Asuncion 5255 ICS Maternal

SAINT MARY’S UNIVERSITY
3700 Bayombong, Nueva Vizcaya

School of Health and Natural Sciences
5255 NCM 109 RLE
Individual Maternal (with acute and chronic abnormalities) Health Case Study
“G1P0 Imminent Abortion 16 weeks AOG”
Presented to the faculty of

SCHOOL OF HEALTH and NATURAL SCIENCES
NURSING DEPARTMENT
In partial fulfillment of the Requirements in

Care of Mother, Child at Risk or with Problems (Acute and Chronic) NCM109 RLE
Submitted by:z
Asuncion, Carelle Faith S.
Submitted to:
Mrs. Viviene L. Camhit, R.N., M.S.N.
Clinical Instructor
March 27, 2022

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TABLE OF CONTENTS
I. Personal Profile, Present and Past OB History 3-6

II. Brief Description 7-20
III. Anatomy and Physiology 21-27
IV. Pathophysiology 28-35
V. Laboratory Results and Diagnostic Studies 36-38
VI. PERSON Assessment 39-56
VII. Drug Analysis 57-73
VIII. Course in the Ward 75-78
IX. Nursing Care Plan 79-99
X. Bibliography 100-103
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CHAPTER I. 3P’s
I. PERSONAL PROFILE
Name Mrs. CFB
Age 35
Pre-pregnancy Weight: 65 kg
Height 5’5”
Weight 58 kg
BMI 22.5 Normal
Birthdate November 26, 1987
Birth place Rizal, Saguday, Quirino
Address 288 Cabilugan, Bunga, Carranglan,
Nueva Ecija
Contact Number +639092136525
Civil Status Married
Occupation Grocery Owner
Monthly Income P35, 000.00
Nationality Filipino
Language Spoken Ilocano, Tagalog, English
Religion Pentecostal
Educational Attainment Bachelor’s Degree, BSBA major in
Marketing
Significant Others:
Name of Spouse Mr. KB
Age 37
Gender Male
Civil Status Married
Religion Pentecostal
Educational Attainment Bachelor’s Degree, BSMath
Occupation BFP Officer I, Jeepney Owner
Monthly Income P42, 000.00
Relationship to the Client Spouse
Date of Admission March 10, 2022, 8pm

Date of Discharge March 11, 2022, 11am
Hospital Heart of Jesus Hospital, San Jose City,
Nueva Ecija
Attending OB/Physician Dra. ADF
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Source of Health Information Fernando’s Women’s Clinic

\Patient’s Diagnosis upon Admission G1P0 (0-0-0-0) 16 weeks AOG, intra-
uterine pregnancy with chief complaints of
vaginal spotting and abdominal cramping
3cm cervical dilatation PTA, no fetal heart
sounds, T/C D&C
Final Diagnosis G1P0 (0-0-1-0-0) 16 weeks AOG,
Imminent Abortion through D&C
Patient Case Gravida: 1
Parity: 0
Term Pregnancy: 0
Pre-Term Pregnancy: 0
Abortion: 1
Living Children: 0
Multiple Pregnancy: 0
16 weeks AOG with vaginal bleeding and

uterine contraction, 3cm dilatation upon
admission, no FHT , Imminent Miscarriage
resolved with D&C.
Chief Complaints Vaginal Bleeding and Abdominal
Cramping
No. of Hospital days 15 hours.
II. HEALTH HISTORY

Mrs. CFB, 35, married, a primi-gravida and 16 weeks pregnant with vaginal bleeding and
abdominal cramping, no FHR on hospital ultrasonography, diagnosed with imminent
miscarriage and D&C as treatment.
A. HISTORY OF PRESENT CONDITION
Mrs. CFB had been married for two years before conceiving and becoming
pregnant as a result of irregular menstruation, which she treated with hormone
therapy for a year as prescribed by her OB-GYN. After a year, she tested positive
for pregnancy on January 13, 2022, at 8 weeks AOG, as confirmed by her UTZ
report at the clinic. To help her pregnancy, she was given calcium and iron
supplements, as well as multivitamins.
Mrs. CFB reports that there is no cramping or spotting at her second check-
up at 12 weeks, and everything is fine. However, by the 15th week, she feels
strange, as if something is wrong, and she can't feel any movement on her
abdomen. By the 16th week, there is already spotting, small tissues passing
through her vagina, and abdominal cramping. Later, while on their way to the Heart
of Jesus Hospital, SJC, N.E., she and her husband called her OB-Gyne to let him
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know what was going on. Upon admission, they immediately performed a
COVID19 RAT, checked her vital signs, and took a tissue sample from her vagina.
While waiting for her OB, Doctor ADF, they perform diagnostic tests such as UTZ
and beta HCG Test to ensure the fetal condition. On the screen, there is an absent
fetal heart tone, which was also confirmed by a fetal MRI, and no signs of fetal
movement inside the womb. She was given local anesthesia and oxygen via IV
infusion at 1:00 a.m. to prepare her for the D&C procedure. Dr. ADF immediately
performed an ultrasound to confirm the uterine perforation causing bleeding during
the procedure at 1:00am when there was a sudden loss of resistance during
evacuation, allowing an instrument to pass well beyond the expected length of the
uterus. After 40 minutes, she was transferred to her private room for a 5-hour close
observation if there were any complications such as severe hemorrhage or fever
following the surgical abortion and was prescribed 100 mg. Doxycycline for
antibiotics, Methergine to help her uterus quickly return to pre-pregnancy shape,
and 800mg Ibuprofen for pain relief.
The couple was also shown how to perform a uterine massage in the event
of light bleeding. At 6 a.m., Mr. KB reported a bleeding of 1 pad soaked for an hour
and a half, and the Doctor prescribed Misoprostol (Cytotec) sublingually to Mrs.
CFB to be taken every 4 hours until light bleeding returned. Aside from bleeding,
they also reported polyuria and cystitis, which their doctor treated with antibiotics.
Mrs. CFB and her spouse were taught about post-abortion care, the risks of the
procedure, and the medicine and its treatment. They were also taught about
potential danger signs that would necessitate hospitalization. They are ready for
discharge at 9:00 a.m., so Mr. KB paid everything and processed their discharge
papers. She was discharged at 11 a.m. on March 11, 2022, and was instructed to
return for a follow-up examination two weeks later, on March 24, to check for the
cervix and uterus.
B. HISTORY OF PAST ILLNESS

At the age of 16, Mrs. CFB had a history of late menarche and thelarche. She had her
first sexual encounter when she was 33 years old, at her husband's wedding. She later
becomes pregnant at the age of 35. She had an irregular menstruation cycle that varies
significantly from month to month and was treated with Hormonal therapy prescribed by her
OB after her wedding. She had a history of hypertension ranging from 140/90 to 160/100
mmHg, which was one of the risk factors for miscarriage, along with her late-age pregnancy
and mental stress from her father's death. Her LMP is set for November 18, 2021, and her
EDC is set for August 25, 2022.
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Her daily routine also includes a cup of coffee or two because it is her favorite beverage,
as well as a loaf of bread for breakfast with her husband. Then they both get ready for work.
She ate whatever she wanted for lunch, preferably meat, in a small eatery near her store,
and then bought fish or vegetable products to cook at home for their dinner. On weekends,
they both go to church and then have free time to go on road trips, go on dates, or do
whatever recreational activities they want for the weekend, such as planting, grafting, and
marcotting her bougainvilleas at home.
Mrs. CFB has received all of her childhood vaccines, the flu vaccine every year, and the
COVID19 booster shot. Aside from her menstrual irregularities and hypertension, which are
modifiable and can be treated with diet therapy and exercise, she has no underlying
diseases. Her family is also financially, socially, and spiritually stable, having married in their
30s and attending church on Sundays. According to her, she was not mentally and
emotionally stable during her pregnancy, particularly from the 10th week onwards, because
her father died from COVID19 and, due to restrictions and risks, she was unable to see her
father personally at his wake and interment because her parents live in Visayas.
It made her very stressed out and on the blues; sometimes she doesn't want to talk and
just sits on her bed crying, mourning the fact that she always misses a meal or her vitamin
schedule, causing her rapid weight loss from 65kg to 58kg.
Her husband earns an average of P42, 000.00 as a fire officer in their municipality and
as a jeep owner, while she earns P35, 000.00 as a grocery owner. Aside from their bills and
monthly allowance, their extra money is invested in health insurance and joint bank savings.
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CHAPTER II. BRIEF DESCRIPTION
Women are bearers of life. Nurturing human inside the womb for nine months is no small
feat, that is why when a woman and her significant others learns about her pregnancy, they
always go the extra mile just to make sure that the health and the safety of both the mother and
the baby are intact. We, as nurses, also have this primary responsibility to be informed about
the dangers to a pregnant woman so we could educate them and protect them too.
Miscarriage is the spontaneous loss of a pregnancy before the 20th week. About 10 to 20
percent of known pregnancies end in miscarriage. But the actual number is likely higher because
many miscarriages occur very early in pregnancy — before you might even know about a
pregnancy.
The term "miscarriage" might suggest that something went wrong in the carrying of the
pregnancy. But this is rarely true. Most miscarriages occur because the fetus isn't developing as
expected.
Miscarriage is a relatively common experience — but that doesn't make it any easier.
Take a step toward emotional healing by understanding what can cause a miscarriage, what
increases the risk and what medical care might be needed.
Symptoms
Signs and symptoms of a miscarriage might include:
 Vaginal spotting or bleeding
 Pain or cramping in your abdomen or lower back
 Fluid or tissue passing from your vagina
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Causes
 Problems with the genes or chromosomes
Most miscarriages occur because the fetus isn't developing as expected. About 50 percent
of miscarriages are associated with extra or missing chromosomes. Most often, chromosome
problems result from errors that occur by chance as the embryo divides and grows — not
problems inherited from the parents.
Chromosome problems might lead to:
 Blighted ovum. Blighted ovum occurs when no embryo forms.
 Intrauterine fetal demise. In this situation, an embryo forms but stops developing and dies
before any symptoms of pregnancy loss occur.
 Molar pregnancy and partial molar pregnancy. With a molar pregnancy, both sets of
chromosomes come from the father. A molar pregnancy is associated with abnormal growth
of the placenta; there is usually no fetal development.
A partial molar pregnancy occurs when the mother's chromosomes remain, but the father
provides two sets of chromosomes. A partial molar pregnancy is usually associated with
abnormalities of the placenta, and an abnormal fetus.
Molar and partial molar pregnancies are not viable pregnancies. Molar and partial molar
pregnancies can sometimes be associated with cancerous changes of the placenta.
 Maternal health conditions
In a few cases, a mother's health condition might lead to miscarriage. Examples include:
 Uncontrolled diabetes
 Infections
 Hormonal problems
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 Uterus or cervix problems
 Thyroid disease
What does NOT cause miscarriage?
Routine activities such as these don't provoke a miscarriage:
 Exercise, including high-intensity activities such as jogging and cycling.
 Sexual intercourse.
 Working, provided you're not exposed to harmful chemicals or radiation. Talk with your
doctor if you are concerned about work-related risks.
Risk factors
Various factors increase the risk of miscarriage, including:
 Age. Women older than age 35 have a higher risk of miscarriage than do younger women.
At age 35, you have about a 20 percent risk. At age 40, the risk is about 40 percent. And
at age 45, it's about 80 percent.
 Previous miscarriages. Women who have had two or more consecutive miscarriages are
at higher risk of miscarriage.
 Chronic conditions. Women who have a chronic condition, such as uncontrolled diabetes,
have a higher risk of miscarriage.
 Uterine or cervical problems. Certain uterine conditions or weak cervical tissues

