Complications Of Miscarriage

Complications of Miscarriage By: Maria Yves Lorraine Magbag

Hemorrhage

With a complete spontaneous miscarriage, serious or fatal hemorrhage is rare. With an incomplete miscarriage or in a woman who develops an accompanying coagulation defect, major hemorrhage is a possibility. Vaginal bleeding can occur frequently in the first trimester of pregnancy and may not be a sign of problems. But bleeding that occurs in the second and third trimester of pregnancy can often be a sign of a possible complication. Bleeding can be caused by a number of reasons.

What to be done?

 Monitor vital signs  immediately position a woman flat and massage the uterine fundus to aid contractions.  A need for D & C or suction curettage to empty the uterus of the material that is preventing it from contracting and achieving homeostasis.  A transfusion may be necessary  Direct replacement of fibrinogen or another clotting factor

After a self limiting complete miscarriage;  A woman needs clear instructions on how much bleeding is abnormal and what color changes she should expect in bleeding.  She should know that any unusual odor or passing of large clots is also abnormal.  If meds are prescribed to her, be sure that she understands why is it being prescribed and importance of taking it.  Some women repress their feelings, anxious to forget the experience as quickly as possible.

Infection  It tends to occur in women who have lost appreciable amounts of blood, most likely from the debilitating effect of blood loss.  UTI or urinary tract infection (UTI) is a bacterial inflammation in the urinary tract which is more common during pregnancy because of changes in the urinary tract. The uterus sits directly on top of the bladder. As the uterus grows, its increased weight can block the drainage of urine from the bladder, causing an infection.

What is going on in the body?  The bladder and the urine it holds are normally free from bacteria and other organisms. A urinary tract infection occurs when organisms are introduced into the bladder. Bacteria from the skin may enter through the urethra. The urethra is the tube that carries urine from the bladder to the outside of the body. Organisms can also enter the bladder on urinary catheters.

Signs and Symptoms Pain or burning (discomfort) when urinating The need to urinate more often than usual A feeling of urgency when you urinate Blood or mucus in the urine Cramps or pain in the lower abdomen Pain during sexual intercourse Chills, fever, sweats, leaking of urine (incontinence) Waking up from sleep to urinate Change in amount of urine, either more or less Urine that looks cloudy, smells foul or unusually strong Pain, pressure, or tenderness in the area of the bladder When a bacterium spreads to the kidneys you may experience: back pain, chills, fever, nausea, and vomiting.  A urinalysis and a urine culture can detect a UTI throughout pregnancy.            

How is a UTI treated?

 UTI's can be safely treated with antibiotics during pregnancy. Doctors usually prescribe a 3-7 day course of antibiotics that is safe for the mother and the baby.

How can you prevent a UTI?

 Drink 6-8 glasses of water each day.  Eliminate refined foods, fruit juices, caffeine, alcohol, and sugar.  Take Vitamin C  Develop a habit of urinating.  Urinate before and after intercourse.  Avoid intercourse while you are being treated for an UTI.  After urinating, blot dry (do not rub), and keep your genital area clean.  Avoid using strong soaps, douches, antiseptic creams, feminine hygiene sprays, and powders.  Change underwear and pantyhose every day.

 For a more complicated infection, endometriris is the type that usually occurs. It may be more extensive, however, and parametritis, peritonitis, thromboplebitis, and septicemia can develop.

Septic Abortion  A septic abortion is a spontaneous or therapeutic/artificial abortion complicated by a pelvic infection. But more frequently it occurs in women who have tried to self-abort or were aborted illegally using a nonsterile instrument such as knitting needle.

A septic abortion may be caused by any of the following factors:

  the membranes surrounding the fetus have ruptured, sometimes without being detected the woman has a   sexually transmitted disease   an intrauterine device (IUD) was left in place during the pregnancy   Tissue from the fetus or placenta is left inside the uterus after a miscarriage or abortion   Attempts were made to end the pregnancy, often illegally, by inserting tools, chemicals, or soaps into the uterus

Sign and Symptoms  fever  crampy abdomen  uterus feels tender palpation

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Left untreated, it will lead to:  toxic shock syndrome  septicemia  kidney failure  death

 The removal of all infected or necrotic tissue from the uterus is important. Typically complete blood count, serum electrolytes, serum creatinine, blood type and cross match, and cervical, vaginal and urine cultures are obtained.  Indwelling Foley catheter may be inserted.  IVF may be given  A central venous pressure or pulmonary artery catheter may be inserted.

Isoimmunization  Blood types are determined by the types of antigens on the blood cells. Antigens are proteins on the surface of blood cells that can cause a response from the immune system. The Rh factor is a type of protein on the surface of red blood cells. Most people who have the Rh factor are Rh-positive. Those who do not have the Rh factor are Rh-negative.

What may happen if the pregnant is Rh-negative?  If you are Rh-negative, you may develop antibodies to an Rh-positive baby. If a small amount of the baby's blood mixes with your blood, which often happens, your body may respond as if it were allergic to the baby. Your body may make antibodies to the Rh antigens in the baby's blood. This means you have become sensitized and your antibodies can cross the placenta and attack your baby's blood. They break down the fetus's red blood cells and produce anemia (the blood has a low number of red blood cells). This condition is called hemolytic disease or hemolytic anemia. It can become severe enough to cause serious illness, brain damage, or even death in the fetus or newborn.

How can problems be prevented?  A blood test can provide you with your blood type and Rh factor.  Antibody screen is another blood test that can show if an Rh-negative woman has developed antibodies to Rh-positive blood.  An injection or Rh immunoglobulin (RhIg), a blood product that can prevent sensitization of an Rhnegative mother.

Depression, Powerlessness or Anxiety

 A medical condition that leads to intense feelings of sadness or despair. These feelings don't go away on their own. They are not necessarily related to a particular life event.

What is going on in the body?  Depression is a disorder of the brain. Nerve impulses cause the release of neurotransmitters from one nerve cell to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression.

As with pregnancy loss for any reason, assess a woman’s adjustment to a spontaneous miscarriage. Sadness and grief over the loss or a feeling that a woman has lost control of her life is to be expected.