Case study-Incomplete Abortion

7/25/2019 Case study-Incomplete Abortion

1/15

Republic of the Philippines

City of Olongapo

Gordon College

SY 2013-201

! Case Study of G1P0 P" # $%& !OG 'nco(plete !bortion

'n Partial )ulfill(ent of the Course re*uire(ent in Clinical Practicu( 20+

Presented to,

he )aculty .e(bers of School of .id/ifery

Sub(itted by,

aruc ane-i

October 2 2013


2/15

'ntroduction

Abortion is the loss or termination of pregnancy less than the age of viability

which is 20-24 weeks of gestation or if the fetus weighs less than 500 grams.

Early abortion happens before 2 weeks of gestation

!ate Abortion happens 2-20 weeks of gestation.

Abortus a fetus that weighs less than 500 grams or e"pelle# from uterus before

age of viability

ypes,

Co(plete abortion- complete e"pulsion of all the pro#ucts of conception.

Cri(inal abortion- termination of pregnancy by illegal interference$ usually un#ertakenwhen legal in#uce# abortion is unavailable. %he most fre&uent complications are severehemorrhagean# sepsis$ an# for those who #elay seeking me#ical attention the mortality rate is high.

abitual abortion - in three or more consecutive pregnancies before the 20th week ofgestation.

'nco(plete abortion-abortion in which parts of the pro#ucts of conception are retaine#in the uterus.

'nduced abortion-abortion brought on intentionally by me#ication or instrumentation.

'ne4itable abortion-a con#ition in which vaginal blee#ing has been profuse$membranes usually show gross rupturing$ the cervi" has become #ilate#$ an# abortionis almost certain.

.issed abortion-retention of #ea# pro#ucts of conception in utero for more than 'weeks.

Septic abortion- abortion associate# with serious infection of the pro#ucts of

conception an# en#ometrial lining of the uterus$ lea#ing to generali(e# infection) it isusually cause# by pathogenic organisms of the bowel or vagina.

Spontaneous abortion - termination of pregnancy before the fetus is sufficiently#evelope# to survive) calle# miscarriage.*hromosomal abnormalities cause at leasthalf of spontaneous abortions.


3/15

herapeutic abortion - abortion in#uce# legally by a &ualifie# physician to safeguar#the health of the mother.

hreatened abortion- a con#ition in which vaginal blee#ing is less than in inevitableabortion$ the cervi" is not #ilate#$ an# abortion may or may not occur) this is the

presume# #iagnosis when any bloo#y vaginal #ischarge or vaginal blee#ing occurs inthe first half of pregnancy.


4/15

)actors,

. )etal )actors abnormal (ygotic #evelopment

2. .aternal )actors infections$ nutrition$ #rug use an# environmental factors$

uterine #efects an# incompetent cervi".

+. Paternal )actors abnormalities of sperm

.anage(ent for inco(plete abortion,

,ilatation an# curettage5ilatation and curettage,*/ refers to the wi#ening or opening of the cervi"

an# surgical removal of part of the lining of the uterusan# or contents of the uterus byscraping an# scooping curettage/. t is a therapeutic gynecologicalproce#ure as wellas a metho# of first trimester abortion.
http://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Curettagehttp://en.wikipedia.org/wiki/Gynecologicalhttp://en.wikipedia.org/wiki/Abortionhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Curettagehttp://en.wikipedia.org/wiki/Gynecologicalhttp://en.wikipedia.org/wiki/Abortionhttp://en.wikipedia.org/wiki/Cervix


5/15


6/15

'nstru(ents for 5ilatation and Curretage,


7/15

Speculu(s Retractors 5ilators and enaculu(s- 1peculums an# vaginal

retractors move the walls of the vagina an# cervi" out of the way so that the #octor

performing the ,* has a better view #uring the proce#ure.

Goodelan# egar 5ilatorsto #ilate the cervi".

)orceps 6ulsellas7- %he #octor uses these instruments for grasping problematic or

suspicious matter from the uterus. %his is especially useful if the #octor nee#s toremove specific tissues for lab tests.

ysteto(eter 6"8R'98 SO"957- %he hystetometer$ also known as a uterometer or

uterine soun#$ is a probe. %he #octor uses this instrument to get an i#ea of how the

uterus is place# #irectionally.

Sharp Currette the most important instrument in ,*.it is use# for scraping an#

gently removes the uterine lining.

5ull Currette for finsi#hing touches after the sharp curette.