(incompetent cervix) might increase the risk of miscarriage.
 Smoking, alcohol and illicit drugs. Women who smoke during pregnancy have a greater
risk of miscarriage than do nonsmokers. Heavy alcohol use and illicit drug use also increase
the risk of miscarriage.
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 Weight. Being underweight or being overweight has been linked with an increased risk of
miscarriage.
 Invasive prenatal tests. Some invasive prenatal genetic tests, such as chorionic villus
sampling and amniocentesis, carry a slight risk of miscarriage.
Complications
Some women who miscarry develop an infection in the uterus. This is also called a septic
miscarriage. Signs and symptoms of this infection include:
 Fever
 Chills
 Lower abdominal tenderness
 Foul-smelling vaginal discharge
Prevention
Often, there's nothing you can do to prevent a miscarriage. Simply focus on taking good care
of yourself and your baby:
 Seek regular prenatal care.
 Avoid known miscarriage risk factors — such as smoking, drinking alcohol and illicit drug
use.
 Take a daily multivitamin.
 Limit your caffeine intake. A recent study found that drinking more than two caffeinated
beverages a day appeared to be associated with a higher risk of miscarriage.
Your health care provider might do a variety of tests:
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 Pelvic exam. Your health care provider might check to see if your cervix has begun to
dilate.
 Ultrasound. During an ultrasound, your health care provider will check for a fetal heartbeat
and determine if the embryo is developing as it should be. If a diagnosis can't be made,
you might need to have another ultrasound in about a week.
 Blood tests. Your health care provider might check the level of the pregnancy hormone,
human chorionic gonadotropin (HCG), in your blood and compare it to previous
measurements. If the pattern of changes in your HCG level is abnormal, it could indicate a
problem. Your health care provider might check to see if you're anemic — which could
happen if you've experienced significant bleeding — and may also check your blood type.
 Tissue tests. If you have passed tissue, it can be sent to a lab to confirm that a miscarriage
has occurred — and that your symptoms aren't related to another cause.
 Chromosomal tests. If you've had two or more previous miscarriages, your health care
provider may order blood tests for both you and your partner to determine if your
chromosomes are a factor.
Inevitable miscarriage refers to the presence of an open internal os in the presence of bleeding
in the first trimester of pregnancy. Most often the conception products are not expelled and
intracervical contents are present at the time of examination. A sac may be seen low within the
uterus and progressive migration of the same may be demonstrated on serial scans.
Essentially, a threatened miscarriage progresses to an inevitable miscarriage if cervical

dilatation occurs. Once tissue has passed through the cervical os, this will then be termed
an incomplete miscarriage, and ultimately a complete miscarriage.
Inevitable abortion is an 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.
In medicine, the term abortion refers to the interruption of an early pregnancy due to any
source, either spontaneous or deliberate. Spontaneous abortions, also known as miscarriages,
occur in up to 15 percent of pregnancies. An inevitable abortion is a situation in which vaginal
bleeding, abdominal pain, cramps, and cervical dilation occur in a pregnant woman and
eventually lead to a miscarriage. Once the cervix dilates, it is unlikely that any medical
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intervention will prevent the loss of the pregnancy. The passage of large blood clots or tissue
through the vagina also indicates an inevitable abortion.
Many factors contribute to an inevitable abortion. In the first trimester of pregnancy, 90
percent of miscarriages stem from genetic or chromosomal abnormalities. Maternal diseases,
such as diabetes, hypertension, lupus, and infections also increase the probability of
miscarriage. Use of tobacco, alcohol, or other illicit drugs can hinder fetal growth and
development, leading to a spontaneous loss of the pregnancy. Finally, anatomic abnormalities
in the mother’s uterus, hormonal problems, and immunologic factors may account for more than
50 percent of miscarriages in the second trimester.
Evaluation for an inevitable abortion includes a pelvic examination during which the doctor
observes the cervix to assess the extent of dilation and thinning that has taken place. An
abdominal or vaginal ultrasound can determine whether the baby's development is appropriate
for his estimated age and whether he still has a heart beat. Additionally, the physician will
perform several blood tests, such as a complete blood count, a human chorionic gonadotropin
(HCG) level, and a white blood cell count to evaluate the amount of blood loss or infection
present and whether the pregnancy is still viable. A severe drop in the HCG levels indicates that
the body has stopped producing this hormone that is essential for maintenance of a pregnancy.
Once an inevitable abortion progresses to a complete miscarriage, the expelled material
can be examined to verify that the entire placenta has passed out of the mother's body. If part
of the fetus or placenta remains inside the uterus, the mother has an increased risk for excessive
bleeding or infection. A vacuum aspiration of the uterine contents, also called a dilation and
curettage (D&C), may be essential to prevent these complications. In addition, the chromosomal
makeup of the fetal tissue may be analyzed to determine whether a genetic defect caused the
miscarriage.
Pathophysiology
 The most common cause of an abortion is abnormal fetal development, which is either
due to a chromosomal aberration or a teratogenic factor.
 Another common cause is the abnormal implantation of the zygote, where there is
inadequate endometrial formation or the zygote was implanted on an inappropriate site.
 This would cause inadequate development of the placental circulation, leading to poor
nutrition of the fetus and eventually, to an abortion.
Risk Factors
There are always precipitating factors for every condition. Here are the risk factors that concerns
abortion:
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 Congenital Structural Defect. This structural defect may be due to chromosomal

aberration or a serious physical defect.
 Low Progesterone. Progesterone maintains the decidua basalis. If the corpus luteum
fails to produce enough progesterone, it would risk the life of the fetus inside the uterus.
 Rh Incompatibility. The fetus could get rejected from a mother’s body if they have an
incompatible Rh.
 Undernutrition. Lack of nutrients would cause undernourishment to both the mother and
the fetus, leading to abortion.
 Drugs. There are drugs which are contraindicated for pregnant women. Ingestion might
compromise the fetus and lead to abortion.
 Infection. In infection, the fetus would fail to grow and estrogen and progesterone
production would fall. This would lead to endometrial sloughing, then prostaglandins
would be released leading to uterine contractions and cervical dilatation along with
expulsion of the products of pregnancy.
Signs and Symptoms
As nurses, we are tasked with assessing our patient to provide baseline and accurate
information to other caregivers. The signs and symptoms of abortion must be identified first
before ruling out any other relative causes.
 Vaginal spotting. Vaginal spotting appears as small brownish to reddish spots

of blood coming out of the woman’s vaginal opening. This usually occurs when the cervix
slightly dilates because the woman may have tried to lift heavy objects or mild trauma to
the abdomen occurred.
 Vaginal bleeding. Bleeding is a serious occurrence during pregnancy because it might
indicate that the cervix has opened and products of conception might be expelled.
 Cramping/sharp/dull pain in the symphysis pubis. This could occur on both sides and
could be caused by trauma or premature contractions that might cause cervical dilation.
 Uterine contractions felt by the mother. Uterine contractions can be false or true, but
either of the two could be alarming during the early stages of pregnancy because it could
expel the contents of the uterus thereby leading to abortion.
Diagnostic Tests
 Pregnancy test. This is to confirm the pregnancy first if vaginal bleeding occurs. If test
turns out negative, then the woman would be subjected to other diagnostic tests that could
confirm the nature and cause of the vaginal bleeding. If it is positive, then abortion would
be considered and it would be classified according to the presenting signs and symptoms.
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 Ultrasound. The safest and confirmatory test for pregnancy, the ultrasound would be
able to confirm if the pregnancy is positive, and also confirm if the products of conception
are still intact.
Medical Management
Medical interventions should also be incorporated in the patient’s care plan to reinforce his
treatment. These are physician’s orders wherein nurses and other caregivers would assist or
take into action, thus ensuring the recovery of the patient.
 Aside from our own nursing management, physicians would also have to order a series
of therapeutic management for the pregnant woman.
 Administration of intravenous fluids. Such as Lactated Ringer’s, IV therapy should be
anticipated by the nurse as well as administration of oxygen regulated at 6-10L/minute by
a face mask to replace intravascular fluid loss and provide adequate fetal oxygenation.
 Avoid vaginal examinations. The physician would also avoid further vaginal
examinations to avoid disturbing the products of conception or triggering cervical
dilatation.
 The physician might also order an ultrasound examination to glean more information
about the fetal and also maternal well-being.
Our role as nurses in these medical interventions would be to assist in every aspect possible,
and ensure the wellbeing of both the mother and the fetus. Through our nursing interventions,
we could initiate care without needing to run after the physicians and ask for their orders. We
should be able to function independently as caregivers and promote their wellness in our own
way as nurses. The most vital pieces of information are always handed to us first, so it would be
up to us to initiate the first intervention to make or break the condition of the client before a doctor
arrives. Nurses are the first line of defense of every hospital, and we should live up to that
expectation.
Surgical Management
Aside from the medical interventions ordered by physician, incidences might occur which
would lead to a surgical operation.
 Dilatation and evacuation. This is to make sure that all products of conception would be
removed from the uterus. However, before undergoing this intervention, the physician
must be sure that no fetal heart sounds could be heard anymore and the ultrasound must
show an empty uterus.
 Dilation and curettage. This is most commonly performed for incomplete abortions to
remove the remainder of the products of conception from the uterus. Since the uterus
would not be able to contract effectively, the contents might be trapped inside and could
cause serious bleeding and infection.
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Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus.
Health care providers 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, your provider uses small instruments or a medication to open
(dilate) the lower, narrow part of your uterus (cervix). Your provider then uses a surgical
instrument called a curette, which can be a sharp instrument or suction device, to remove
uterine tissue.
Why it's done
Dilation and curettage is used to diagnose or treat a uterine condition.
To diagnose a condition
Before doing a D&C, your provider might recommend a procedure called endometrial biopsy or
endometrial sampling to diagnose a condition. Endometrial sampling might be done if:
 You have unusual uterine bleeding
 You have bleeding after menopause
 You have unusual endometrial cells, which are discovered during a routine test for cervical
cancer
To perform the test, your provider collects a tissue sample from the lining of your uterus
(endometrium) and sends the sample to a lab for testing. The test can check for:
 Endometrial intraepithelial hyperplasia — a precancerous condition in which the uterine

lining becomes too thick
 Uterine polyps
 Uterine cancer
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If more information is needed, your provider then might recommend a D&C, which is usually
done in an operating room.
To treat a condition
When performing a D&C to treat a condition, your provider removes the contents from inside
your uterus, not just a small tissue sample. This might be done to:
 Prevent infection or heavy bleeding by clearing tissues that remain in the uterus after a
miscarriage or abortion
 Remove a tumor that forms instead of a typical pregnancy (molar pregnancy)
 Treat excessive bleeding after delivery by clearing out any placenta that remains in the
uterus
 Remove cervical or uterine polyps, which are usually noncancerous (benign)
A D&C might be combined with another procedure called hysteroscopy. During hysteroscopy,
your provider inserts a slim instrument with a light and camera on the end into your vagina,
through your cervix and into your uterus.
Your provider then views the lining of your uterus on a screen, checking for areas that look
unusual. Your provider also checks for polyps and takes tissue samples as needed. During a
hysteroscopy, uterine polyps and fibroid tumors can be removed.
At times, a hysteroscopy might be done combined with an endometrial biopsy before a

full D&C procedure.
Risks
Complications from dilation and curettage are rare. However, there are risks, including:
 Perforation of the uterus. This occurs when a surgical instrument pokes a hole in the
uterus. This happens more often in women who were recently pregnant and in women who
have gone through menopause.
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Most perforations heal on their own. However, if a blood vessel or other organ is damaged,
a second procedure might be needed to repair it.
 Damage to the cervix. If the cervix is torn during the D&C, your provider can apply
pressure or medicine to stop the bleeding or can close the wound with stitches (sutures).
This might be prevented if the cervix is softened with medication before the D&C.
 Scar tissue on the uterine wall. Rarely, a D&C results in development of scar tissue in
the uterus, a condition known as Asherman's syndrome. Asherman's syndrome happens
most often when the D&C is done after a miscarriage or delivery.
This can lead to unusual, absent or painful menstrual cycles, future miscarriages and
infertility. It can often be treated with surgery.
 Infection. Infection after a D&C is rare.
Dilation and curettage can be done in a hospital, clinic or your provider's office, usually as an
outpatient procedure.
Before the procedure:
 Follow your provider's instructions on limiting food and drink.
 Arrange for someone to take you home because you may be drowsy after the anesthesia
wears off.
 Allow time for the procedure and a few hours of recovery afterward.
In some cases, your provider might start dilating your cervix a few hours or even a day before
the procedure. This helps your cervix open gradually and is usually done when your cervix needs
to be dilated more than in a standard D&C, such as during pregnancy terminations or with certain
types of hysteroscopy.
To promote dilation, your provider may use a medication called misoprostol (Cytotec) — given
orally or vaginally — to soften the cervix. Another dilation method is to insert a slender rod made
of laminaria into your cervix. The laminaria gradually expands by absorbing fluid in your cervix,
causing your cervix to open.
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During the procedure
Dilation and curettage (D&C)Open pop-up dialog box
For dilation and curettage, you'll receive anesthesia. The choice of anesthesia depends on the
reason for the D&C and your medical history.
 You lie on your back on an exam table while your heels rest in supports called stirrups.
 Your provider inserts an instrument called a speculum into your vagina, as during a Pap
test, to see your cervix.
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 Your provider inserts a series of increasingly thick rods into your cervix to slowly dilate it
until it's open enough.
 Your provider removes the dilation rods and inserts a spoon-shaped instrument with a
sharp edge or a suction device and removes uterine tissue.
Because you're either unconscious or sedated during a D&C, you shouldn't feel any discomfort.
After the procedure
You'll likely spend a few hours in a recovery room after the D&C so that you can be
monitored for heavy bleeding or other complications. This also gives you time to recover from
the effects of anesthesia.
Typical side effects of a D&C can last a few days and include:
 Mild cramping
 Spotting or light bleeding
For discomfort from cramping, your provider might suggest taking ibuprofen (Advil, Motrin IB,
others) or another medication.
You should be able to resume your activities within a day or two.
To prevent infection, don't put anything in your vagina until your provider says it's OK.
Ask when you can use tampons and resume sexual activity.
Your uterus must build a new lining after a D&C, so your next period might be early or
late. If you had a D&C because of a miscarriage, and you want to become pregnant, talk with
your provider about when it's safe to start trying again.
Nursing Management
Nurses must also have their own independent functions to ensure the safety and well-
being of the patient. The following are measures that would allow the nurse to act independently.
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Nursing Assessment
 The presenting symptom of an abortion is always vaginal spotting, and once this is noticed
by the pregnant woman, she should immediately notify her healthcare provider
 As nurses, we are always the first to receive the initial information so we should be aware
of the guidelines in assessing bleeding during pregnancy.
 Ask of the pregnant woman’s actions before the spotting or bleeding occurred and
identifies the measures she did when she first noticed the bleeding.
 Inquire of the duration and intensity of the bleeding or pain felt. Lastly, identify the client’s
blood type for cases of Rh incompatibility.
Nursing Interventions
 If bleeding is profuse, place the woman flat in bed on her side and monitor uterine
contractions and fetal heart rate through an external monitor.
 Also measure intake and output to establish renal function and assess the woman’s vital
signs to establish maternal response to blood loss.
 Measure the maternal blood loss by saving and weighing the used pads.
 Save any tissue found in the pads because this might be a part of the products of
conception.
Evaluation
 The aim for evaluation is inclined towards restoring the maternal blood volume and
stopping the source of the bleeding.
 The client’s blood pressure must be maintained above 100/60 mmHg.
 The pulse rate should be below 100 beats per minute and the fetal heart rate must be at
a normal level of 120-160 beats per minute.
 The client’s urine output should be more than 30 mL/hr, and only minimal bleeding should
be apparent for not more than 24 hours.
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5255 NCM 109 RLE
CHAPTER III. ANATOMY AND PHYSIOLOGY
The uterus, also known as the womb, is the hollow, pear-shaped organ in the female
pelvis in which fertilization of an ovary (egg), implantation of the resulting embryo, and
development of a baby take place. It is a muscular organ that both stretches exponentially to
accommodate a growing fetus and contracts in order to push a baby out during childbirth. The
lining of the uterus, the endometrium, is the source of the blood and tissue shed each month
during menstruation.
Anatomy
Three distinct layers of tissue comprise the uterus:
 Perimetrium: The outer layer of tissue made of epithelial cells

