Presentation on theme: "CASE PRESENTATION ON EARLY PREGNANCY LOSS (ABORTION)"— Presentation transcript:
1CASE PRESENTATION ON EARLY PREGNANCY LOSS (ABORTION) MARIA MADONNA REFAMA, R.N.OPD-OB GYNE
21. DEMOGRAPHIC DATACase number: 187***Age: 24 Y/OSex: FemaleDiagnosis: G1 P0 11 weeks and 6 days AOG; Incomplete Abortion
32. PHYSICAL ASSESSMENTGENERALAmbulatoryConscious and coherentSlightly weak(+) dizzinessActive vaginal bleedingIn pain; presented by grimaced face and guarding the abdominal area.Vital signs:B/P= 90/60mmHg PR= 90 bpmT= C RR= 22 bpm
4INTEGUMENTARYPale in appearanceCold and clammy skinNail beds slightly bluish in color
5HEAD AND NECKFacial symmetryNo lesions nor masses palpatedNo deformity notedNo palpable lymph nodes notedNo nasal flaring, congestion or drainages notedPale conjunctiva notedDry and pale lips also noted
6No physical deformities, contractures nor paralysis noted. BODY AND UPPER/LOWER extremitiesNo physical deformities, contractures nor paralysis noted.Good range of motion.
7GENITOURINARYProfuse 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.
8NEUROLOGICSlightly anxious.Uncooperative in internal examination.Oriented to time, place and person.
9LMP: not sure 3. PATIENT HISTORY PAST HISTORY Consultation done at DAAH under Dra. Sofia dated 17/10/12, investigations done as follows:LMP: not sure
10SERUM B-HCG (QUANTITATIVE) RESULT 58,598 mIU/ ml
11Transvaginal Ultrasound Impression:Anembryonic pregnancy6 weeks and 5 days AOG by MSDNo embryonic pole seenNo yolk sacIrregularly shaped gestational sacNormal ovaries with corpus luteum on the right
121 day prior to admission (03/11/12) (+) vaginalspottingHypogastric pain
13PRESENT HISTORYG1 P0 11 weeks and 6 days by UTZComplaint of:Profuse vaginal bleedingHypogastric painDizzinessQuick scan with UTZ revealed gestational sac at the lower uterine segment.
144. TOPIC PRESENTATIONABORTIONIs the spontaneous or induced loss of an early pregnancy.Any interruption of pregnancy before a fetus is viable or that is less than 20 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.
15TYPES OF SPONTANEOUS ABORTION 1.Threatened AbortionConsists 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.
16Very 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.
172. Inevitable AbortionAn 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.
183. Incomplete AbortionA 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.
194. Complete AbortionA 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.
20Anembryonic 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.
318. 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.
329. TREATMENTMEDICALCOMPLETE ABORTION usually needs no further treatment, medically or surgically.THREATENED ABORTION- use of progestogen.MISOPROSTOL is 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.
33SURGICALInevitable 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.
3410. COMPLICATIONS Hemorrhage High fever due to infection. Maternal mortality.Accumulation of clot in the uterine cavity without expulsion due to uterine atony.
3511. 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.
37GOALS AND DESIRED OUTCOME NURSING INTERVENTIONs ASSESSMENTPLANNINGIMPLEMENTATIONEVALUATIONCUES/ EVIDENCENURSING DIAGNOSISGOALS AND DESIRED OUTCOMENURSING INTERVENTIONsRATIONALE FOR INTERVENTIONSUBJECTIVE:“I felt dizzy and I consumed 5-6 pads today and it’s fully soaked.”OBJECTIVE:*Profuse vaginal bleeding with soaked pad and with minimal blood clots.*Skin pallor noted.*Bluish nail beds.*Cold and clammy skin.*Dry oral mucous membranes.*V/S as follows:BP- 90/60mmHgT CPR- 90, bpmRR- 22 bpmFluid volume deficit related to profuse vaginal bleeding secondary to incomplete abortion.After 6-8 hours of nursing intervention the patient will be able to demonstrate improve fluid balance as evidence by minimal vaginal bleeding, good skin turgor, diminish pallor.INDEPENDENT:Assessed the stability of the patient through monitoring vital signs.Inserted gauge 18 of cannula at the left metacarpal vein.Instructed the patient to do pad counts.Maintained bed rest and assisted in ADL. Schedule activities to undisturbed rest periods.DEPENDENT:Administered fluids as ordered.Hgb, Hct, RBC monitored.Provide baseline data regarding patient’s condition.IV line is needed for the hydration of the patient to replace the blood loss.To monitor the bleeding and able to assess the blood loss.Activity increases intra-abdominal pressure that may cause further bleeding and also to promote fast recovery.To replace fluid loss and aids in fast recovery.Through laboratory results we can see the effectiveness of the theraphy.After 6-8 hours of nursing interventions the goals were met as evidenced by:Scanty vaginal bleeding.Good skin turgor and color.Fast capillary refill <2 secV/S stable:BP- 110/70mmHgT CPR- 80 bpmRR- 20 bpm
3813. 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.
39Instructed 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.
4014. CONCLUSIONFirst 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.
41If 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.
4215. BIBLIOGRAPHY1. Philippine Obstetrical and Gynecological Society (Foundation), Inc.Clinical Practice Guidelines on Abortion (November 2010)Pages 1-152. Lippincott Manual of Nursing Practice 9th Edition; pages 1316, 1317, 13183. Maternal and Child Health Nursing by Adele Pillitteri 5th Edition; pages4.5.6.http://nursingcrib.com/nursing-notes-reviewer/fundamentals-of-nursing/nursing-diagnosis-for-female-reproductive-diseasesdisorders/