Straight Catheter to empty bla##er


8/15

Pathophysiology

)ertili:ationi(plantation)etal .aternal or Paternal )actors

Sign and sy(pto(s,

- aginal bleeding- "terine cra(ps

hreatened

(ay go to ter( ine4itable

inco(plete abortion

6passage of so(e parts of conception7

co(plete abortion

6passage of all parts of conception7

-


9/15

Patient;s Profie

atient 3 is a 20 years ol# female currently resi#ing at 1ubic$ ambales. er

menarche was when she was 2 years ol# with a regular flow of + to 4 #ays consuming2 pa#s per #ay with negative #ysmenorrhea. er coitarche happen when she was 6

years ol# with a total number of 2 partners with no history of 1%,. atient 3 is known as

non smoker an# non alcohol #rinker. er height in cm is 60 an# weight of 57 kg.

atient tells me that + #ays before a#mission$ she goes to an unlicense# birth

atten#ant an# after several hours she e"perience# vaginal blee#ing consuming + fully

soake# regular napkin pa#s with episo#es of bloo# clots. 1he suspects that she is

pregnant because of month amenorrhea an# a positive pregnancy test but #i#n8t go to

any health facility for pre-natal check-up. 1he a#mits that she engage# on pre-marital

se" with her partner$ but they #i#n8t want the chil# because they are not marrie# an# stillstu#ying an# their parents will be in an uproar if they knew this unwante# pregnancy so

they #eci#e# to get the baby aborte#.

Course in the 70 mmg. er family history reveals that there is

negative hypertension. er physical e"am was conscious$ coherent$ afebrile an# not in

car#io-pulmonary #istress. 1he has symmetrical chest e"pansion$ no retractions an#

clear breath soun#s. ,octor8s or#ere# were carrie# out) her #iet was B$ with an CD

,5!?8s " +0 gtts>min an# 11 500cc CB$ insert in#welling folley catheter an#

connect to urine bag. Also she was or#ere# for #iagnostics of *@* with @% stat$ F>A$

@1ag$ 91>*1 of bloo# per vagina an# ??. A1% was #one with negative results for

hypersensitivity. $ E reveals of cervi" open$ patient has positive vaginal blee#ing an#

passage of some parts of conception in os. reparation has been #one for completion

curettage. C>1 an# B monitore# an# recor#e# every hour.


10/15

Aroun# 7;0' pm$ patient transferre# to ,? table for ,*. !ocal anesthesia an#

se#ative was given to patient. Evacuation of placental fragments was aseptically #one

by ,r. *orpu($ at 7;45 pm o"ytocin was given : to stimulate contractions.

atient was transferre# to 9yne war# safely by stretcher aroun# ;20 pm with

an ongoing ,5!?8s CD an# 11 an# place# comfortably on be#$ with no activeblee#ing an# uterus was firm an# contracte#. ostpartum or#ers were as follows which

were carrie# out monitore# C>1 & 5 minutes " hr$ & +0 minutes " hr$ & 4 hrs until

stable$ GBD profuse vaginal blee#ing. ?efer as necessesary.

Cital 1igns :onitoring with the following results;

5ate Shift i(e =P PR RR

6>2>+ pm 5 20>H0mmh

g

'2bpm Hbpm +6.6 *

6 20>H0mmh

g

'0bpm 'bpm +6.7 *

7 0>'0mmh

g

7Hbpm 'bpm +6.5 *

' 20>H0mmh

g

'5bpm Hbpm +6.6 *

H 20>'0mmh

g

'7bpm Hbpm +6.5 *

0 0>'0mmh

g

'6bpm 20bpm +6.6 *

0>70mmh

g

'4bpm 22bpm +6.7 *

2 H0>60mmhg 'Hbpm 20bpm +6.5 *

e(atology i(e, $,30 p(

=lood ype O Rh 6>7 9or(al alues

gb 2+ :; 40-'0 D; 20-50

ct 0.+7 :; 0.40-0.50 D; 0.+0-0.40G@* 5-+ "0H>! 5.0-0.0 " 0 "0H>!

eutrophils 0.70 0.+0-0.70

!ymphocytes 0.+5 0.20-0.40

latelet 226 " 0 "0H>! 50-+50 " 0 "0H>!

'nterpretation, he result in he(atology /as in the range of nor(al?


11/15

=lood type , O Rh 6>7

.edical .icrobiology and culture and sensiti4ity test,

=lood per 4agina , epithelial cells @ occasional

, no gro/th of (icroorganis(s after 3 days incubation

5ay 2

une 13 2013

i(e, A,00 a(

Bn the following #ay$ atient 3 was fully awake an# coherent$ not in afebrile

con#ition with an ongoing CD ,5!?8s ! +00cc level an# 11 terminate#$ patientinstructs #iet as tolerate#. C>1 was taken an# recor#e# an# me#ication was given by

staff nurse. ealth teaching was #one while perineal hygiene was a#vise#. er uterus

has kept well-contracte# but have a minimal vaginal blee#ing while nee#s are atten#e#

an# care was ren#ere#$ so the evaluation is stable. After ,r. *orpu( sees the patient $

she or#ere# an :9 #isposition.