 Myometrium: The middle layer made of smooth muscle tissue
 Endometrium: The inner lining that builds up over the course of a month and is shed if
pregnancy does not occur
Shaped like an inverted pear, the uterus sits behind the bladder and in front of the rectum. It has
four main sections:
 Fundus: The broad curved area at the top and widest portion of the organ that connects
to the fallopian tubes
 Corpus: The main part of uterus that starts directly below the level of fallopian tubes and
continues downward, becoming increasingly narrower
 Isthmus: The lower narrow part of the uterus
 Cervix: The lowest two inches of the uterus. Tubular in shape, the cervix opens into the
vagina and dilates (widens) to allow
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5255 NCM 109 RLE
The uterus is supported in the pelvis by the diaphragm, the perineal body, and a collection
of ligaments, including the round ligaments.
Function
The uterus performs multiple important functions in the reproductive cycle, fertility, and
childbearing.
During a normal menstrual cycle, the endometrial lining of the uterus goes through a
process called vascularization during which tiny blood vessels proliferate, leaving the lining
thicker and rich with blood in the event the egg released during that cycle is fertilized. If this does
not happen, the uterus sheds the lining as a menstrual period.
If conception occurs, the fertilized egg (the embryo) burrows into the endometrium from
which the maternal portion of the placenta, the decidua basalis, will develop.1
As a pregnancy progresses, the uterus grows and the muscular walls become thinner,
like a balloon being blown up, to accommodate the developing fetus and the protective amniotic
fluid produced first by the mother and later by urine and lung secretions of the baby.
During pregnancy, the muscular layer of the uterus begins contracting on-and-off in
preparation for childbirth. These "practice" contractions, Braxton-Hicks contractions, resemble
menstrual cramps; some women don't even notice them. They are not the increasingly powerful
and regular contractions that are strong enough to squeeze the baby out of the uterus and into
the vagina.1
After a baby is born, the uterus continues to contract in order to expel the placenta. It will
continue to contract in the coming weeks to return the uterus to its normal size and to stop the
bleeding that occurs in the uterus during childbirth.
Associated Conditions
The uterus can be subject to any of a number of health issues. The most common uterine
conditions include:
Endometriosis
An estimated 11% of women are affected by endometriosis, a condition in which the tissue
of the endometrial lining grows outside of the uterus,causing symptoms that include painful
cramps, chronic lower back pain, and pain during or after sex. Less common symptoms of
endometriosis include spotting between periods, digestive problems, and infertility.4
Endometriosis typically is treated with extended-cycle hormonal birth control or

an intrauterine device (IUD), though some women respond to complementary and alternative
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5255 NCM 109 RLE
therapies such as acupuncture, chiropractic care, or supplements. The condition often goes
away after menopause.
Fibroids
Uterine fibroids are noncancerous tumors that grow in the muscular tissue of the uterus.
Fibroids often do not cause symptoms or require treatment.
For some women, however, uterine fibroids lead to heavy periods or pain, symptoms
typically treated with over-the-counter pain relievers containing ibuprofen or acetaminophen or
hormonal contraception.
In severe cases, surgery such as endometrial ablation, myomectomy, or
Uterine Polyps
Polyps are fingerlike growths that attach to the wall of the uterus. They can range in size
from as small as a sesame seed to larger than a golf ball. Many women have polyps without
knowing it. When symptoms do occur, they can include irregular periods, heavy
bleeding, breakthrough bleeding, and infertility.
Uterine polyps carry a small risk of cancer and should be removed with a procedure
known as hysteroscopy. Sometimes a dilation and curettage (D and C) is done to remove and
biopsy endometrial polyps.
Tipped Uterus
Some women have a retroverted or retroflexed uterus, which means it is in a tipped or

tilted position. This anatomical anomaly usually isn't detected unless a woman becomes
pregnant, and usually is not an issue.1
However, some women with a tilted uterus may have a higher risk of miscarriage or
experience a pregnancy complication known as uterine incarceration. If that happens,
a Caesarean delivery will be necessary.1
Uterine Cancer
There are two types of cancers that can affect the uterus: One, uterine sarcoma, is very
rare. The other, endometrial cancer, originates in the endometrial lining and is fairly common. It
typically occurs after menopause.
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5255 NCM 109 RLE
The primary symptom of endometrial cancer is abnormal vaginal bleeding, which may
start as a watery, blood-streaked flow that gradually contains more blood. Abnormal vaginal
bleeding is not a normal part of menopause and should be discussed with a gynecologist.7
Tests
Tests involving the uterus are used to screen for cancer, diagnose certain diseases and
conditions, aid in fertility treatments, and monitor the progress of a pregancy. They include:
 Pap smear: A test in which cervical cells are collected and analyzed in a lab to look for
precancerous and other changes
 Ultrasound: An imaging test that can be performed intravaginally (using a slender
transducer—a wand-like instrument inserted into the vagina) or externally with a
transducer applied to the abdomen. Ultrasound uses sound waves to produce images of
the uterus, Fallopian tubes, ovaries, and surrounding tissue. In pregnancy, external
ultrasound is used to check the baby’s progress.
 Pelvic X-rays: An imaging test that uses radiation to take pictures of the pelvis. X-rays
can be used to check the placement of the uterus and identify masses.
 Hysteroscopy: An interventional procedure in which a tube is inserted into the cervix to
see inside the uterus. Hysterectomy is often used to aid in the removal of fibroids.
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5255 NCM 109 RLE
The cervix is the lower portion (or the "neck") of the uterus. It is approximately 1 inch long
and 1 inch wide and opens into the vagina. The cervix functions as the entrance for sperm to
enter the uterus. During menstruation, the cervix opens slightly to allow menstrual blood to flow
out of the uterus.
Cervix Functions
Your cervix has several important functions, including:
 Producing cervical mucus during the most fertile phase of the menstrual cycle, which
helps sperm travel from the vagina into the uterus
 Opening during labor to allow the baby to pass through the birth canal
 Protecting the uterus from bacteria and other foreign objects 1
Here is how the cervix functions during specific phases of the menstrual cycle and pregnancy:
During Menstruation
During menstruation, the cervix opens a small amount to permit the passage of menstrual
blood out of the uterus and through the vagina.
During Conception
Conception occurs when sperm travel through the cervix to enter the uterus and ultimately
fertilize an egg. Around ovulation, the most fertile part of the menstrual cycle, your cervix
produces clear mucus, which helps the sperm reach the uterus.
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5255 NCM 109 RLE
During Pregnancy and Labor
During pregnancy, cervical mucus thickens to create a cervical "plug" that shields the
growing embryo from infection.
When a woman gets closer to going into labor, the cervical plug thins and is expelled. The
cervix softens and shortens (this is called effacement) and then dilates in preparation for birth.
As your due date nears, your healthcare provider will check the cervix for dilation to try to
gauge when you are likely to give birth.
During Menopause
During menopause, hormonal changes and aging change the nature of the cervical
mucus and vaginal discharge. As a result, some menopausal women experience vaginal
dryness.
Where Is the Cervix?
The cervix is located between the uterus and the vagina. It's possible to feel the cervix
with your finger; if you do so, you'll notice that it changes texture over the course of your cycle.
In order to actually see your cervix, you will need to use a mirror and a bright light, but it may still
be difficult to see based on the length of your vagina.
The narrow opening of the cervix is called the os. The cervical os allows menstrual
blood to flow out from the vagina during menstruation.
There are three parts of the cervix:
1. The lowest part, which can be seen from inside the vagina during a gynecological exam,
is called the ectocervix. The center of the ectocervix can open, creating a passage
between the uterus and vagina.
2. The highest part is the endocervix, also called the endocervical canal. It's the passage
between the ectocervix and the uterus.
3. The point in the middle where the endocervix and ectocervix meet is called the
transformation zone.
The cervix is covered by the epithelium, which is made of a thin layer of cells. Epithelial cells are
either squamous or columnar (also called glandular cells). Squamous cells are flat and scaly,
while columnar cells are, as their name suggests, column-like.
Conditions and Problems

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5255 NCM 109 RLE
The cervix is prone to certain conditions and diseases, including:
 Cervical cancer: Most cases of cervical cancer are caused by human

papillomavirus (HPV), a sexually transmitted infection (STI) that can lead to cervical
cancer. The Centers for Disease Control and Prevention suggest that all children be
vaccinated against HPV at ages 11 to 12, but some people can be vaccinated up to age
45.
 Cervicitis: Cervicitis occurs when the the cervix becomes inflamed, sometimes as the
result of a sexually transmitted infection such as chlamydia, gonorrhea, or herpes.
 Cervical dysplasia: This is the term for abnormal cells in the cervix that can develop into
cervical cancer. Cervical dysplasia may be discovered with a Pap test.
 Cervical polyps: These are small growths on the ectocervix. Polyps are painless and
usually harmless, but they can cause vaginal bleeding.
 Cervical insufficiency: Also called incompetent cervix, this occurs when the cervix is too
weak to maintain a pregnancy, potentially leading to a miscarriage.
In some cases, the cervix is surgically removed along with the uterus to treat cancer or certain
other conditions. This is called a total hysterectomy.
A surgical procedure removes the fetus from the uterus through the vagina. It’s typically done
using suction and a sharp, spoon-shaped tool (curet). Rarely, this can cause scarring of the
uterine wall (Asherman syndrome), which may make it difficult to get pregnant. Women who
have multiple surgical abortion procedures may also have more risk of trauma to the cervix.
There’s also a very small risk to your fertility and future pregnancies if you develop a womb
infection during the procedure that’s not treated promptly. The infection could spread to your
fallopian tubes and ovaries, known as pelvic inflammatory disease (PID).
PID can increase your risk of infertility or an ectopic pregnancy, where an egg implants itself
outside the womb. But most infections are treated before they reach this stage, and you’ll often
be given antibiotics before an abortion to reduce the risk of infection. Get medical advice as soon
as possible if you experience any signs of infection after an abortion, such as severe pain, high
fever or odorous vaginal discharge.
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CHAPTER IV. PATHOPHYSIOLOGY
NON-MODIFIABLE RISK MODIFIABLE RISK

