping and bleeding that will continue to worsen over time. Eventually these women may miscarry. If miscarriage happens multiple times (three or more), it is clinically know as recurrent abortion. Even though there is a risk that it will happen more than once, women may eventually carry a fetus to the full term and deliver a full term baby.

8 Conclusion Overall, miscarriages cannot be prevented. However, a woman can decrease her susceptibility to miscarriage by maintaining a healthy lifestyle prior to becoming pregnant. Another crucial factor to consider is quality health care. Women should be aware of any preexisting conditions that may affect a pregnancy. Moreover, prenatal care, including vital information on the dos-and-donts of pregnancy, can make all the difference in maintaining a healthy pregnancy. Unfortunately, twelve percent of women will still experience the misfortune of miscarriage, and although there is no actual treatment for the miscarriage itself, there is medication to treat the effects of miscarriage. In addition, there are several organizations that are dedicated to assisting women in coping with the physiological and physical aspects of experiencing this loss.

9 Works cited About.com (n.d.). Readers Respond: What to Call a Miscarriage. Retrieved November 7, 2013, from http://miscarriage.about.com/u/ua/coping Alijotas-Reig, J. (n.d.). Current concepts and new trends in the diagnosis and management of recurrent miscarriage. NCBI. Retrieved October 15, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/23942472 American Pregnancy Association | Promoting Pregnancy Wellness. (n.d.). American Pregnancy Association. Retrieved October 15, 2013, from http://americanpregnancy.org/ Babarinsa, Isaac MSc, MRCOG. (2012,11-12).Key Highlights Epocrates Online. Retrieved November 7, 2013, from https://online.epocrates.com/u/2911666/Miscarriage/Summary/Highlights Bottomley, C., & Bourne, T. (2009, August 23). Diagnosing miscarriage. NCBI. Retrieved October 28, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/19502113 Damjanov, I. (2012). Pathology for the health professions (4th Ed.). St. Louis, MO.: Elsevier/Saunders. Early Options: Complications of Medical Abortion. (n.d.). Early Options: Complications of Medical Abortion. Retrieved October 27, 2013, from http://www.prochoice.org/education/cme/online_cme/m2complications.asp Forbes, S. (1997). The evolutionary biology of spontaneous abortion in humans. Trends in Ecology & Evolution, 12(11), 446-450. Retrieved October 15, 2013, from the Trends in Ecology & Evolution database. Irvine, L., & Sertchell, M (20010. Reproductive epidemiology. Declining incidence of

10 ectopic pregnancy in the UK city health district between 1990 and 1999. Human Reproduction, 16(10), 2230. Key. (n.d.). Spontaneous Abortion. Spontaneous Abortion. Retrieved October 13, 2013, from https://www.clinicalkey.com/topics/obstetrics-gynecology/spontaneousabortion.html#sectionEtiology Marquardt, U. (2011). Management of miscarriage and ectopic pregnancy. Emergency Nurse, 19(7), 29-35 March of Dimes. Miscarriage. Retrieved 16 October 2013, from http://www.marchofdimes.com/loss/miscarriage.aspx Merz, E. (2005). Ultrasound in obstetrics and gynecology (Second ed.). Stuttgart: Georg Thieme Verlag. Mdguidelines.com (n.d.). Miscarriage Prognosis - Medical Disability Guidelines. Disability Guidelines Return to Work Durations and Treatment - MDGuidelines. http://www.mdguidelines.com/miscarriage/prognosis Miscarriage. (2012, November 8). NCBI. Retrieved October 15, 2013, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002458/ Saravelos, S., Yan, J., Rehmani, H., & Li, T. (2011, August 9). Human Reproduction. The prevalence and impact of fibroids and their treatment on the outcome of pregnancy in women with recurrent miscarriage. Retrieved October 15, 2013, from http://humrep.oxfordjournals.org/content/26/12/3274.short Sebire, N., Fisher, R., Foskett, M., Rees, H., Seckl, M., & Newlands, E. (2003). Risk Of Recurrent Hydatidiform Mole And Subsequent Pregnancy Outcome Following Complete Or Partial Hydatidiform Molar Pregnancy. BJOG: An International

11 Journal of Obstetrics and Gynecology, 110(1), 22-26. Retrieved October 28, 2013, from the Science Direct database. Spontaneous Abortion Etiology Early Pregnancy Risks. (2006, June 2). Medical and health information from Armenian Medical Network. Retrieved October 13, 2013, from http://www.health.am/pregnancy/more/spontaneous-abortion-etiology/ Steer, P (2010). Threatened Miscarriage and Pregnancy Outcome. BJOG: An International Journal of Obstetrics & Gynecology, 117(7), 893. Todd, MD, N. (2012, June 21). Pregnancy and Miscarriage. Retrieved from http://www.webmd.com/baby/pregnancy-miscarriage Toth, D. A. (n.d.). Spontaneous Abortion: Cause of Secondary Infertility | Fertility Solution. Fertility Solution: Infertility & Prostatitis Treatment / Attila Toth MD. Retrieved October 14, 2013, from http://www.fertilitysolution.com/Latest-

Research/Spontaneous-Abortion.html Wilcox, A., & Weinberg, C. (n.d.). Incidence of early loss of pregnancy. NCBI. Retrieved October 15, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/3393170

You might also like