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CASE PRESENTATION ON EARLY PREGNANCY LOSS (ABORTION )

CASE PRESENTATION ON EARLY PREGNANCY LOSS (ABORTION ). MARIA MADONNA REFAMA, R.N. OPD-OB GYNE. 1. DEMOGRAPHIC DATA Case number: 187*** Age: 24 Y/O Sex: Female Diagnosis: G1 P0 11 weeks and 6 days AOG; Incomplete Abortion. 2. PHYSICAL ASSESSMENT GENERAL Ambulatory

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CASE PRESENTATION ON EARLY PREGNANCY LOSS (ABORTION )

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  1. CASE PRESENTATION ONEARLY PREGNANCY LOSS(ABORTION) MARIA MADONNA REFAMA, R.N. OPD-OB GYNE

  2. 1.DEMOGRAPHIC DATA Case number: 187*** Age: 24 Y/O Sex: Female Diagnosis: G1 P0 11 weeks and 6 days AOG; Incomplete Abortion

  3. 2. PHYSICAL ASSESSMENT • GENERAL • Ambulatory • Conscious and coherent • Slightly weak • (+) dizziness • Active vaginal bleeding • In pain; presented by grimaced face and guarding the abdominal area. • Vital signs: B/P= 90/60mmHg PR= 90bpm • T= 36. 5 C RR= 22 bpm

  4. INTEGUMENTARY • Pale in appearance • Cold and clammy skin • Nail beds slightly bluish in color

  5. HEAD AND NECK • Facial symmetry • No lesions nor masses palpated • No deformity noted • No palpable lymph nodes noted • No nasal flaring, congestion or drainages noted • Pale conjunctiva noted • Dry and pale lips also noted

  6. BODY AND UPPER/LOWER extremities • No physical deformities, contractures nor paralysis noted. • Good range of motion.

  7. GENITOURINARY • Profuse vaginal bleeding with soaked pads. • With minimal blood clots. • Cervix closed upon vaginal examination by SOD. • Able to void freely in adequate amount. • No painful sensation during urination as reported.

  8. NEUROLOGIC • Slightly anxious. • Uncooperative in internal examination. • Oriented to time, place and person.

  9. 3. PATIENT HISTORY • PAST HISTORY • Consultation done at DAAH under Dra. Sofia dated 17/10/12, investigations done as follows: • LMP: not sure

  10. SERUM B-HCG (QUANTITATIVE) RESULT 58,598 mIU/ ml

  11. Transvaginal Ultrasound Impression: • Anembryonic pregnancy 6 weeks and 5 days AOG by MSD • No embryonic pole seen • No yolk sac • Irregularly shaped gestational sac • Normal ovaries with corpus luteum on the right

  12. 1 day prior to admission (03/11/12) • (+) vaginal • spotting • Hypogastric pain

  13. PRESENT HISTORY • G1 P0 11 weeks and 6 days by UTZ Complaint of: • Profuse vaginal bleeding • Hypogastric pain • Dizziness Quick scan with UTZ revealed gestational sac at the lower uterine segment.

  14. 4. TOPIC PRESENTATION ABORTION • Is the spontaneous or induced loss of an early pregnancy. • Any interruption of pregnancy before afetus is viableor that is less than20 weeks age of gestation (AOG), or that which weighs less than 500g. • The term miscarriage is used often in the lay language and refers to spontaneous abortion.

  15. TYPES OF SPONTANEOUS ABORTION • 1.Threatened Abortion • Consists of any vaginal bleeding during early pregnancy without cervical dilatation or change in cervical consistency. • Usually, no significant pain exists, although mild cramps may occur. More severe cramps may lead to an inevitable abortion.

  16. Very common in the first trimester; about 25-30% of all pregnancies have some bleeding during the pregnancy. • Less than one half proceed to a complete abortion. • On examination: blood or brownish discharge may be present in the vagina. The cervix is not tender, and the cervical os is closed. No fetal tissue or membranes have passed. • The ultrasound shows a continuing intrauterine pregnancy.

  17. 2. Inevitable Abortion • An early pregnancy with vaginal bleeding and dilatation of the cervix. • Typically, the vaginal bleeding is worse than with a threatened abortion, and more cramping is present. • No tissue has passed yet. • On ultrasound, the products of conception are located in the lower uterine segment or the cervical canal.

  18. 3.Incomplete Abortion • A pregnancy that is associated with vaginal bleeding, dilatation of the cervical canal, and passage of products of conception. • Usually, the cramps are intense, and the vaginal bleeding is heavy. • With passage of tissue within the vagina. • Ultrasound may show that some of the products of conception are still present in the uterus.

  19. 4. Complete Abortion • A history of vaginal bleeding, abdominal pain, and passage of tissue exists. • After the tissue passes, the patient notes that the pain subsides and the vaginal bleeding significantly diminishes. • The examination reveals some blood in the vaginal vault; a closed cervical os; and no tenderness of the cervix, uterus, adnexa, or abdomen. • The ultrasound demonstrates an empty uterus.

  20. Anembryonic gestation • (also known as a blighted ovum) is a pregnancy in which the very early pregnancy appears normal on an ultrasound scan, but as the pregnancy progresses a visible embryo never develops. In a normal pregnancy, an embryo would be visible on an ultrasound by six weeks after the woman's last menstrual period. • Anembryonic gestation is one of the causes of miscarriage of a pregnancy.