FACTORS: FACTORS:
Maternal causes: Maternal Causes:
-Primi Gravida -Infections
-Malformation of the Uterus -Hormonal disorder
-Tumors of the Uterus -Anemia
-Cervical weakness -Disorders of genital tract
ETIOLOGY:
-Age: 35 y/o
-Unknown
-Frequent pregnancy Social & Environmental
-Hypertension causes:
-Related to Maternal, Fetal,
-Auto-immune diseases -Smoking
Paternal and Social Causes.
-Overweightness/ -Alcohol
Underweightness -Drugs
-Excessive Caffeine Intake
Paternal Causes: -Mental Stress
-Defective sperm -Teenage Pregnancy
-Age: 37 y/o -Unmet Needs
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5255 NCM 109 RLE
Fet
Fetal Causes:
-Chromosomal Abnormalities
-Mal-development
-Defective Implantation
Social Causes:
-Failed family planning
-Rape conception
Maternal Stress
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5255 NCM 109 RLE
Activation of Maternal HPA Axis
Cortisol
CRH Fetal stress (Uteroplacental insufficiency)
Prostaglandins Activation of Fetal HPA Axis
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5255 NCM 109 RLE
Abdominal Adrenal
Cervical change
Contractions
DHEAS
Abdominal pain Cervical dilation
Estrogen
Myometrial OTR, RG’s, MLCK, Calmodulin gap

junctions
Vaginal Bleeding Rupture of membranes
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5255 NCM 109 RLE
Passing of small tissues of pregnancy
Low HCG levels
Absent FHR and Fetal movement
Spontaneous Miscarriage
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5255 NCM 109 RLE
Complete Miscarriage Incomplete Miscarriage
Threatened
Missed Miscarriage
Miscarriage
A A A
c c c
Inevitable
t t Recurrent
t
Miscarriage Septic Miscarriage
i i Miscarriage
i
v v v
a a a
t t t
Ai i i
co o o
tn n n
ImminentioAbortion o
o
vf f f
aM M M 33
ta a a
it t t
oe e e
5255 NCM 109 RLE
Dilation & Curettage
Maternal Risks
Perforation of the Damage to the Scar Tissue on the

Infection
Uterus Cervix uterine wall
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5255 NCM 109 RLE
Tears/cuts in the Asherman’s

Increase cramping cervix Severe cramping
Syndrome
Lower Abdominal Unusual/Absent/Pain Heavy bleeding

Stitches
Pain ful Menstruation
Heavy Vaginal Future miscarriages Fever

bleeding
Fever Antibiotic therapy

Infertility
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Lethargy
5255 NCM 109 RLE
CHAPTER V. LABORATORY RESULTS AND DIAGNOSTIC STUDIES
Pregnancy ultrasound: Creating an image of the developing fetus within the uterus by means
of measuring the vibrations returned when a device emits high-frequency sound waves.
Ultrasound imaging has been done during pregnancy for over three decades. It has proven to
be a very useful, safe, and very effective diagnostic procedure. Ultrasound may be performed
in early pregnancy to:
 establish whether a normal pregnancy is present

 confirm gestational age
 identify cases of multiple gestation
 determine fetal heartbeat
 Later on in pregnancy, ultrasound can be used to look for any developmental or other
problems in the fetus, to measure the size, growth, and position of the fetus, to
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5255 NCM 109 RLE
determine the gender of the fetus, and to check for abnormalities of the placenta,
uterus, or amniotic fluid.
PrROCEDURE: During an ultrasound, you lie down on an examination table or bed. An

ultrasound technician applies a special gel to your abdomen and pelvic area. The gel is water-
based, so it shouldn’t leave marks on your clothes or skin. The gel helps the sound waves travel
properly. Next, the technician places a small wand, called a transducer, onto your belly. They
move the transducer to capture black and white images onto the ultrasound screen. The
technician may also take measurements of the image on the screen. They may ask you to move
or hold your breath while they capture images. The technician then checks to see if the
necessary images were captured and if they are clear. Then, the technician wipes off the gel
and you can empty your bladder.
RESULT INDICATION NORMAL INTERPRETATION
VALUES
Fetal heart tone Absent fetal Intrauterine 120-160bpm IUD and
(FHT) heartbeat. death (IUD) Miscarriage is
Absent fetal Incomplete caused by fetal and
movement. Miscarriage. maternal causes.
Mrs. CFB’s IUD
was caused by fetal
mal-development
and maternal
factors such as
hypertension, age
vulnerability
(35y/o), and
emotional stress
experienced
throughout the
pregnancy.
Beta-hCG (β-hCG) is a test that measures the amount of human chorionic gonadotropin
(hCG) in the blood. This hormone is produced as soon as 10 days post-conception and an
above-normal level can confirm pregnancy.
The beta-hCG test may be done to confirm pregnancy at an early prenatal doctor's visit (as a
follow-up to a positive at-home or in-office urine test). But the beta hCG is not always done or
necessary in routine pregnancies.
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5255 NCM 109 RLE
 Determining the age of a fetus: A beta-hCG test cannot always pinpoint the precise
gestational age. However, your results—considered alongside the date of your last
period—can give your doctor a general idea, as expected hCG ranges change with
each passing week in the first trimester.
 Fetal screening: A beta hCG is one part of both the maternal serum triple and
quadruple screening tests done between 15 and 20 weeks' gestation to assess for
markers of certain fetal health problems, including Down syndrome.
PROCEDURE: Specimen type: Serum (Blood Sample) How is the specimen collected:
Venipuncture collection of blood from a vein in the arm.
RESULT INDICATION NORMAL INTERPRETATION
VALUES
hCG level and 5,000mIU / mL Low hcG level 16 weeks – If hCG levels are
range for 16 weeks 8,904 to 55, low, a possible
AOG 332 mIU / mL miscarriage,
miscalculated
gestational age and
ectopic pregnancy
might happen.
Mrs. CFB is in the
onset of an
incomplete
miscarriage that
was resolved with
imminent abortion.
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CHAPTER VI. PHYSICAL ASSESSMENT AND ITS PHYSIOLOGICAL BASIS

DAY/TIME OF ASSESSMENT
Date: March 10, 2022

Time: 9:30 pm
P-PSYCHOSOCIAL
ASSESSMENT/FINDINGS PHYSIOLOGICAL BASIS
Type of Family Nuclear Family Nuclear families, also known
Mrs. CFB is living together as elementary or traditional
with her husband in one roof families, consist of two
and was expecting to have parents (usually married or
their offspring soon before the common law) and their
miscarriage happen and children. Nuclear families
became a childless family may have one or more
again. children who are biological or
adopted, but the main idea is
that the parents are raising
their kids together in the
family home.
Significant Others Mr. KB, her husband. Significant others are
individuals representing
family members or neighbors,
friends, colleagues or
members of the same
household, who act as
relatives or surrogates.
Significant others play an
important role when patients
are admitted, transferred or
discharged after
hospitalization for physical,
mental, emotional and
spiritual support. And in case
the patient isn’t stable to
make a medical decision, the
significant other will be the
one to decide.
Coping Mechanism Problem-focused coping Coping mechanisms can thus
mechanism be defined as emotions,
Mrs. CFB prays together with thoughts, and behaviour
her husband and talks to him that assist to reduce the
with lots of crying and psychological stress
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5255 NCM 109 RLE
expression of guilt but her

undergone by individuals and
spouse never failed to make
promote mental wellbeing,
her see the bright side of their
which allows individuals to
situation. adjust to the complexities of
life.
Coping mechanism
contributes towards reducing
this stress and tension
through different coping
strategies. Stress can be both
positive and negative. It is
usually a response to change.
Coping mechanisms help
people to adjust to such
situations without risking the
well-being of the individual.
Religion Born Again Christian Born again Christian beliefs
are based on accepting Jesus
Christ in your life as Savior.
This is often called the
“Gospel.” It is the basic
understanding of God’s gift of
salvation. Now there was a
Pharisee, a man named
Nicodemus who was a
member of the Jewish ruling
council. Faith and belief to the
Almighty will help her to
understand that everything
has its purpose.
Primary Language Ilocano Ilocano (also Ilokano;
/iːloʊˈkɑːnoʊ/; Ilocano:
Pagsasao nga Ilokano) is an
Austronesian language
spoken in the Philippines,
primarily by Ilocano people
and as a lingua franca by the
Igorot people. It is the third
most-spoken native language
in the country.
Primary Source of Health Fernando’s Women Clinic, Personalized care by your
Care Dr. ADF, OB-Gynecologist’s private obstetrician can also
private clinic. ensure your desires for pain
relief are met. For example,
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5255 NCM 109 RLE
women who are terrified of

pain may be organised an
epidural in place before
contractions start, which may
be more difficult to organise
in a public system.
A woman, with a private

obstetrician, may have a
choice of an elective
caesarean section if she
wishes, without a medical
indication. Whilst there is a
controversy whether this is
an advantage, there are
women who prefer to plan
their delivery day, and their
life around it. Some are
simply terrified of birth and its
associated complications and
prefer to opt for a C-section.
And for cases of abortion, a
personal and private OB is
important because she
knows your progress of
pregnancy since your 1st
prenatal visit. In the public
sector this birth option is only
available to high-risk
obstetric patients.
Financial Resources Related The client and her spouse In times of medical
to Illness both have updated Philhealth, emergencies and necessities,
hers is voluntary and her it is important to have an extra
husband is government paid. money and a health
Also both of them have insurance to cover a portions
allotted an allowance for of hospital bills and
medical emergencies from medicines.
their earnings and salary.
Occupation/ Educational Mrs. CFB is a BSBA graduate Education and occupation is a
Attainment majoring in marketing and significant part of
now has her own grocery communication and learning
store near the public market. between healthcare workers
Mr. KB, her spouse is a BFP and patients to determine the
officer and a jeepney owner level of understanding and
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5255 NCM 109 RLE
that is used as a PUV routing cooperation during the

from Carranglan to San Jose necessary procedure.
every weekdays and
Saturdays.
General Appearance Hair and eyes are black. Medical hypotheses are
5’5” ft., 58kg with NORMAL generated by data obtained
BMI of 22.5. from the patient's general
Normal posture and gait. appearance. The possibilities
Well-groomed, appropriately will require confirmation by
clothed with proper hygiene. more detailed history (has
Healthy mental status based there been fever, chills,
on behavior. weight loss, night sweats),
physical examination (is there
an aortic regurgitant murmur,
splenomegaly or podagra),
and laboratory data (blood
cultures, complete blood
count, peripheral smear, uric
acid). But we have used the
patient's general appearance
to begin the scientific process
that will eventually lead to
accurate diagnosis.
Affect Broad Affect A normal range of emotions
Mrs. CFB shows positivity, and expressions is known as
acceptance of her the broad affect. However,
preagnancy’s fate, calmness what is considered a normal
and readiness to the D&C range of affect may differ from
procedure. one culture to the other, from
one household to the other,
and from one situation to the
other.
Orientation Well Oriented. Orientation is the
She is aware of what shes determination of the relative
doing, saying, what’s position of something or
happening around her and someone (especially
what is about to oneself). Health teaching is a
happen.(D&C) great factor in patient’s
learning and orientation
before a medical surgery.
To assessed client’s memory
Memory and brain status. Asking the
client of immediate, recent
and remote response to
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5255 NCM 109 RLE
-Immediate -Able to state what is D&C questions will help the nurse
according to what the doctor determine the status of
explained to her. client’s mind health.
-Able to remember the color,

-Recent number of pads used, and
appearance of tissues passed
through her vagina before
they’ve gone to the hospital.
-Remote -Able to remember her

parents’ birthday and
wedding anniversary.
Speech Clear, moderately sound, and Speech characteristics is a
organized. factor to diagnose client’s
She speak and communicate desires, point of view and
clearly and with good maybe an impending illness.
manners, right usage of
words and can understand
easily what the doctor and
nurse is saying.
Non-Verbal Behaviors The client and her spouse act Non-verbal behaviors can
accordingly and well- support client’s genuine
behaved. There are no signs feelings and words through
of aggressions despite in pain gestures, signs, and facial
physically and emotionally. expressions that is a
significant factor for health
care workers to understand
and communicate effectively
to the client.

Time: 7:00 am
E-ELIMINATION
ASSESMENT/FINDINGS PHYSIOLOGICAL BASIS
STOOL No stool passed yet. Normally, after D&C
procedure, there will be
constipation or few to none
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5255 NCM 109 RLE
stool passing for 3-4 days

then a loose and watery stool
will follow.
URINE Oliguria and Cystitis related to Oliguria is normal reaction
surgical abortion. after a delivery or an abortion
due to the effects of local
anesthesia and bladder
inflammation such as when
feeling the urge to urinate but
cannot immediately urinate
can be treated with antibiotics
prescribed after a D&C
procedure.
ABDOMEN Abdomen is fair, slightly hard, With the use of IaPerPal
symmetric, and non-tender method of assessing the
without distention. There are abdomen, the client’s
no visible lesions or scars. elimination process in her
The aorta is midline without state of post-operation, is
bruit or visible pulsation. proven normal for post-
abortion patients.
TOILETING ABILITY Can defecate without There is no noted discomfort
assistance with a knowledge in bowel movement except for
on what is proper to eat and constipation but is
ways of easy-defecation. manageable with proper care,
she also can go alone to the
bathroom even after the
procedure.

