WCL Staff Nurse - 2019
Obstetrics & Gynaecology
Hard
Dark brown vaginal discharge and a negative pregnancy test are seen in which type of abortion?
Appeared in: WCL Staff Nurse - 2019
Explanation
- In a missed abortion, the embryo or fetus dies, but the products of conception are retained in the uterus for days or weeks.
- The cervix remains closed, and there is no active expulsion.
- Retained blood breaks down over time, leading to a characteristic dark brown vaginal discharge.
- After fetal demise, the placenta stops producing hCG, causing levels to fall. This can lead to a negative pregnancy test after a period of time.
- The uterus is often smaller than expected for the gestational age due to the cessation of growth.
Why Other Options Were Wrong
- Option A: In a threatened abortion, the fetus is still viable, and the pregnancy continues. Therefore, the pregnancy test would be positive, and any bleeding is typically bright red, not dark brown.
- Option B: Imminent (or inevitable) abortion is an active process where the cervix is dilated, and abortion is certain to occur. Bleeding is usually moderate to heavy and bright red, and the pregnancy test is positive as the process has just begun.
- Option D: In an incomplete abortion, some, but not all, of the products of conception have been expelled. This condition is associated with heavy vaginal bleeding, an open cervix, and a positive pregnancy test because trophoblastic tissue is often still present and functional.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical differentiation of spontaneous abortion types as background academic context rather than a clinical decision trigger.
- The definitive diagnosis of a missed abortion is made by transvaginal ultrasound (TVS), which will show a gestational sac with an embryo or fetus but no cardiac activity.
- Management options include expectant management (waiting for spontaneous expulsion), medical management (using medications like misoprostol to induce expulsion), or surgical management (dilation and curettage, D&C).
- Nurses must provide emotional support and counseling, as a diagnosis of missed abortion can be psychologically distressing for the patient and her family.
How to Approach the Question
- First, identify the key clinical signs presented in the question: 1) dark brown vaginal discharge and 2) a negative pregnancy test.
- Analyze the meaning of these signs. Dark brown discharge suggests old, retained blood. A negative pregnancy test indicates falling or absent hCG levels.
- Systematically evaluate each option. Consider the typical presentation of threatened, imminent, incomplete, and missed abortions.
- Threatened, imminent, and incomplete abortions are typically associated with active bleeding (bright red) and a positive pregnancy test because the process is acute or ongoing with viable or recently non-viable tissue.
- Recognize that only a missed abortion involves the retention of a dead fetus for a prolonged period, which explains both the old, dark discharge and the eventual decline of hCG to undetectable levels.
- Select the option that aligns with both key signs.
Concept Tested & Keywords
- Concept Tested: Clinical differentiation of spontaneous abortion types
- Stem keywords: Dark brown vaginal discharge, negative pregnancy test, abortion
- Lead-in keywords: which type
Question ID
Qkkw7uA9skqy5_jocHhLSS
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 8397-8399
E6 Obstetrics Williams p. 3
Practise the full WCL Staff Nurse - 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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