Download - Case study-Incomplete Abortion
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Republic of the Philippines
City of Olongapo
Gordon College
SY 2013-201
! Case Study of G1P0 P" # $%& !OG 'nco(plete !bortion
'n Partial )ulfill(ent of the Course re*uire(ent in Clinical Practicu( 20+
Presented to,
he )aculty .e(bers of School of .id/ifery
Sub(itted by,
aruc ane-i
October 2 2013
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'ntroduction
Abortion is the loss or termination of pregnancy less than the age of viability
which is 20-24 weeks of gestation or if the fetus weighs less than 500 grams.
Early abortion happens before 2 weeks of gestation
!ate Abortion happens 2-20 weeks of gestation.
Abortus a fetus that weighs less than 500 grams or e"pelle# from uterus before
age of viability
ypes,
Co(plete abortion- complete e"pulsion of all the pro#ucts of conception.
Cri(inal abortion- termination of pregnancy by illegal interference$ 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.
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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.
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)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 -
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'nstru(ents for 5ilatation and Curretage,
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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
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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
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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.
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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, $,30 p(
=lood ype O Rh 6>7 9or(al alues
gb 2+ :; 40-'0 D; 20-50
ct 0.+7 :; 0.40-0.50 D; 0.+0-0.40G@* 5-+ "0H>! 5.0-0.0 " 0 "0H>!
eutrophils 0.70 0.+0-0.70
!ymphocytes 0.+5 0.20-0.40
latelet 226 " 0 "0H>! 50-+50 " 0 "0H>!
'nterpretation, he result in he(atology /as in the range of nor(al?
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=lood type , O Rh 6>7
.edical .icrobiology and culture and sensiti4ity test,
=lood per 4agina , epithelial cells @ occasional
, no gro/th of (icroorganis(s after 3 days incubation
5ay 2
une 13 2013
i(e, A,00 a(
Bn the following #ay$ 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
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'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.
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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
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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;
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. @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 .