Time: 7:00 am
R-REST AND ACTIVITY
ASESSMENT/FINDINGS PHYSIOLOGICAL BASIS
Current Activity Level The client has a bit limited Physical activity routines, can
movements in her post- be back within 2-3 days post-
abortion state but can do easy operative. Movements right
movements like hand after D&C is limited due to the
movements and walking effects of anesthesia and pain
slowly. in the perineum area.
ADL’S Can walk slowly to the CR Activity routines after D&C
without assistance, can eat procedure can almost
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5255 NCM 109 RLE
alone, and can do basic immediately be back to

movements. normal.
Sleep 6hrs. of sleep after Local anesthesia is used
administration of local during surgeries in a hospital
anesthesia. or surgical center
setting. Medication is given
both as an inhaled gas and
through an IV (into the vein)
before and during surgery.
When you're "put to sleep" in

this way, you actually enter a
state of consciousness that's
much deeper than normal
sleep. You become
completely unaware of your
surroundings and don't feel
pain.
The muscles of your body

are temporarily paralyzed by
the medication so that you
stay perfectly still during your
procedure.
Since the muscles you use to

breathe are included in this,
a breathing tube is inserted
into your throat and hooked
up to a machine that will
breathe for you (ventilator)
while you are under
anesthesia.
Body Frame Ectomorph Because of the client’s stress

after her father’s demise, she
lose so much weight causing
her to look tall and slim.
Posture A basic analysis of a patient's
gait and posture provides
information about the body
and the capability of the
musculoskeletal system to
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5255 NCM 109 RLE
adjust to physical stressors.

An understanding of normal
gait and posture is essential
for identifying and treating
musculoskeletal pain.
Gait A basic analysis of a patient's
gait and posture provides
information about the body
and the capability of the
musculoskeletal system to
adjust to physical stressors.
An understanding of normal
gait and posture is essential
for identifying and treating
musculoskeletal pain.
As she is still in her fifth
Coordination Proper and normal month, she can still do proper
Coordination. coordination in action on her
body.
-Can do finger to nose, to the
-Upper Extremities nursing finger, and alternating
pronation-supination of the
hands on the knees.
-Lower Extremities
-Can do heel down opposite
shin and toe or ball of the foot
to the nurse’s finger.
Balance Properly aligned There is an even distribution
of weight enabling the client
to remain upright and steady
in doing basic movements
such as walking.
Muscle Strength Range of motion after D&C
Limited range of motion procedure goes back almost
against gravity and against immediately when the local
full resistance. anesthesia wears off its
Muscle Tone effect.
Motor Function Excellent
Fine -She can do and use a fork She can do fine motor skills
with precision. with a high degree of control
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5255 NCM 109 RLE
and precision in the small

muscles of the hand and
other parts of the body.
-She can walk slowly and She can use the large
have a low hop. muscles in her body to allow
Gross
for balance, coordination,
reaction time, and physical
strength so that we can do
bigger movements.
Range of Motion Passive Relaxed Range of The client shows no

Motion hypermobility in the range of
motion as the anesthesia is
still slowly wearing off and
she can only do limited
movements during the time of
assessment.
First off, if you have a
Pain Relief Measure miscarriage, your body is
under high stress. A uterine
-Non pharmacologic -Uterine Massage massage may effectively
alleviate this stress and help
you recover.
As such, a uterine massage
can help you improve your
physical wellness and help
your body get ready for a
successful conception in the
future. A uterine massage
helps relieve the stiff muscles
and reduce your physical
pain.
It can help your body expel
any old materials left behind
and get you back to your
normal menstrual cycle. With
a miscarriage, the
abdominals, back, and hips
can be affected. A uterine
massage can reduce the
47
5255 NCM 109 RLE
tension and pain here.

Additionally, it helps boost
oxygen and blood flow to
these tissues, allowing your
body to remove toxins better
and nourish those muscles.
This will help improve their
function. Additionally, having
a uterine massage after a
miscarriage can release
endorphins which will
naturally help your pain. Your
lymph flow will also increase
to bolster your immunity.
800mg Ibuprofen Ibuprofen is a medication in

-Pharmacologic the nonsteroidal anti-
inflammatory drug class that
is used for treating pain,
fever, and inflammation. This
includes painful menstrual
periods, migraines, and
rheumatoid arthritis. It may
also be used to close a
patent ductus arteriosus in a
premature baby or in a
therapeutic abortion.
The client can walk and take At her age, Mrs. CB doesn’t
Mobility / Use of assistive an action freely will full need assistive device as she
device (crutches and cane) coordination and balance. No is still in middle-aged adult
recorded use of assistive and still so fit and strong.
device.
48
5255 NCM 109 RLE

Time: 8:30 pm
S-SAFETY
FINDINGS/ASSESSMENT PHYSIOLOGICAL BASIS
Allergies No known allergies to food, Allergies to medicine
medicine or any substances. ingredients, if there is any
might be contraindicated and
might have cause greater
risks and illness. Patients who
are allergic to or sensitive to
medications, iodine, or latex
should notify their doctor.
Eyes/Vision-PERRLA Normal pupillomotor function. The pupil dilates to dark and
constrict to light or
accommodation.
Hearing/Hearing Aid Not using any hearing aids. Client’s ears are functioning
Techniques properly.
Skin Integrity Not assessed.
Mucous Membrane Mucuos tissues such as The mucus plug is a "cork"
slippery, pinkish-white along barrier that seals your
with the liver-like blood clots cervix, the opening to your
spontaneously passing uterus, during pregnancy.
through the vagina. Along with your amniotic sac,
it helps protect your baby
from the outside world while
you're pregnant until you’re
ready to deliver.
Temperature 38.2ºC –Mild feverish A body temperature
above 102F (38.90C) for an
extended period of time could
become problematic. A
temperature above 103F
(39.50C) during early weeks
of pregnancy (usually the first
trimester) may be responsible
for a miscarriage, spinal cord
or mental defects in the baby.
Lab Analysis
FHT IUD and Miscarriage is

caused by fetal and maternal
49
5255 NCM 109 RLE
Absent fetal heart tone and no causes. Mrs. CFB’s IUD was
visible fetal movement caused by fetal mal-
indicating IUD. development and maternal
factors such as hypertension,
age vulnerability (35y/o), and
emotional stress experienced
throughout the pregnancy.
hCG If hCG levels are low, a

possible miscarriage,
5,000Miu/ml, low hCG level at miscalculated gestational
16 weeks AOG age and ectopic pregnancy
might happen.
Mrs. CFB is in the onset of an
incomplete miscarriage that
was resolved with imminent
abortion.
50
5255 NCM 109 RLE

Time: 7:30 am
O-OXYGENATION
Activity Intolerance No activity intolerance but D&C procedure needs rest
advised by the doctor to avoid after for fast recovery and
strenuous activities and healing of the uterus and
heavy weight lifting for 2 days. anesthesia affects the activity
tolerance of a patient after a
surgical procedure.
Airway Clearance No airway clearance
technique done during the
time of assessment.
Respiration 18 bpm indicating normal
respiratory rate.
Respiratory complications
are a major cause of
morbidity and impaired
recovery in the PACU, as
respiratory function is already
affected by local anesthesia.
Thus, impaired oxygenation
and a reduction of up to 50%
in functional residual capacity
when compared with pre-
anesthesia values were
reported. Your respiratory
rate is an important vital sign.
It can potentially indicate a
more serious condition, such
as cardiac arrest.If your
respiratory rate is below
average, it could indicate
central nervous system
51
5255 NCM 109 RLE
dysfunction. If your
respiratory rate is above
average, it could indicate
another underlying condition.
Some variation in respiratory
rate occurs naturally as we
age. As we get older, we
become more prone to
diseases and health
conditions. Some organs are
closely linked to your
respiratory health and can
change your respiratory rate.
Most females are able to go

Color back home after a few hours
of undergoing a D&C and can
-skin Fair brownish resume their daily activities
within a day or two after the
procedure. There can be mild
cramping or / along with light
bleeding after the procedure.
One sign of pregnancy is the

Chadwick’s sign which is the
-urine Turbid changes in color of the
vagina.
-stool
No stool passed yet.
52
5255 NCM 109 RLE
-vaginal discharge Reddish discharge
-Vagina - Vaginal color may vary,

normally it’s pinkish but
during the early pregnancy,
the hue may shift to blue or
purple but after miscarriage it
is reddish in color due to the
extraction done through the
vagina.
Capillary Refill 1 seconds – Normal CR Upon pinching on the nail of
the client the pinkish color
return immediately.
Pulse Oximetry spO2 = 95% Using pulse oximeter, the
client’s oxygen saturation is
measured, normal.
Peripheral Pulse 82 bpm Normal pulse
Apical Pulse 82 bpm Normal pulse
Blood Pressure 110/85 mmHg BP is in normal range.
EDEMA The client states that her
There is no assessed edema. walking and minimal
1+ exercising helps a lot in not
having a swelling.
Homan’s Sign Negative Homan’s sign There is no calf pain at
dorsiflexion of the foot.
Laboratory Analyses Absent FHT and fetal IUD and Miscarriage is
movement during UTZ. caused by fetal and maternal
5000mIU/ml, low hCG level causes. Mrs. CFB’s IUD was
53
5255 NCM 109 RLE
caused by fetal mal-

development and maternal
factors such as hypertension,
age vulnerability (35y/o), and
emotional stress experienced
throughout the pregnancy.
If hCG levels are low, a

possible miscarriage,
miscalculated gestational
age and ectopic pregnancy
might happen.
Mrs. CFB is in the onset of an
incomplete miscarriage that
was resolved with imminent
abortion.
O2 Therapy Not applicable, disconnected Client’s oxygen is well
after an hour post-operation. saturated and free from
respiratory diseases.
54
5255 NCM 109 RLE

Time: 9:00 pm
N-NUTRITION
Hospital or Diet Restriction 5hours NPO PT D&C A patient is placed on NPO
status before surgery to
prepare the gastrointestinal
tract. Your stomach and
esophagus (food tube)
relaxes when anesthesia is
administered which makes it
possible for food to move up
into your mouth from where a
patient may aspirate it down
their trachea (wind pipe) into
their lungs. Such aspirate is
usually very acidic (pH
around 1-3) and can cause
severe damage to the lungs
requiring artificial ventilation
and hospitalization. By
placing a patient on NPO
status, there will be nothing to
aspirate because any food
would have been absorbed
into the small intestines by
that time of surgery 6-8 hrs
later.
Fluid Intake 2L/day
8-12 glasses of water a day
may frequent the bathroom
trips and urine color will
become pale or colorless.
Another advantage of
adequate fluid is to reduced
temperature, alleviates
respiration rate and helps in
fighting UTI.
Intravenous Fluid D5LRS 1000mL Hypertonic solutions are
those that have an effective
osmolarity greater than the
55
5255 NCM 109 RLE
body fluids. This pulls the

fluid into the vascular by
osmosis resulting in an
increase vascular volume. It
raises intravascular osmotic
pressure and provides fluid,
electrolytes and calories for
energy.
To provide client adequate
nutritional support during
NPO and post-abortion.
Height and Weight 5’5” 58kg. Normal BMI and somatotype.

