ST. ANTHONY COLLEGE OF ROXAS CITY, INC.

San Roque Extension, Roxas City 5800, Capiz, Philippines

Member, DC-SLMES, DC-SLMHS Philippines

Emboldened…On Fire: Building a Culture of Innovation and Communion

ST. ANTHONY COLLEGE OF ROXAS CITY, INC.

COLLEGE OF NURSING
A.Y. 2019 - 2020

REQUIREMENT IN
NCM109: MATERNAL AND CHILD HEALTH NURSING

MARCO RAY V. VELA, SN (BSNII-STEM)

18-00132

MRS. NITA A. AMMOGAO, RN

CLINICIAL INSTRUCTOR

JANUARY 20, 2020

 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City 5800, Capiz, Philippines
Member, DC-SLMES, DC-SLMHS Philippines

Emboldened…On Fire: Building a Culture of Innovation and Communion

MISCARRIAGE

What is miscarriage? Miscarriage is the expulsion of the fetus from the womb
independently, spontaneously or as the result of trauma, before it is able to survive independently
or before 24 weeks from Age of Gestation on which the 24th week is the age where the fetus can
survive outside of the womb. Other word for Miscarriage is abortion, usually miscarriage happens
at before 20 weeks AOG and a sign of it is when a mother experience bleeding during the 1 st
Trimester, it could mean ectopic pregnancy or abortion may be due to trauma, blighted ovum,
hormonal imbalances mainly progesterone, or infection from Rubella or influenza.
There are many types of abortions, mainly:
1. Threatened Abortion: The only abortion that the fetus is alive dt Cervix closed
Signs and Symptoms: Mild Uterine Contraction, Mild Bright Red Bleeding, Cervix closed
MOC: Hormonal Therapy = Progesterone
2. Imminent Abortion = Cannot be saved
Signs and Symptoms: Severe Uterine Contraction accompanied by bleeding, Cervix is opened,
Loss of products of conceptus is inevitable
Types of Imminent Abortion
A. Complete Abortion = All products expelled, minimal bleeding
B. Incomplete Abortion = Some products expelled
C. Missed Abortion = Fetal Death in Utero, not expelled dt cervix closed
Signs and symptoms of a Dead Fetus: No FHT, No Fetal Movement, Abnormal Fundic height,
Scant-Brown Vaginal discharge, increase in HCG
Note: Labor will automatically occur in 2 weeks, if not, then Doctor will recommend induced labor
D. Habitual Abortion = 3 consecutive abortions, any time in AOG, dt incompetent cervix
Symptom of Incompetent cervix: Severe Knife-like pain on Left or Right Lower Quadrant of the
Abdomen
Risk Factors for Abortion: More than 35 years old, had a previous miscarriage, exposure to tobacco
or narcotics, obesity, diabetes, drugs or alcohol use.
 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City 5800, Capiz, Philippines
Member, DC-SLMES, DC-SLMHS Philippines

Emboldened…On Fire: Building a Culture of Innovation and Communion

WHAT IS A MISCARRIAGE?
Miscarriage is when an embryo or fetus dies before the 20th week of pregnancy. Miscarriage
usually happens early in your pregnancy — 8 out of 10 miscarriages happen in the first 3 months
or 1st Trimester. Lots of people experience this kind of pregnancy loss. In fact, 10-20% of
pregnancies end in miscarriage. But even though miscarriage is common, it can be emotionally
difficult. Feelings of grief and loss are normal after losing a pregnancy.
The medical term for miscarriage is “spontaneous abortion.”

WHAT ARE THE CAUSES OF MISCARRIAGE?

It can be difficult to know exactly why a miscarriage happened, but it’s almost never caused by
something the pregnant person did. Normal activities like sex, exercise, working, and taking
most medicines do NOT cause a miscarriage. Minor injuries, like falling, don’t generally cause a
miscarriage either.
Some things that are known to cause miscarriages include:
 When the fertilized egg has an abnormal number of chromosomes (genes). This happens
at random, so you can’t prevent it or cause it to happen.

