UNIVERSITY COLLEGE SHAHPUTRA

FACULTY OF ALLIED HEALTH SCIENCES

DIPLOMA IN MEDICAL ASSISTANT

THREATENED ABORTION

NAME: MOHAMAD RAIS BIN MOHD SHUHAIMI

MATRIC NO.: SP51213039

SUBJECT: OBSTETRIC & GYNAECOLOGY (MOG 2141)

LECTURER: MR. AB. HADI HJ. ISMAIL

DEFINITION

The term "abortion" is commonly used to mean all forms of early pregnancy loss;

however, due to the polarizing social stigma assigned to this term, the term

"miscarriage" is used here to indicate all forms of spontaneous early pregnancy loss or

potential loss. One of the common complications of pregnancy is spontaneous

miscarriage, which occurs in an estimated 5-15% of pregnancies. Spontaneous

miscarriages are categorized as threatened, inevitable, incomplete, complete, or

missed, and can be further classified as sporadic or recurrent (>3 occurrences). A

threatened abortion is vaginal bleeding that occurs in the first 20 weeks of pregnancy.

The bleeding is sometimes accompanied by abdominal cramps. These symptoms

indicate that a miscarriage is possible, which is why the condition is known as a

threatened abortion or threatened miscarriage. Vaginal bleeding is fairly common

among pregnant women. About 20 to 30 percent of women will experience bleeding

during the first 20 weeks of pregnancy. Approximately 50 percent of these women will

carry their baby to term. The exact cause of a threatened abortion usually isnt known.

However, its more common among women who have previously had a miscarriage.

CAUSES

Although the actual cause of the miscarriage is frequently unclear, many miscarriages

before 14 weeks occur because there is something wrong with thebaby. Chronic

illnesses, including diabetes, severe high blood pressure, kidney disease, lupus and

underactive or overactive thyroid gland, are risk factors for miscarriage. Antenatal care
is important because it screens for some of these diseases. Inadequate ovarian

hormone production is one of the most common causes of a miscarriage. Acute

infections, including rubella (German measles), CMV ( cytomegalovirus), mycoplasma

('walking' pneumonia) and other unusual germs, and severe emotional shock, can also

cause miscarriage. Diseases and abnormalities of the internal female organs can also

cause miscarriage. Some examples are an abnormal womb, fibroids, poor muscle tone

in the opening of the entrance of the womb, abnormal growth of the placenta (also

called the afterbirth), and being pregnant with multiples.

SYMPTOMS

Any vaginal bleeding during the first 20 weeks of pregnancy can be a symptom of a

threatened abortion. Some women also have abdominal cramps or lower back pain.

During an actual miscarriage, women often experience either a dull or sharp pain in the

abdomen and lower back. They may also pass tissue with clot-like material from the

vagina.

PHYSICAL EXAMINATION

The doctor or midwife may assess the opening of the entrance to the womb (called the

cervical os) and, depending on the findings, will be able to tell you more accurately

which of the stages of miscarriage you might be experiencing.

 This is done during a pelvic examination where the health care professional puts gloved

fingers in the patient's vagina and feel the abdomen with the other hand. He or she can

feel whether the cervical os is open, how big the uterus may be, and whether there are

any signs of infection or tubal pregnancy. He or she may perform a speculum

examination using a metal or plastic device that helps examine the cervical os. The

patient should not feel any pain during this part of the examination, although the

procedure may be uncomfortable.

DIFFERENTIAL DIAGNOSES

Abortion Complications
Appendicitis
Dysfunctional Uterine Bleeding in Emergency Medicine
Dysmenorrhea
Emergent Management of Ectopic Pregnancy
Emergent Treatment of Endometriosis
Molar pregnancy
Ovarian Cysts
Ovarian Torsion
Pregnancy Trauma
Urinary Tract Infections in Pregnancy
Vaginitis
 LABORATORY TEST

A pregnancy test may be performed, as may blood tests to check for anaemia, for

example. If the woman does not know her blood type, this will also be checked. If she is

Rh-negative, the patient will probably receive a special injection of anti-RhD

immunoglobulin to protect the mother and her baby from a bad reaction. An ultrasound

may be performed to assess the stage of pregnancy and exclude the possibility of an

ectopic pregnancy.

