Pathophysiology 5u1h70

III. TEXTBOOK DISCUSSION a. Definition An incomplete abortion is the termination of pregnancy in which the products of conception are not entirely expelled or removed. It also involves the expulsion of the fetus with retention of placenta. It often causes hemorrhage that may require surgical evacuation by curettage, oxytocics, and blood replacement. Infection is also a frequent complication of incomplete abortion. b. Manifestations Signs and symptoms S/S Found in the Book Manifested by the Patient Vaginal Bleeding + Cramps + Fever Continued bleeding after three weeks Decrease in the usual signs of early + pregnancy, such as nausea and breast tenderness

C. Pathophysiology

Precipitating Factors   

Predisposing Factors   

Works 2 days in a week Work-related stressor Environment

Abdominal contraction

Abdominal pain

Cervical dilation

Intermittent vaginal bleeding

Age: 25 years old Gender: Female Previous incomplete abortion

ing of small pieces of pregnancy tissue

Dilatation and Curettage D. Management 1. Medical management With missed, incomplete, or inevitable abortion present before 13 weeks' gestation, the standard therapy has been suction D&C. However, at least 2 randomized controlled trials show that misoprostol is an effective alternative medical therapy. In one study of incomplete abortion, the patients were randomized between oral misoprostol (600 mcg) or suction D&C, with success rates at 96.3% and 91.5%, respectively. The complication rate is low (0.9% for misoprostol). The other study was a randomized controlled trial with a 3:1 randomization to medical therapy versus D&C. It included subjects with the following diagnoses: missed abortion (with or without a fetal pole; no fetal heart motion when the fetal pole was present), incomplete abortion, or inevitable abortion. In this study, the initial dose of misoprostol was 800 mcg (4 tab 200 mcg placed vaginally), and the subject was reevaluated on day 3. If the expulsion had not occurred, then a second dose of 800 mcg of misoprostol was placed vaginally. The study showed that 71% had completed abortion after the first dose by day 3, and 84% had success with misoprostol by day 8 (95% confidence interval, 81-87%).

2. Surgical management Suction dilation and curettage (D&C). Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion. In a dilation and curettage — sometimes spelled "dilatation" and curettage — your doctor uses small instruments or a medication to open (dilate) your cervix — the lower, narrow part of your uterus. Your doctor then uses a surgical instrument called a curette to remove uterine tissue. Curettes used in a D&C can be sharp or use suction.

3. Nursing management       

Check patient’s name, type of surgery, history Monitor vital signs, blood test, bleeding and vaginal secretion (character, color and volume) Strict aseptic technique Strengthen the perineum care and maintain the vulva cleanliness Psychological care: sympathizing, understanding and caring To check or trace ultrasound result Empty the bladder

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Comfort the patient Bed rest for 48 hours Antibiotic cover Avoid sexual intercourse

E. Discharge planning and health teaching Medication 

Instruct client to follow and take medication prescribed by the physician R: Treatment regimen is important to have faster recovery.

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Explain to the client the nature of the drugs so as the prescription. R: Knowledge about the medication will make the client aware of what she is taking and may increase her cooperation. Treatment: Cefuroxime 500 mg twice a day for 5 days Mefenamic Acid 500 mg/tab 3 times a day Ferrous sulfate once a day for 1 month

References: Brunner and Suddarth., Textbook in Medical-Surgical Nursing 10th Edition. Lowdermilk, Deitra Leonard, and Perry, Shannon E. Maternity and Women’s Health Care Eighth Edition. Mosby, Inc: Singapore _____ (n.d.) Retrieved from website medical-dictionary.thefreedictionary last February 7, 2016 _____ (n.d.) Retrieved from website 2womenshealth.com last February 8, 2016 Gaufberg, Slava V., (n.d.) Retrieved from website medscape.com last February 8, 2016 Puscheck, Elizabeth E., (n.d) Retrieved from website medscape.com last February 8, 2016 _____ (n.d.) Retrieved from website womenonwaves.org last February 8, 2016 _____ (n.d.) Retrieved from website nursingslideshare.net last February 8, 2016 _____ (n.d.) Retrieved from website mayoclinic.org last February 8, 2016