 Certain illnesses, like severe diabetes, can increase your chances of having a miscarriage.

 A very serious infection or a major injury may cause miscarriage.

 Late miscarriages — after 3 months — may be caused by abnormalities in the uterus.

 If you’ve had more than 2 miscarriages in a row, you’re more likely to have a
miscarriage.

WHAT ARE THE DIFFERENT TYPES OF MISCARRIAGE?

 Threatened miscarriage — You have vaginal bleeding and may have mild cramps, but
your cervix stays closed. Half of the time, the bleeding stops and your pregnancy goes on
normally. The other half of threatened miscarriages become inevitable miscarriages, and
end in pregnancy loss.

 Inevitable miscarriage — You have increasing bleeding, and your cervix opens. If this
happens, there’s no chance for your pregnancy to continue.

 Incomplete miscarriage — Some of the pregnancy tissue comes out of your uterus, and
some stays inside. You may need follow-up treatment to remove the remaining tissue.
 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City 5800, Capiz, Philippines
Member, DC-SLMES, DC-SLMHS Philippines

Emboldened…On Fire: Building a Culture of Innovation and Communion

 Complete miscarriage — All the pregnancy tissue comes out of your uterus. You usually
don’t need any extra treatment.

 Missed miscarriage — You have no cramps or bleeding. But ultrasound shows an embryo
without a heartbeat or an empty pregnancy sac without an embryo. Usually the tissue
passes on its own, but you may need treatment.

PHYSIOLOGY OF A MISCARRIAGE
The pathophysiology of a spontaneous miscarriage may be suggested by its timing.
Chromosomal defects are commonly seen in spontaneous miscarriages, especially those that
occur during 4-8 weeks' gestation. Infectious, immunologic, and environmental factors are
generally seen in first-trimester pregnancy loss.
Other known causes include infection, abnormalities of the uterus or cervix, smoking, substance
abuse, exposure to environmental or industrial toxins, diabetes, thyroid disease, and autoimmune
disease. Older women are more likely to miscarry than younger women are. Serious physical
trauma can also cause a miscarriage.

SIGNS AND SYMPTOMS OF A MISCARRIAGE

The symptoms of a miscarriage vary, depending on your stage of pregnancy. In some cases, it
happens so quickly that you may not even know you’re pregnant before you miscarry.
Here are some of the symptoms of a miscarriage:
 Heavy spotting
 Vaginal bleeding
 Discharge of tissue or fluid from your vagina
 Severe abdominal pain or cramping
 Mild to severe back pain

MANAGEMENT FOR MISCARRIAGE

Medical interventions should also be incorporated in the patient’s care plan to reinforce his
treatment. These are physician’s orders wherein nurses and other caregivers would assist or take
into action, thus ensuring the recovery of the patient.
 Aside from our own nursing management, physicians would also have to order a series of
therapeutic management for the pregnant woman.
 Administration of intravenous fluids. Such as Lactated Ringer’s, IV therapy should be
anticipated by the nurse as well as administration of oxygen regulated at 6-10L/minute by
a face mask to replace intravascular fluid loss and provide adequate fetal oxygenation.
 Avoid vaginal examinations. The physician would also avoid further vaginal
examinations to avoid disturbing the products of conception or triggering cervical
dilatation.
 The physician might also order an ultrasound examination to glean more information
about the fetal and also maternal well-being.
 Dilatation and evacuation. This is to make sure that all products of conception would be
removed from the uterus. However, before undergoing this intervention, the physician
 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City 5800, Capiz, Philippines
Member, DC-SLMES, DC-SLMHS Philippines

Emboldened…On Fire: Building a Culture of Innovation and Communion

must be sure that no fetal heart sounds could be heard anymore and the ultrasound must
show an empty uterus.
 Dilation and curettage. This is most commonly performed for incomplete abortions to
remove the remainder of the products of conception from the uterus. Since the uterus
would not be able to contract effectively, the contents might be trapped inside and could
cause serious bleeding and infection.