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 to
palpation
 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 Rh-
negative 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.