  21. 5. ANATOMY ANDPHYSIOLOGY

  22. PATHOPHYSIOLOGY AND ETIOLOGY

  23. EARLY PREGNANCY RISK FACTORS MATERNAL/ PARENTAL FACTORS LIFESTYLE ENVIRONMENTAL FACTORS *AGE *POOR NUTRITIONAL STATUS *POOR IMMUNE SYSTEM *W/ UNDERLYING DISEASE OR CONDITION *USE OF ALCOHOL *PROHIBITED DRUGS *SMOKING *EXPOSURE TO RADIATION *TERATOGENS AUTOIMMUNE (APAS) CHROMOSOMAL ABNORMALITIES INFECTION SIGNS & SYMPTOMS: *LOWER BACK PAIN *VAGINAL BLEEDING *ABDOMINAL CRAMPS HIGH RISK PREGNANCY MISCARRIAGE

  24. UTERINE CRAMPING LOWER BACK PAIN • 7. SIGNS AND SYMPTOMS

  25. VAGINAL BLEEDING

  26. 8. NURSING • INTERVENTIONS • Monitor vital signs. • Monitor vaginal bleeding through pad count. • Promote bed rest. • Provide fluid resuscitation. • If considerable amount of blood loss has occurred, aggressive hydration, iron therapy or transfusions may be indicated. • Prevent infection. • Provide emotional support.

  27. 9. TREATMENT • MEDICAL • COMPLETE ABORTIONusually needs no further treatment, medically or surgically. • THREATENED ABORTION- use of progestogen. • MISOPROSTOLis an effective medical therapy. It increase uterine smooth muscle contractions and soften the cervix to allow passage of products of conception from missed abortion, inevitable abortion, or incomplete abortion. • Risks for medical therapy include bleeding, infection, possible incomplete abortion, and possible failure of the medication to work.

  28. SURGICAL • Inevitable and incomplete abortions are typically treated surgically with D&C. • Methylergonovine maleate (Methergine) (0.2 mg IM)- given after D&C to contract the uterus. This will also decrease the likelihood that clots will be retained in the uterus. • Risks of a D&C include bleeding, infection, possible perforation of the uterus, and possible Asherman syndrome after the procedure.

  29. 10.COMPLICATIONS • Hemorrhage • High fever due to infection. • Maternal mortality. • Accumulation of clot in the uterine cavity without expulsion due to uterine atony.

  30. 11. PRIORITIZATION OF NURSING PROBLEMS • Fluid volume deficit related to profuse vaginal bleeding secondary to incomplete abortion. • B. Acute pain related to uterine cramping secondary to expulsion of some products of conception. • C. Anticipatory grieving related to loss of pregnancy. • D. Risk for infection related to dilated cervix and open uterine vessels.

  31. 12. NURSING CARE PLAN

  32. 13. NURSING HEALTH TEACHING • Explained to the patient the need to wait for at least 3-6 months before attempting another pregnancy. • Reinforced or discussed with the couple the methods of contraception to be used.

  33. Instructed the couple to observe for signs of infection such as fever, pelvic pain, and change in character or amount of vaginal discharge and advise to report them immediately. • Explained to the patient the importance of follow up check-up to monitor the presence of bleeding and contraction of the uterus after D&C. • Emphasized the importance of take home medications prescribed by the physician.

  34. 14. CONCLUSION • First Trimester/early pregnancy is the most crucial stage of pregnancy in which the mother must have a closed watch or gives much attention to. Therefore I conclude that Antenatal check-up during pregnancy is important to monitor the status of the fetus and the mother. Any presence of unusual signs and symptoms must be reported immediately.

  35. If in any case pregnancy loss is inevitable immediate action is needed, any delay may result to infection or further complications to mother. • As a nurse, we need to encourage pregnant women to have their routine check-ups to prevent any complications during or throughout their pregnancy. Importance of vitamins and other pregnancy supplements should be emphasized. Medical team stands an important role in human well-being. The role of a healthcare provider must not just within the hospital but also in the home wherein provided health teachings must be implemented.

  36. 15. BIBLIOGRAPHY • 1. Philippine Obstetrical and Gynecological Society (Foundation), Inc. Clinical Practice Guidelines on Abortion (November 2010) Pages 1-15 • 2. Lippincott Manual of Nursing Practice 9th Edition; pages 1316, 1317, 1318 • 3. Maternal and Child Health Nursing by Adele Pillitteri 5th Edition; pages 400-409 • 4. http://www.scribd.com/doc/15991947/Nursingcribcom-Spontaneous-Abortion • 5. http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/spontaneous-abortion/ • 6.http://nursingcrib.com/nursing-notes-reviewer/fundamentals-of-nursing/nursing-diagnosis-for-female-reproductive-diseasesdisorders/

  37. 7. http://nursingcrib.com/nursing-care-plan/nursing-care-plan-dilatation-and-curettage-d-c/ • 8. http://emedicine.medscape.com/article/795085-overview • 9. http://emedicine.medscape.com/article/795085-clinical • 10.http://www.rightdiagnosis.com/m/miscarriage/complic.htm • 11. http://arispestanyo.hubpages.com/hub/nursing-care-plan-abortion • 12. http://www.healthplus24.com/womens-health/miscarriage.aspx

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