TREATMENT

PREHOSPITAL CARE

Maintain routine universal precautions in view of potentially heavy vaginal bleeding.

Emergency medical services (EMS) personnel should be aware of the potential for

hemorrhagic shock and should treat any hemodynamic instability. Obtain vital signs and

establish an intravenous line in all pregnant patients who have abdominal pain and

vaginal bleeding. If the patient is hypotensive, an intravenous bolus of normal saline

(NS) is indicated for hemodynamic stabilization. Administer oxygen. Encourage the

patient to bring any passed tissue to the hospital for evaluation .

EMERGENCY DEPARTMENT CARE

Treat all patients with vaginal bleeding of any etiology as follows:

Determine hemodynamic stability and treat instability. If the patient is inhemorrhagic

shock, treatment includes the Trendelenburg position, oxygen, aggressive fluid

 resuscitation (at least 2 large-bore IV lines with lactated Ringer [LR] solution or normal

saline, wide open), and hemotransfusion.

Determine pregnancy status (qualitative and quantitative).

Make laboratory determination of hematocrit (Hct) level and Rh status.

Perform a pelvic examination to determine the rate of bleeding; presence of blood

clots or products of conception; and condition of cervical os, cervix, uterus, and

adnexa.

Perform pelvic ultrasonography to determine intrauterine and/or extrauterine contents

(fetal heart activity) and/or to clinically classify spontaneous miscarriage.

MEDICATIONS

Immune globulins

This agent suppresses immune response and antibody formation.

Rho(D) Immune Globulin (RhoGAM)

In nonsensitized Rho(D)-negative mothers who are exposed to Rho(D) prevents

antibody formation to Rh-positive red blood cells of the fetus caused by abortion,

fetomaternal hemorrhage, abdominal trauma, amniocentesis, full-term delivery, or

transfusion accident.

Oxytocic Agent

This agent has vasopressive effects and prevents postpartum bleeding.

Oxytocin (Pitocin, Syntocinon) Produces rhythmic uterine contractions and can control

postpartum bleeding or hemorrhage.

Prostaglandin

These agents induce uterine contractions.

Misoprostol (Cytotec)

Not approved for use in pregnancy, yet is an invaluable medication widely used for

cervical preparation for miscarriage, labor induction, and as a medical abortifacient.

Provides safe, passive method of cervical dilatation and should be considered for

facilitation of passage of products of conception in the setting of inevitable or incomplete

miscarriage, preabortion ripening when prior uterine surgery (ie, LEEP, cesarean

delivery) are known risk factors for uterine perforation during surgical abortion. Can be

administered orally or vaginally. Some studies show premoistened tablets placed

vaginally help absorption. Patients can be instructed in self-administration to help time

the dose in synchrony with their abortion procedure. In a study by Singh of primigravid

women (6-11 wk gestation), 93.3% achieved dilatation of the cervix of 8 mm or greater

after 3 h postintravaginal misoprostol 400 mcg, whereas only 16.7% of women achieved

this after 2 h of 600 mcg. The 600-mcg group had slightly greater adverse effects (eg,

bleeding, abdominal pain, fever >38C). Dosage intended for cervical ripening can

induce abortion in some patients. Oral doses of 100-400 mcg can be combined with

vaginal insertion of prostaglandins to enhance cervical dilatation.

PREVENTION

While there is no way to predict or prevent miscarriage in most cases, certain steps can

be taken to improve the chance of a pregnancy continuing to term.

 Get antenatal care and follow the advice of your health care professional

Avoid alcohol, nicotine and illegal drugs, especially cocaine.

Limit caffeine intake.

Manage high blood pressure and diabetes.

Get treatment for any infections.

BIBLIOGRAPHY

http://www.healthline.com/health/miscarriage-threatened#Overview1

http://emedicine.medscape.com/article/795085-overview

http://www.webmd.boots.com/pregnancy/guide/threatened-miscarriage