Which data at the first prenatal visit should alert the nurse that the client is at risk for spontaneous abortion?

• A. Age 35 years
• B. History of syphilis
• C. History of genital herpes
• D. History of diabetes mellitus

Answer: (B)

Infection with syphilis during early pregnancy is a red flag for spontaneous abortion. Treponema pallidum can cross the placenta and cause placental inflammation and fetal infection, which increases the risk of miscarriage if the infection isn’t treated. At the first prenatal visit, a history of syphilis should prompt serologic screening (RPR or VDRL with confirmatory testing) and, if positive, treatment with penicillin G to protect the pregnancy.

Advanced maternal age, while associated with higher miscarriage risk due to chromosomal issues, is not as direct a signal for spontaneous abortion as an active infection. Genital herpes mainly raises concern for neonatal herpes and delivery planning, not spontaneous abortion. Diabetes mellitus can raise miscarriage risk as well, but the infection with syphilis specifically points to an infectious cause of early pregnancy loss and requires immediate evaluation and treatment.