Threatened abortion can occur in any pregnancy regardless of maternal age, race, comorbidities, lifestyle, or socioeconomic status. If a woman has previously had bleeding in the first trimester of pregnancy, her risk of bleeding in the first trimester of subsequent pregnancies does appear to be increased. Risk factors for any type of miscarriage include advanced maternal age, advanced paternal age, prior history of pregnancy loss, TORCH infections, uncontrolled hyperglycemia, obesity, uncontrolled thyroid disease, significant stressors, use of teratogenic medications, and presence of a subchorionic hemorrhage.
Patient education should be provided as both verbal and written explanations and instructions. It should be explained to the patient that it is possible her pregnancy will continue and it is also possible that she will undergo a miscarriage. The patient needs to understand that the vast majority of miscarriages are not preventable and that she is not at fault for the loss of the pregnancy if a loss does occur. Providers should explain to the patient that mild to moderate bleeding and cramping can be expected, but uncontrolled pain or heavy bleeding should be evaluated by an obstetric care provider or in the emergency department. Many providers explain that saturating more than 1-2 pads per hour for 2 hours is considered to be heavy bleeding and should be promptly evaluated. Patients can be instructed to take acetaminophen as directed for pain relief. Patients should avoid ibuprofen for pain control during a threatened abortion as it is contraindicated in pregnancy and the patient's pregnancy may progress to viability. Patients who undergo threatened abortion should be evaluated for mood disorders including depression and anxiety. Especially if a threatened abortion proceeds to pregnancy loss, the patient should be allowed to grieve as appropriate for each individual and should be offered grief counseling.
There will be times when you would not know what to do with stubborn children to control their anger and aggressive behavior. But if you react without thought, you may develop a negative attitude towards the problem and even reinforce their negative behavior unwittingly.
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