Tissue Turgor The OB grasps the skin on
Normal Skin Turgor her lower arm between two
The client is well hydrated. fingers for a few seconds then
released and it snaps rapidly
back to its normal position.
Ability The client can chew, swallow, The client has a normal eating
tolerate food and can feed ability. After D&C the client
herself. may have restricted activity
but can resume in maximum
ability 1-2 days after
procedure.
Lab Analysis Not applicable
Blood Glucose Monitoring Not applicable
56
5255 NCM 109 RLE
CHAPTER VII. DRUG ANALYSIS
1. D5LR’s 1000L Solution
Medication Action Indication Contraindication Side Effects Adverse Nursing

Effects Consideration
 Hypertonic  Treatment  Hypersensitivity Lactated  Do not
Brand Name:  itching,
solutions are for persons to any of the Ringers in administer
those that needing components.  hives, 5% unless solution
Lactated have an extra -Electrolytes Dextrose is clear and
effective calories -Sodium  swelling of may cause container is
Ringer's in 5%
Dextrose osmolarity who cannot -Potassium the face, serious undamaged.
greater than tolerate -Calcium side effects  Caution must
the body fluid -Chloride  puffy eyes, including: be exercised in
Generic Name:
fluids. This overload. -Lactate  coughing, swelling of the
lactated ringer's pulls the fluid  Treatment -Osmolality the face, administration
into the of shock.  sneezing, arms, of parenteral
and 5% dextrose
injection
vascular by  sore hands, fluids,
osmosis lower legs, especially
resulting in throat, or fee. those
Classification:
an increase  difficulty containing
vascular sodium ions to
IV fuids volume. It breathing, patients
raises  fever, and receiving
Doctor’s Order: intravascular corticosteroids
osmotic  injection or
pressure and site corticotrophin.
provides
57
5255 NCM 109 RLE
fluid,  Solution
1 x 1000Ml reactions
electrolytes containing
D5LRS upon and calories (infection, acetate should
admission for energy. be used with
swelling, caution as
Date Ordered: redness). excess
administration
March 10, 2022 may result in
9:00pm metabolic
alkalosis.
 Solution
Date
containing
Discontinued:
dextrose
March 11, 2022 should be used
7:00am with caution in
patients with
known
subclinical or
overt diabetes
mellitus.
 Discard
unused
portion.
 In very low
birth weight
infants,
excessive or
rapid
administration
of dextrose
58
5255 NCM 109 RLE
injection may
result in
increased
serum
osmolality and
possible
intracerebral
hemorrhage.
 Properly label
the IV Fluid
 Observe
aseptic
technique
when changing
IV fluid
59
5255 NCM 109 RLE
2. Local Anesthesia
Medicatio Action Indicat Contraindication Side Effects Adverse Effects Nursing Consideration
n ion
Lidocaine is used to
Brand  Hypersensitivity to  Low blood  Cardiac arrest  Constant monitoring
used to relieve numb
Name: nerve pain an area lidocaine or pressure (hypo  Abnormal with an EKG
after shingles (i of your
nfection with body to amide-type tension) heartbeat is essential to the
Lidopen
the herpes help local anesthetic  Swelling  Methemoglobin proper administration
Generic zoster virus). reduce
This type of pain pain or  Adams-Stokes (edema) emia of lidocaine IV;
Name:
is called post- discomf syndrome,  Redness at  Seizures discontinue
Lidocaine herpetic neuralg ort
ia. Lidocaine caused SA/AV/intraventric the injection  Severe allergic immediately with signs
Classifica helps to reduce by ular heart block in site reactions of excessive
tion: sharp/burning/a invasiv
ching pain as e the absence of  Small red or (anaphylaxis) depression of cardiac
Anesthetic
well as medical an artificial purple spots  Malignant hype conductivity (e.g., PR
discomfort proced
caused by skin ures pacemaker on the skin rthermia interval prolongation,
Doctor’s
areas that are such as  CHF,  Skin irritation QRS interval
Order: overly sensitive surgery
to touch. , needle cardiogenic shock  Constipation widening, arrhythmia e
1 x Lidocaine punctur , 2nd and 3rd-  Nausea xacerbation)
100mg/10 belongs to a es, or
0mL of class of drugs insertio degree heart  Vomiting  Lidocaine effects
Lidocaine known as local n of a block (if  Confusion increased by beta-
admitted anesthetics. It cathete
works by r or no pacemaker is  Dizziness
through
60
5255 NCM 109 RLE
site causing a breathi

present), Wolff-  Headache blockers
injection at temporary loss ng
1:00am. of feeling in the tube. Parkinson-White  Numbness and cimetidine
area where you
apply the patch. Syndrome and tingling  Not recommended
Date
Ordered:  Drowsiness as prophylaxis in acute
 Tremor myocardial
March 10,
 Irritation infarction (MI)
2022
1:00am symptoms (controversial)
Date (topical  Liver disease,
Discontin
ued: products); i.e., CHF, bradycardia,
March 10, redness, Wolff-Parkinson-White
2022
2:30 am swelling syndrome,
marked hypoxia,
severe respiratory
depression, hypovolem
ia, incomplete heart
block
 Good for automatic
and re-entrant
61
5255 NCM 109 RLE
arrhythmias, not
PSVTs
62
5255 NCM 109 RLE
3. Misoprostol Cytotec
Medicati Action Indication Contraindication Side Effects Adverse Effects Nursing
on Consideration
Misoprostol is  diarrhea /  teratogenesis  Nurses
Brand Cytotec reduces Cytotec is contraindicated duri Early / 14.0- / Delayed / need to
Name: stomach acid and used to ng pregnancy for 40.0 Incidence not understa
helps protect the prevent use to reduce the chills / Rapid / known nd the
stomach from stomach ulcers
Cytotec risk of stomach 30.0-40.0  uterine physiolo
damage that can during ulcers associated gy of
rupture / Early
Generic be caused by treatment with with NSAIDs (the  shivering / / Incidence prostagl
taking a aspirin or an FDA-approved andins
Name: Rapid / 30.0- not known
nonsteroidal anti- NSAID. indication). This 40.0  cervical and
inflammatory drug agent causes manage
Misopros (NSAID) such abdominal laceration /
tol reproductive risk, pain / Early / Early / ment of
as aspirin, ibuprofe including uterine misopros
7.0-20.0 Incidence not
n (Advil, Motrin), na contractions, tol in
Classific proxen (Aleve), cel known
ation:
miscarriage, and  nausea / Early  fetal death / iabor.
ecoxib, diclofenac, i other problems if / 3.2-3.2 Delayed /  Nurses
ndomethacin, melo administered during vomiting / Incidence not often
Miscella xicam, and others. pregnancy. Early / 3.2-3.2 known must
neous GI Misoprostol is  myocardial assess
agents contraindicated in  flatulence / infarction / the
patients with a Early / 2.9-2.9 Delayed / safety of
Doctor’s history of allergy to headache / Incidence not mother
Order: misoprostol or with Early / 2.4-2.4 known and fetus
previous  pulmonary during a
200 mcg prostaglandin  dyspepsia / embolism / misopros
Cytotec hypersensitivity. Early / 2.0-2.0 Delayed / tol
sublingu breakthrough induction
63
5255 NCM 109 RLE
al route bleeding / Incidence not without a

DIQ. Delayed / 0.7- known protocol
0.7  stroke / Early / based on
Date Incidence not research
Ordered  menstrual known findings.
: March irregularity /  anaphylactoid
Delayed / 0.3- reactions /
10, 2022 0.3 Rapid /
9:30pm Incidence not
 dysmenorrhea known
/ Delayed /  thrombosis /
Date 0.1-0.1 Delayed /
Disconti Incidence not
nued:  vertigo / Early / known
Incidence not
March known
11, 2022
9:30am  lethargy / Early
/ Incidence not
known
 infection /
Delayed /
Incidence not
known
 weakness /
Early /
Incidence not
64
5255 NCM 109 RLE
known
 syncope /
Early /
Incidence not
known
 agitation /
Early /
Incidence not
known
 leukocytosis /
Delayed /
Incidence not
known
 fever / Early /
Incidence not
known
 pelvic pain /
Delayed /
Incidence not
known
 diaphoresis /
Early /
Incidence not
65
5255 NCM 109 RLE
known
 rash / Early /
Incidence not
known
66
5255 NCM 109 RLE
4. Doxycycline
Medication Action Indication Contraindication Side Effects Adverse Effects Nursing
Consideration
It works to treat Doxycycline is Antibiotics such  nausea  headache Report sudden
Brand Name: infections by used to treat as doxycycline onset of painful
preventing the infections will not work for  vomiting  blurred vision, or difficult
Doryx growth and caused by colds, flu, or other seeing swallowing
spread of bacteria, viral infections.  diarrhea promptly to
double, or
Generic Name: bacteria. It works including Using antibiotics loss of vision physician.
to treat acne by pneumonia and when they are not  loss of Doxycycline
Doxycycline killing the other respiratory needed increases appetite  rash that may (capsule and
bacteria that tract infections; your risk of occur with tablet forms) is
Classification: infects pores and certain infections getting an  itching of the associated with a
rectum or fever or
decreasing a of the skin or infection later that comparatively
vagina swollen
tetracycline certain natural eye; infections of resists antibiotic high incidence of
oily substance the lymphatic, treatment. glands esophagitis,
antibiotics.
that causes intestinal,  sore or especially in
Doctor’s Order: acne. It works to genital, and irritated throat  hives
patients >40 y.
treat rosacea by urinary systems;  skin redness, Report evidence
 swollen
100 mg decreasing the and certain other
peeling or
of
tongue
Doxycycline QD inflammation that infections that
blistering
superinfections.
causes this are spread by
x 5 days  dry mouth
condition. ticks, lice, mites,
 difficulty
infected animals,
Date Ordered:  anxiety breathing or
or contaminated
food and water. swallowing
March 11, 2022  back pain
It is also used
2:30am  swelling of
along with other  changes in
medications to the eyes,
color of skin, face, throat,
67
5255 NCM 109 RLE
Date treat acne. scars, nails, tongue, or

Discontinued: Doxycycline is eyes, or lips
March 16, 2022 also used to mouth
treat or prevent  unusual
anthrax (a bleeding or
serious infection bruising
that may be
spread on  watery or
purpose as part bloody stools,
of a bioterror stomach
attack), in
cramps, or
people who may
have been fever during
exposed to treatment or
anthrax in the for up to two
air, and to treat or more
plague and months after
tuleramia stopping
(serious treatment
infections that
may be spread  a return of
on purpose as fever, sore
part of a
throat, chills,
bioterror attack).
or other signs
It is also used to
prevent malaria. of infection
Doxycycline can
 joint pain
also be used in
people who  chest pain
cannot be
68
5255 NCM 109 RLE
treated with  discoloration

penicillin to treat of permanent
certain types of (adult) teeth
food poisoning.
Doxycycline
(Oracea) is used
only to treat
pimples and
bumps caused
by rosacea (a
skin disease that
causes redness,
flushing, and
pimples on the
face).
69
5255 NCM 109 RLE
5. Methergine
Consideration
It works by This medicati Use of Methergine Headache, naus chest  General. This
Brand Name: increasing the on is used is ea, vomiting, pain, vision change drug should
rate and strength after childbirth contraindicated du or dizziness s,
Methergine of contractions a and ring confusion, seizures not be
nd the stiffness of abortion to pregnancy becau . administered
Generic Name: the uterus help stop se of its uterotonic I.V. routinely
Methylergonovan muscles. These bleeding from effects. The because of
effects help to the uterus. uterotonic effect of the possibility
Classification: decrease Methergine is
bleeding. utilized after of inducing
Ergot alkaloids delivery to assist sudden
involution and hypertensive
Doctor’s Order: decrease and
hemorrhage, cerebrovascu
0.2MG Methergine shortening the third
lar accidents.
QID x 5 days stage of labor.
 Breast-
Date Ordered: feeding.

Mothers
March 11, 2022 should not
2:30am breast-feed
Date during
Discontinued: treatment
March 16, 2022
with
Methergine.
70
5255 NCM 109 RLE
Milk secreted
during this
period should
be discarded.
 Coronary
Artery
Disease.
Patients with
coronary
artery
disease or
risk factors
for coronary
artery
disease (e.g.,
smoking,
obesity,
diabetes,
high
cholesterol)
may be more
susceptible
to developing
myocardial
71
5255 NCM 109 RLE
ischemia and
...
6. Ibuprofen
Consideration
Decreases pain Mild to moderate  new or worse  shortness of  may cause
Brand Name: and pain, Ibuprofen tablets high blood breath or GI bleeding,
inflammation by inflammatory are pressure trouble hepatitis,
contraindicated in
Advil inhibiting states  heart failure breathing Stevens-
patients with
prostaglandins  liver  chest pain Johnson
Generic Name: known
problems  weakness in Syndrome
hypersensitivity
including liver one part or  may cause
Ibuprofen to ibuprofen.
failure side of your anaphylaxis
 kidney body • monitor for
Classification: Ibuprofen tablets
problems  slurred headache,
should not be nausea,
including speech
non-steroidal given to patients
kidney failure  swelling of vomiting,
who have
anti-  low red blood the face or constipation
experienced
inflammatory cells throat  therapy
asthma, urticaria,
drug (NSAID) (anemia) should be
or allergic-type
reactions after  life- discontinued
Doctor’s Order: threatening after first sign
taking aspirin or
skin of rash
other NSAIDs.
800mg Ibuprofen reactions  monitor renal
QID x 5 days  life- and liver labs
threatening
72
5255 NCM 109 RLE
allergic  patient
Date Ordered: reactions should avoid
 Other side using alcohol
March 11, 2022 effects of
2:30am NSAIDs
include:
stomach
Date pain,
Discontinued: constipation,
March 16, 2022 diarrhea,
gas,
heartburn,
nausea,
vomiting and
dizziness.
73
5255 NCM 109 RLE
74
5255 NCM 109 RLE
CHAPTER VIII. COURSE IN THE WARD
MARCH 10, 2022