Cital 1igns :onitoring with the following results;

5ate Shift i(e =P PR RR

6>+>+ Am ' 20>H0mmh

g

'+bpm 20bpm +6.6 *

2 0>H0mmh

g

'5bpm 'bpm +6.7 *

: 4 0>'0mmh

g

7Hbpm 20bpm +6.5 *

' 0>H0mmh

g

'4bpm 'bpm +6.7 *

2 20>H0mmh

g

'+bpm Hbpm +6.' *

Serology-'((unology i(e, $,30 a(

Result

@1ag on-reactive

1yphilis on-reactive


12/15

'nterpretation, he patient /as non-reacti4e in both =Sag and Syphilis and it is

nor(al (eaning the patient don;t ha4e the disease?

"rinalysis i(e, 3 p(

.acroscopic Results*olor Iellow

%ransparency 1lightly clou#y

1pecific gravity .00

?eaction Aci#ic

rotein -/

9lucose -/

.icroscopic Results 9or(al alues

?@* 26.+ > J! 0- > J!

G@* +.0 > J! 0-7 > J!@acteria 4544.2> J! 0- > J!

'nterpretation; %he result in Frinalysis microscopic/ was above normal #ue to the

cause of infection prior to ,* an# #ue to the trauma an# stress e"perience by the

woman #uring the proce#ure.

5rug Study,

'ntrapartu(,

.edications 5osage Route 'ndications !pplication to

the patient

B"ytocin 0 unit : %o improve

an# stimulate

the uterine

contractions

%o facilitate

an# stimulate

of the uterine

contraction of

the woman

an# control

postpartum

blee#ing,5!?8s liter

regulate# of +0

#rops per

minute

arenteral A type of

hypertonic

solution that is

source of

water

electrolytes

%o replace an#

replenish the

electrolytes

mainly glucose

of the woman.


13/15

an# calories

11 500 cc

regulate# CB

arenteral A type of

isotonic

solution $ an#

prevent for

hypocvolemic

shock

A solution for

flui# an#

electrolyte

replenishment.

An# use# to

woman for

prevention of

shock

,ia(epam 0mg : A se#ation that

provi#es light

anesthesia

an# muscle

rela"ant

Fse# to se#ate

the woman

#uring the

proce#ure

.edications 5osage Route 'ndications !pplication to

the patient

Dortifier DA 25mg>tab Bral %o prevent an#

treat iron

#eficiency

anemia

@ecause the

patient ha# a

lot of bloo# loss

so she nee#s to

regain by taking

this an# she is

prone to

anemia

:efenamic aci# 500mg>tab with

meals

Bral ?elief of pain

#uring post op

an# postpartum

@ecause

postpartum

women ha# a

traumatic

e"perience an#

pain #uring

proce#ure

*o-amo"iclav 625 mg>cap

@, " 7 #ays

Bral Fse# to prevent

an infection

:other who

have been for

completion

curettage can

be at risk of

getting

infection$

e"ample; the


14/15

patient has a

poor perineal

hygiene

Postpartu(,

Conclusion

atient 3$ a 20 years ol# 9+20F ' 6>7 weeks of AB9$ is rushe# an# a#mitte#

to the 3ames !. 9or#on :emorial ospital because of vaginal blee#ing. 1he has no

pre-natal check-up an# no %% vaccine. 1he goes to an unlicense# birth atten#antbecause of unwante# pregnancy eventhough she know the risk an# #angers having an

illegal abortion. 1he has an incomplete abortion an# for completion curettage un#er the

service of ,r.*orpu(.

atient 3 was stable# after the #ay of proce#ure$ uterus was firm an#

globular$well-contracte#$ an# no post partum problem$ also she #i#n8t ac&uire# any

infection so the #octor or#ere# an :9 #isposition.

Reco((endation

ere are the list of the health teachings that share to my patient for the health of her

baby an# herself;


15/15

. @eing an a#olescent$ suggest that she atten# family planning seminar or go

the nearest health center to provi#e information about family planning$ so she

can have plan for her repro#uctive health an# prevent the recurring of unsafe

abortion. Damily planning re#uces maternal mortality.2. *ounseling the patient is very vital because of having or e"periencing an

#epression an# suggest to talk to her family what she feels an# also tol# her

about the #anger having an unsafe abortion.+. also a#vise# her perineal hygiene washing an# wiping from front to back to

prevent infection. 1he may use boile# guava leaves for #ecoction.4. 1he shoul# watch out for any complications an# seek imme#iately me#ical

attention like heavy blee#ing.5. also tol# her that she shoul# be able to resume her regular activities within a

#ay or two. :il# cramping an# spotting may occur for a few hours or #ays.6. 1he shoul# not put anything insi#e the vagina tampons$ #ouches/ #uring this

time to prevent infection.

7. also tol# her ne"t menstrual perio# usually occurs within four to si" weeksafter the proce#ure .

Documents

Case study-Incomplete Abortion