Genetic Considerations

It is estimated that 50% or more of fetuses spontaneously aborted during the first trimester have significant chromosomal abnormalities. Slightly more than 50% of these are trisomies, 19% are monosomy X, and 23% are polypoloidies (multiples of the usual number of chromosomes). About 9% of aborted fetuses and 2.5% of stillbirths are due to trisomies 13, 18, or 21. Infants born with trisomy 13 or 18 rarely survive the perinatal period.

GENDER, ETHNIC/RACIAL, AND LIFE SPAN CONSIDERATIONS

More than 80% of abortions occur in the first 12 weeks of pregnancy. SABs are more common in teens (12%), elderly primigravidas (26%), and those women who engage in high-risk behaviors, such as drug and alcohol use or multiple sex partners. The incidence of abortion increases if a woman conceives within 3 months of term delivery. Surveillance data for pregnancy-related deaths between 1987 and 1990 demonstrated that more black mothers died after ectopic pregnancies and abortions, both spontaneous (14%) and induced (7%), than white mothers (8% and 4%, respectively).

^ ASSESSMENT

HISTORY. Obtain a complete obstetric history. Determine the date of the last menstrual period to calculate the fetus's gestational age. Vaginal bleeding is usually the first symptom that signals the onset of a spontaneous abortion. Question the patient as to the onset and amount of bleeding. Inquire further about a small gush of fluid, which indicates a rupture of membranes, although at this early point in gestation, there is only a small amount of amniotic fluid expelled. Ask the patient to describe the duration, location, and intensity of her pain. Pain varies from a mild cramping to severe abdominal pain, depending on the type of abortion; pain can also occur as a backache or pelvic pressure. Although it is a sensitive topic, ask the patient about the passage of fetal tissue. If possible, the patient should bring the tissue passed at home into the hospital because sometimes laboratory pathological analysis can reveal the cause of the abortion. With a missed abortion, early signs of pregnancy cease; thus, inquire about nausea, vomiting, breast tenderness, urinary frequency, and leukorrhea (white or yellow mucous discharge from the vagina).

PHYSICAL EXAMINATION. Temperature is elevated above 100.4°F if a maternal infection is present. In addition, pallor, cool and clammy skin, and changes in the level of consciousness are symptoms of shock. Examine the patient's peripad for blood loss, and determine if any tissue has been expelled. Sometimes tissue can be observed at the introitus, but do not perform a vaginal examination if that situation occurs.

PSYCHOSOCIAL. Assess the patient's emotional status, as well as that of the baby's father and other family members. Often this hospital admission is the first one for the patient, and it may cause anxiety and fear. The father may withhold expressing his grief, feeling he needs to "be strong" for the mother.

Diagnostic Highlights

General Comments: Most of the time, diagnosis of SAB is made based on patient

symptoms and the documentation of a positive pregnancy test.

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