HOUR DOCTOR’S ORDER PROGRESS NOTES
8:30 pm 2019-nCoV Antigen Test Focus:
Hospital Protocol PTA-RAT
Objective Data:
Temp: 38.2ºC
Action:
Temperature taken.
Nasopharyngeal swab
Response:
No presence of SARS-CoV2
antigen detected/NEGATIVE
9:00pm Admit the patient, performed Focus:
UTZ and hCG Beta test. Patient Admission and
Diagnosis.
Subjective Data:
“May bleeding na po ako,
buo-buo po yung lumalabas
at nakakaramdam po ako ng
hilab sa lower part ng
abdomen kop o at yung sakit
naglalakbay hanggang sa
balakang ko po.” , Mrs. CFB
stated.
Objective Data:
Pain 5/10
3cm Dilation
Action:
Analysis of lab results.
-Absent FHT and movement.
-Low hCG level for 16 weeks
AOG.
Response:
75
5255 NCM 109 RLE
Client was diagnosed with

incomplete miscarriage to be
resolved with Imminent
Abortion through D&C.
9:30 pm Health teaching about Focus:
Incomplete Miscarriage, Discussion of diagnosis and
Imminent abortion and D&C medical interventions
procedure. regarding surgical abortion.
Administer 1000mL D5LRS Subjective Data:

IV injection, 200mcg Cytotec “Doc. Nakapag decide nap o
sublingual route. kami, I consent to the D&C.”,
Mrs. CFB stated.
Move to PR#6 with NPO
instruction and at OR#1 at Objective Data:
12:30 am. NPO for 4hrs. PT D&C.
Action:
Verbal consent.
IV fluid and Misoprostol
admission.
Response:
D&C to be performed at
1:00am.
MARCH 11, 2022

HOUR DOCTOR’S ORDER PROGRESS NOTES
1:00am Prep the patient with 1 x Focus:
100mg/100mL of Lidocaine Local anesthetic
injected at the site of surgery. administration.
Subjective Data:
“Nagsisimulana pong mag
numb yung perineum area
ko.”
Objective Data:
30 minutes after anesthesia,
to prep before the procedure.
Action:
76
5255 NCM 109 RLE
Injected L.A. inside the

vagina.
Response:
L.A has taken effect within 30
minutes.
1:30 am Imminent Abortion through Focus:
D&C. Removing tissue remains
inside the uterus.
Objective Data:
Uterine perforation confirmed
through UTZ test.
Action:
Administered 100 mg
Doxycycline and 0.2mg
Methergine.
Response:
D&C was performed and
Mrs. CFB was back at PR#6
at 2:20 am.
7:00 am -Order 800mg Ibuprofen QID Focus:
x 5 days. Pain relief measures.
-Demonstrate uterine Subjective Data:

massage and health teaching “Doc malakas po yung
regarding D&C’s side effects, pagdurugo ng asawa ko.”,
medications, and post- Mr. KB informed.
abortion care,
Objective Data:
1 pad soaked 1 ½ hours
Pain 6/10
Action:
Pain relief taken, uterine
massage was demonstrated
to the SO.
Response:
Pain was relieved to 2/10
scale.
77
5255 NCM 109 RLE
9:00 am Unhook IV fluids, discharge Focus:

papers for release. Settling of bills for discharge.
Subjective Data:
“Doc pwede na po ba
kaming umuwi,? Gusto kop o
kasing magpagaling sa
bahay.”, Mrs. CFB stated.
Action:
Prescription of post-abortion
medicines was given.
Response:
Discharge papers were
settled.
11:00 am Ready for discharge. Focus:
-Discharging
Objective Data:
11:10am, discharge at the
hospital.
Action:
-Belongings were checked.
Response:
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5255 NCM 109 RLE
CHAPTER IX. NURSING CARE PLAN
ASSESSMEN DIAGNOSIS SCIENTIFIC PLANNING INTERVENTION RATIONALE EVALUATION

T EXPLANATIO
N
Subjective Acute pain Dilatation and After implementation Assessment: Goal met.
Data: related to curettage (D&C) of nursing Assess the Changes in
The client disruption of basically interventions client’s vital these vital After implementation
verbalizes pain endometrial include procedure, the client signs, noting signs often of nursing
of 8/10 in a tissues as dilatation of the is expected to: tachycardia, indicate acute interventions, the
scale, 10 as the evidenced by cervix and hypertension, pain and client:
highest. verbalization removal of the and increased discomfort.
 Verbalize
s of pain and uterus content. respiration. Note: Some
Objective facial mask of Although D&C relief of or clients may  Verbalized
Data: pain. is not defined as reduced have a slightly relief of or
-Lidocaine to a major lowered BP,
pain at 3/10 reduced
be operation, this which returns
administered procedure has scale. to the normal pain at 2/10
30 minutes invasive  Appear range after scale.
before the characteristics pain relief is
relaxed,  Appeared
procedure. and may be achieved.
-Pain is evident associated with able to rest relaxed,
on the patient’s severe or sleep, Evaluate pain Evaluation of able to rest
face. postoperative and frequently pain provides or sleep,
-The patient is pain and following the information
narrowly- periprocedural participate postprocedural about the need and
focused. anxiety. in daily phase, noting for, the participated
Dilatation of the activities characteristics, effectiveness in daily
cervix, uterine location, and of,
79
5255 NCM 109 RLE
manipulation, accordingly intensity on a 0- interventions. It activities

and the removal 10 scale. may not
of the uterine . always be accordingly
content may possible to .
cause pain eliminate pain;
during D&C. however,
One of the analgesics
typical side should reduce
effects of D&C pain to a
also includes tolerable level.
postprocedural
cramping, which Note the Anxiety among
may increase presence of clients
the client’s anxiety or fear, undergoing
discomfort. and relate with various
the nature of and surgical
preparation for procedures
the procedure. has been an
issue not only
for healthcare
professionals
since the
perioperative
anxiety may be
harmful
concerning
intraoperative
hemodynamic
s and recovery.
Anxiety has
80
5255 NCM 109 RLE
been shown to
act as a risk
factor for the
perception of
significant
pain.
INDEPENDENT
:
Encourage the Relaxation
use of relaxation techniques
techniques such relieve muscle
as deep- and emotional
breathing tension,
exercises, enhance the
guided imagery, sense of
visualization, or control, and
music. may improve
coping
abilities.
Educate the Anticipation of

client about the pain may help
nature of the client cope
discomfort with the reality
expected. of its presence.
Informing the
Provide client
additional regarding the
81
5255 NCM 109 RLE
comfort forthcoming
measures such procedure is
as back rub and an effective
heat or cold tool for
applications. reducing
preoperative
anxiety, which
contributes to
the perception
of significant
pain.
DEPENDENT:
Administer pain Heat or cold
medications, as application
indicated. may improve
circulation,
reduce muscle
tension and
anxiety
associated
with pain. It
may also
enhance the
sense of well-
being.
Administer local Analgesics

anesthesia may be
82
5255 NCM 109 RLE
before the prescribed to

procedure as alleviate the
indicated. cramping after
the procedure.
Some
cramping or
mild abdominal
discomfort is
considered
usual after
D&C. The
paracervical
block (PCB) is
a local
anesthesia
technique used
widely for
gynecological
procedures.
PCB produces
significantly
less pain
during
dilatation and
aspiration as
well as after
the procedure.
It also avoids
the side effects
commonly
83
5255 NCM 109 RLE
caused by
general
anesthesia,
such as
nausea,
vomiting,
dizziness,
drowsiness,
and greater
hemodynamic
changes.
84
5255 NCM 109 RLE
ASSESSMEN DIAGNOSI SCIENTIFIC PLANNING INTERVENTION RATIONALE EVALUATION

T S EXPLANATIO
N
Subjective Risk for Uterine After implementation ASSESSMENT: Partially Met.
Data: perforation is of nursing Assess the client’s Hemorrhagic
The client injury due the most interventions, the vital signs, noting shock is After implementation
verbalized, to common client is expected to: tachycardia, induced by a of nursing
she felt a gush excessive immediate hypotension, and certain amount interventions, the
of fluid coming complication in tachypnea. of intra- client:
pressure  Display
out of her pregnant and abdominal
vagina. from the non-pregnant hemodynami bleeding. The
surgeon’s D&Cs. Uterine c stability body  Displayed
Objective: perforation is compensates hemodyna
hand through
- a sudden most likely to for the bleeding
mic stability
loss of during the occur at the normal vital by increasing
resistance procedure fundus of the signs. the heart rate. through
occurs during uterus, and As diastolic normal vital
 Be free of
dilation & risk factors are ventricular filling
intrauterine signs.
curettage, postpartum continues to
allowing an hemorrhage, bleeding. decline and  Not freed
instrument to post-  Recognize cardiac output of
pass well menopausal decreases, intrauterine
beyond the status, signs and systolic blood
expected nulliparity, and symptoms of pressure drops. bleeding.
length of the retroverted postprocedu
uterus. uterus. Many Assess the client Clinical  Recognized
perforations go ral for the presence of symptoms of signs and
undetected complication abdominal pain or uterine symptoms of
and are not tenderness. perforation are postprocedural
s.
recognized, prompt complications
85
5255 NCM 109 RLE
and the uterus abdominal pain

is most and peritoneal
commonly irritation
perforated resulting from
during dilation intraperitoneal
or uterine bleeding. Large
sounding. defects in the
When intrauterine wall
instruments can result in
pass further acute
into the uterine abdominal pain
cavity than as a result of
appropriate for intraabdominal
postpartum hemorrhage or
uterine, uterine injury.
perforation
may occur. Assess for signs of Brisk vaginal
significant vaginal bleeding may
bleeding. be present,
although, for
some cases, it
may be
unnoticeable at
first and
gradually
increase in time.
Count and
weigh the
client’s perineal
86
5255 NCM 109 RLE
pads for each

shift.
INDEPENDENT:
Educate the client Clinical
on the signs and symptoms of
symptoms that uterine
should be reported perforation are
immediately after prompt
the procedure or abdominal pain,
after discharge. dizziness,
palpitations,
peritoneal
irritation, and
significant
vaginal
bleeding.
However, there
are some
instances
wherein these
symptoms are
delayed to
present and the
client may only
experience an
inexplicable
discomfort after
the procedure,
to which the
87
5255 NCM 109 RLE
healthcare
provider should
pay close
attention.
Educate the client The immediate

about the or short-term
importance of consequences
follow-up visits. of uterine
perforation may
be life-
threatening,
with a long-term
complication
that can affect
the client’s
future
pregnancies.
Provide comfort Heat or cold

measures and application may
relaxation improve
techniques to circulation,
alleviate reduce muscle
abdominal pain tension and
such as heat or anxiety
cold applications, associated with
diversional pain. Relaxation
activities, deep techniques
breathing relieve muscle
88
5255 NCM 109 RLE
exercises, guided and emotional

imagery, etc. tension
and enhance
the client’s
sense of
control.
Monitor for signs of Delayed

infection. presentation of
the signs of
uterine
perforation may
lead to infection.
Signs of
infection may
include
hyperthermia,
chills, foul-
smelling vaginal
discharges, and
body malaise.
COLLABORATIV
E:
Assist with Perforation
ultrasonography should be
as indicated. suspected when
ultrasonograph
y reveals
89
5255 NCM 109 RLE
hyperechogenic
mass with
several follicles
in the
postpartum
uterus,
especially if the
client was
asymptomatic
after a difficult
intrauterine
operation. The
ultrasound must
be used for the
detection of the
location of the
perforation.
Assist with Laparoscopy is

laparoscopy after the preferred
uterine perforation approach for a
has been client with
suspected. suspected
uterine
perforation who
is
hemodynamical
ly stable.
Laparoscopy is
usually
90
5255 NCM 109 RLE
recommended
to examine for
injury and to
complete the
procedure if
needed.
91
5255 NCM 109 RLE
ASSESSMEN DIAGNOSIS SCIENTIFIC PLANNING INTERVENTIO RATIONALE EVALUATION

