Professional Documents
Culture Documents
City of Olongapo
Gordon College
SY 2013-2014
Presented to:
The Faculty Members of School of Midwifery
Submitted by:
Taruc, Jane-Vi
October 2, 2013
Introduction
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 12 weeks of gestation
Late Abortion happens 12-20 weeks of gestation.
Abortus a fetus that weighs less than 500 grams or expelled from uterus before
age of viability
Types:
Complete abortion- complete expulsion of all the products of conception.
Criminal abortion - termination of pregnancy by illegal interference, usually undertaken
when legal induced abortion is unavailable. The most frequent complications are severe
hemorrhage
and sepsis, and for those who delay seeking medical attention the mortality rate is high.
Habitual abortion - in three or more consecutive pregnancies before the 20th week of
gestation.
Incomplete abortion- abortion in which parts of the products of conception are retained
in the uterus.
Induced abortion -abortion brought on intentionally by medication or instrumentation.
Inevitable abortion- a condition in which vaginal bleeding has been profuse,
membranes usually show gross rupturing, the cervix has become dilated, and abortion
is almost certain.
Missed abortion- retention of dead products of conception in utero for more than 8
weeks.
Septic abortion - abortion associated with serious infection of the products of
conception and endometrial lining of the uterus, leading to generalized infection; it is
usually caused by pathogenic organisms of the bowel or vagina.
Spontaneous abortion - termination of pregnancy before the fetus is sufficiently
developed to survive; called miscarriage .Chromosomal abnormalities cause at least
half of spontaneous abortions.
Factors:
1. Fetal Factors abnormal zygotic development
2. Maternal Factors infections, nutrition, drug use and environmental factors,
uterine defects and incompetent cervix.
3. Paternal Factors abnormalities of sperm
Management for incomplete abortion:
Dilatation and curettage
Dilatation and curettage (D&C) refers to the widening or opening of the cervix
and surgical removal of part of the lining of the uterus and or contents of the uterus by
scraping and scooping (curettage). It is a therapeutic gynecological procedure as well
as a method of first trimester abortion.
Pathophysiology
Vaginal bleeding
Uterine cramps
Threatened
may go to term
inevitable
incomplete abortion
(passage of some parts of conception)
complete abortion
(passage of all parts of conception)
-
Patients Profie
Around 7:08 pm, patient transferred to DR table for D&C. Local anesthesia and
sedative was given to patient. Evacuation of placental fragments was aseptically done
by Dr. Corpuz, at 7:45 pm oxytocin was given IM to stimulate contractions.
Patient was transferred to Gyne ward safely by stretcher around 11:20 pm with
an ongoing D5LRs IVF and PNSS and placed comfortably on bed, with no active
bleeding and uterus was firm and contracted. Postpartum orders were as follows which
were carried out monitored V/S q 15 minutes x 1 hr, q 30 minutes x 1 hr, q 4 hrs until
stable, WOF profuse vaginal bleeding. Refer as necessesary.
Shift
pm
Time
5
6
7
8
9
10
11
12
BP
120/90mmh
g
120/90mmh
g
110/80mmh
g
120/90mmh
g
120/80mmh
g
110/80mmh
g
110/70mmh
g
90/60mmhg
PR
82bpm
RR
19bpm
T
36.6 C
80bpm
18bpm
36.7 C
79bpm
18bpm
36.5 C
85bpm
19bpm
36.6 C
87bpm
19bpm
36.5 C
86bpm
20bpm
36.6 C
84bpm
22bpm
36.7 C
89bpm
20bpm
36.5 C
O Rh (+)
123
0.37
15-13 x109/L
0.70
0.35
226 x 10 x109/L
Normal Values
M: 140-180 F: 120-150
M: 0.40-0.50 F: 0.30-0.40
5.0-10.0 x 10 x109/L
0.30-0.70
0.20-0.40
150-350 x 10 x109/L
On the following day, Patient J was fully awake and coherent, not in afebrile
condition with an ongoing IVF D5LRs 1L 300cc level and PNSS terminated, patient
instructs diet as tolerated. V/S was taken and recorded and medication was given by
staff nurse. Health teaching was done while perineal hygiene was advised. Her uterus
has kept well-contracted but have a minimal vaginal bleeding while needs are attended
and care was rendered, so the evaluation is stable. After Dr. Corpuz sees the patient ,
she ordered an MGH disposition.