T EXPLANATIO N
N
Subjective Risk for Surgical After implementation ASSESSMENT Partially met.
Data: evacuation is of nursing :
“Doc, is there infection due one of the interventions, the Monitor the Frequent After implementation
a chance na I to Invasive modalities of client is expected to: client’s vital temperature of nursing
will get procedures managing signs, including elevations or interventions, the
infected different types temperature. onset of new client :
and/or  Remain
because of of miscarriage fever indicate
those curettes increased which occur afebrile that the body is
na ipapasok environment very frequently  Achieve responding to a  Remained
niyo po in daily life and new infectious afebrile
al exposure timely
saakin?” is associated process or that
healing as  Is yet to
with many medications are
complications appropriate not effectively Achieve
Objective that lead to an controlling timely
 Verbalize
Data: increase in incurable
understandi healing as
All the maternal infections.
equipment morbidity and ng of appropriate
and supplies mortality. individual Note risk Understanding  Verbalized
are sterilized Infection due factors for the the nature and understandi
and place in a to uterine exposure occurrence of properties of
sterile area. perforation can and risk infection- infectious ng of
Health care be very factors environmental agents and individual
team were serious when exposure, individual exposure
 Identify
wearing the perforation compromised exposure
scrubs and reaches the interventions host, traumatic determines the and risk
sterile gown, bowel, causing to prevent injury. choice of factors
gloves and damage and
and reduce
92
5255 NCM 109 RLE
other infection necessitating the risk of therapeutic  Identified

control performing intervention.
methods. The laparotomy so infection interventions
perineum is as to manage INDEPENDEN to prevent
cleaned the case. T: and reduce
before the Practice and Hand hygiene is
the risk of
procedure. demonstrate the first-line
proper hand defense to limit infection
hygiene. the spread of
Promote good infection. In
hand hygiene healthcare, the
by staff and use of effective
visitors. hand hygiene
practices to
prevent
healthcare-
associated
infections,
cross-infection,
and reduce the
spread of
antimicrobial
resistance has
been common
practice for
many years.
Nightingale
called on nurses
to wash their
hands and faces
93
5255 NCM 109 RLE
frequently
throughout the
day, reflecting a
long-standing
recognition of
the
effectiveness of
hand hygiene.
Verify sterility of Prepackaged

all items used items may
in procedure as appear to be
event-related. sterile; however,
each item must
be scrutinized
for
manufacturer’s
sterility
statement or
central sterile
processing
indicators,
package
integrity,
environmental
effect on the
package, and
delivery
techniques.
94
5255 NCM 109 RLE
Identify breaks Contamination

in the aseptic by
technique and environmental
resolve them or personnel
immediately contact renders
upon the sterile field
occurrence. unsterile,
thereby
increasing the
risk of infection.
Encourage Adequate fluid

increased fluid intake enhances
intake. the immune
system and aids
in natural
defense
mechanisms.
Encourage the The client’s

client to body must
increase intake overcome
of protein-rich infection and
foods and heal any wound
vitamin C-rich ultimately.
foods. Nutrition is an
essential
component of
her body’s
defenses. The
95
5255 NCM 109 RLE
nurse should
teach the client
about foods that
are high in
protein (meats,
cheese, milk,
legumes) and
vitamin C (citrus
fruits and juices,
strawberries,
cantaloupe)
because these
nutrients are
especially
important for
healing.
Emphasize the Premature

necessity of discontinuation
taking of treatment
antibiotics as when the client
directed, begins to feel
especially well may result
dosage and in the return of
length of the infection.
therapy. However, the
unnecessary
use of
antibiotics may
result in the
96
5255 NCM 109 RLE
development of
secondary
infections or
resistant
organisms.
Monitor the White blood

client’s WBC cells (WBCs)
count. are normally
elevated during
the early
postpartum
period to about
20,000 to
30,000
cells/mm³,
which limits the
usefulness of
the blood count
to identify
infection.
Leukocyte
counts in the
upper limits are
more likely to be
associated with
infection than
lower counts.
97
5255 NCM 109 RLE
DEPENDENT:
Administer If an infection
antimicrobials, occurs, one or
as indicated. more agents
may be used,
depending on
identified
pathogens.
Intravenous
antibiotics
usually are
prescribed for a
postpartum
infection.
Frequently used
antibiotics
include ampicilli
n, gentamicin,
and third-
generation
cephalosporins
such as
cefixime.
A culture and
Obtain a sensitivity test of
specimen for the uterine
culture and cavity may be
sensitivity, as performed as
indicated. ordered by the
98
5255 NCM 109 RLE
healthcare
provider to
identify the
pathogens and
determine the
appropriate
antibiotic agent
to administer.
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5255 NCM 109 RLE
CHAPTER X. BIBLIOGRAPHY
Inevitable Miscarriage, Jones, 2021., Radiopaedia. Retrieved from

https://radiopaedia.org/articles/inevitable-miscarriage2W
Miscarriage, Symptoms & Causes, Diagnosis & Treatment., Mayo Clinic. Retrieved from
https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-
miscarriage/symptoms-causes/syc-20354298
What is an Inevitable Abortion?, Elizabeth E. Puscheck, MD, 2018. Retrieved from

https://www.medscape.com/answers/266317-187489/what-is-an-inevitable-abortion
Inevitable Abortion, Jayson Pangilinan Aban, 2016., Scribd Retrieved from

https://www.scribd.com/presentation/317904460/Inevitable-Abortion
What is an Inevitable Abortion?, Toni Herthorn, 2022., wisegeek. Retrieved from

https://www.wise-geek.com/what-is-an-inevitable-abortion.htm
Abortion, Nursing Management & Care, Barrianne Bellega RN. 2017., Nurseslabs
Retrieved from https://nurseslabs.com/abortion/
Dilatation and Curettage (D&C)., Mayo Clinic. Retrieved from

https://www.mayoclinic.org/tests-procedures/dilation-and-curettage/about/pac-20384910
The anatomy of the uterus, Jennifer Whilhock, 2021., Sexual Health> reproductive Issues.,
verywell health. Retrieved from https://www.verywellhealth.com/uterus-location-
function-female-anatomy-
3157180#:~:text=The%20uterus%2C%20also%20known%20as%20the%20womb%2C%20
is,embryo%2C%20and%20development%20of%20a%20baby%20take%20place.
100
5255 NCM 109 RLE
What to know about Cervix function and female Health, Tracee Conforth, 2021., Sexual
Health>Reproductive Health Issues., verywell health. Retrieved from
https://www.verywellhealth.com/what-is-the-cervix-3520584
Will an abortion affect my health?., Eastside Gynecology. Retrieved from

https://eastsidegynecology.com/blog/will-an-abortion-affect-my-health/
Medical Definition of Pregnancy Ultrasound, Melissa Conrad Stoppler, 2021., Medicine

Net. Retrieved from https://www.medicinenet.com/pregnancy_ultrasound/definition.htm
Refaey, M., Weerakkody, Y. Fetal death in utero. Reference article, Radiopaedia.org.

(accessed on 21 Mar 2022) https://doi.org/10.53347/rID-4877 Retrieved from
https://radiopaedia.org/articles/fetal-death-in-utero-1
hCG levels after a miscarriage or a medical abortion, Maria Rodriguez Ramirez, 2016.,
inviTRA. Retrieved from https://www.invitra.com/en/hcg-levels-after-a-miscarriage/
There are 6 Different Family Types and each one has a unique family dynamic, Patricia
Oelze, 2022., betterhelp. Retrieved from https://www.betterhelp.com/advice/family/there-
are-6-different-family-types-and-each-one-has-a-unique-family-dynamic/
Significant others’ experience of hospitalized patients’ transfer to home: a systematic

review and meta-synthesis, Uhrenfeldt, Fegram, Aagaard & Ludvigsen, 2018.,
PubMed.gov-NIH. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30477973/’
What is coping mechanism, 2015., Emotional Health, PEDIAA. Retrieved from

https://pediaa.com/what-is-coping-
mechanism/#:~:text=1%20Coping%20mechanisms%20are%20emotions%2C%20thought
s%2C%20and%20behaviour,focused%20and%20appraisal%20focused%20mechanisms.
%20More%20items...%20
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Advantages of a private Obstetrician, Alex Polyakov. Retrieved from

https://www.dralexpolyakov.com.au/blog/advantages-of-a-private-obstetrician
Chapter 217. General Appearance, clinical methods: The History, Physical, and
Laboratory Examinations 3rd Edition., Berk & Verghese, 2018., Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK330/
Blunted affect vs. Constricted affect: Feelings not fathomed, Psycholo Genie. Retrieved
from https://psychologenie.com/blunted-affect-vs-constricted-
affect#:~:text=A%20normal%20range%20of%20emotions%20and%20expressions%20is,
other%2C%20and%20from%20one%20situation%20to%20the%20other.
Gait and posture-Asessment in general practice, Australian Family Physician, 2007.,

PubMed, Research gate. Retrieved from
https://www.researchgate.net/publication/6272443_Gait_and_posture_-
_Assessment_in_general_practice
Pregnancy Fever-high Body Temperature when pregnant, Dr. Alison., HealthHype.com

Retrieved from https://www.healthhype.com/pregnancy-fever-high-body-temperature-
when-
pregnant.html#:~:text=A%20body%20temperature%20above%20102F%20%2838.90C%2
9%20for%20an,cause%20more%20harm%20than%20fever%20in%20late%20pregnancy.
D5LRS IV fluid., RN Pedia Retrieved from https://www.rnpedia.com/nursing-

notes/fundamentals-in-nursing-notes/d5lrs-lactated-ringers-solution-iv-fluid/
Lactated Ringer’s in 5% Dextrose., RXList Retrieved from https://www.rxlist.com/lactated-

ringers-in-5-dextrose-side-effects-drug-center.htm
Lidocaine., RXList Retrieved from

https://www.rxlist.com/consumer_lidocaine_lidopen/drugs-condition.htm
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Cytotec., drugs.com Retrieved from https://www.drugs.com/mtm/cytotec.html
Misoprostol-Drug Summary., PDR Retrieved from https://www.pdr.net/drug-

summary/Cytotec-misoprostol-
1044#:~:text=Misoprostol%20is%20contraindicated%20during%20pregnancy%20for%20
use%20to,miscarriage%2C%20and%20other%20problems%20if%20administered%20dur
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https://www.webmd.com/drugs/2/drug-12365/methergine-oral/details
Ibuprofen 800 mg., Drugs.com Retrieved from https://www.drugs.com/pro/ibuprofen-

800mg.html#:~:text=Ibuprofen%20800mg%20-
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Asuncion 5255 ICS Maternal

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SAINT MARY’S UNIVERSITY

3700 Bayombong, Nueva Vizcaya

Presented to the faculty of

In partial fulfillment of the Requirements in

March 27, 2022

I. Personal Profile, Present and Past OB History 3-6

Date of Admission March 10, 2022, 8pm

Source of Health Information Fernando’s Women’s Clinic

16 weeks AOG with vaginal bleeding and

II. HEALTH HISTORY

B. HISTORY OF PAST ILLNESS

CHAPTER II. BRIEF DESCRIPTION

Signs and symptoms of a miscarriage might include:

 Vaginal spotting or bleeding

 Pain or cramping in your abdomen or lower back

 Fluid or tissue passing from your vagina

 Problems with the genes or chromosomes

Chromosome problems might lead to:

 Blighted ovum. Blighted ovum occurs when no embryo forms.

 Maternal health conditions

 Uterus or cervix problems

What does NOT cause miscarriage?

Routine activities such as these don't provoke a miscarriage:

 Exercise, including high-intensity activities such as jogging and cycling.

Various factors increase the risk of miscarriage, including:

 Uterine or cervical problems. Certain uterine conditions or weak cervical tissues

 Lower abdominal tenderness

 Foul-smelling vaginal discharge

 Seek regular prenatal care.

 Take a daily multivitamin.

Your health care provider might do a variety of tests:

Essentially, a threatened miscarriage progresses to an inevitable miscarriage if cervical

 Congenital Structural Defect. This structural defect may be due to chromosomal

Signs and Symptoms

 Vaginal spotting. Vaginal spotting appears as small brownish to reddish spots

Why it's done

Dilation and curettage is used to diagnose or treat a uterine condition.

 You have unusual uterine bleeding

 You have bleeding after menopause

 Endometrial intraepithelial hyperplasia — a precancerous condition in which the uterine

 Remove a tumor that forms instead of a typical pregnancy (molar pregnancy)

 Remove cervical or uterine polyps, which are usually noncancerous (benign)

At times, a hysteroscopy might be done combined with an endometrial biopsy before a

 Infection. Infection after a D&C is rare.

Before the procedure:

 Follow your provider's instructions on limiting food and drink.

During the procedure

Dilation and curettage (D&C)Open pop-up dialog box

After the procedure

 Spotting or light bleeding

You should be able to resume your activities within a day or two.

CHAPTER III. ANATOMY AND PHYSIOLOGY

Three distinct layers of tissue comprise the uterus:

 Perimetrium: The outer layer of tissue made of epithelial cells

Endometriosis typically is treated with extended-cycle hormonal birth control or

In severe cases, surgery such as endometrial ablation, myomectomy, or

Some women have a retroverted or retroflexed uterus, which means it is in a tipped or

Your cervix has several important functions, including:

During Pregnancy and Labor

Where Is the Cervix?

There are three parts of the cervix:

Conditions and Problems

The cervix is prone to certain conditions and diseases, including:

 Cervical cancer: Most cases of cervical cancer are caused by human