Vital Signs Monitoring with the following results:
Date
6/13/13
Shift
Am
Time
8
12
PM
4
8
12
BP
120/90mmh
g
110/90mmh
g
110/80mmh
g
110/90mmh
g
120/90mmh
g
PR
83bpm
RR
20bpm
T
36.6 C
85bpm
18bpm
36.7 C
79bpm
20bpm
36.5 C
84bpm
18bpm
36.7 C
83bpm
19bpm
36.8 C
Result
Non-reactive
Non-reactive
Interpretation: The patient was non-reactive in both HBSag and Syphilis and it is
normal, meaning the patient dont have the disease.
Urinalysis Time: 3 pm
Macroscopic
Color
Transparency
Specific gravity
Reaction
Protein
Glucose
Results
Yellow
Slightly cloudy
1.010
Acidic
(-)
(-)
Microscopic
RBC
WBC
Bacteria
Results
126.3 / L
31.10 / L
4544.2/ L
Normal Values
0-11 / L
0-17 / L
0-1 / L
Interpretation: The result in Urinalysis (microscopic) was above normal due to the
cause of infection prior to D&C and due to the trauma and stress experience by the
woman during the procedure.
Drug Study:
Intrapartum:
Medications
Dosage
Route
Indications
Oxytocin
10 unit
IM
To improve
and stimulate
the uterine
contractions
D5LRs
1 liter
Parenteral
regulated of 30
drops per
minute
A type of
hypertonic
solution that is
source of
water
electrolytes
Application to
the patient
To facilitate
and stimulate
of the uterine
contraction of
the woman
and control
postpartum
bleeding
To replace and
replenish the
electrolytes
mainly glucose
of the woman.
PNSS
500 cc
regulated KVO
Parenteral
Diazepam
10mg
IM
Medications
Dosage
Route
Fortifier FA
125mg/tab
Oral
Oral
Co-amoxiclav
Oral
625 mg/cap
BID x 7 days
and calories
A type of
isotonic
solution , and
prevent for
hypocvolemic
shock
A sedation that
provides light
anesthesia
and muscle
relaxant
Indications
A solution for
fluid and
electrolyte
replenishment.
And used to
woman for
prevention of
shock
Used to sedate
the woman
during the
procedure
Application to
the patient
To prevent and Because the
treat iron
patient had a
deficiency
lot of blood loss
anemia
so she needs to
regain by taking
this and she is
prone to
anemia
Relief of pain
Because
during post op
postpartum
and postpartum women had a
traumatic
experience and
pain during
procedure
Used to prevent Mother who
an infection
have been for
completion
curettage can
be at risk of
getting
infection,
example: the
patient has a
poor perineal
hygiene
Postpartum:
Conclusion
Patient J, a 20 years old G31P20PU 8 6/7 weeks of AOG, is rushed and admitted
to the James L. Gordon Memorial Hospital because of vaginal bleeding. She has no
pre-natal check-up and no TT vaccine. She goes to an unlicensed birth attendant
because of unwanted pregnancy eventhough she know the risk and dangers having an
illegal abortion. She has an incomplete abortion and for completion curettage under the
service of Dr.Corpuz.
Patient J was stabled after the day of procedure, uterus was firm and
globular,well-contracted, and no post partum problem, also she didnt acquired any
infection so the doctor ordered an MGH disposition.
Recommendation
Here are the list of the health teachings that I share to my patient for the health of her
baby and herself: