ILOILO DOCTOR’S COLLEGE

COLLEGE OF NURSING

NCM 109 ( RLE )

CARE OF MOTHER AND CHILD RISK OR WITH PROBLEMS
(ACUTE AND CHRONIC)

CASE SCENARIO
ABORTION
 I. INTRODUCTION
Abortion is a medical term for the disruption of a pregnancy before the fetus reaches its viable age of more than 20 to 24 weeks of gestation or
weighs at least 500g. 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.

There are always precipitating factors for every condition. Here are the risk factors that concerns abortion: 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.
Several types of abortion are used to classify every case for a pregnant woman. Once a thorough assessment is done, that would be the time
that the type of abortion that occurred could be established. Threatened abortion. The embryo is already viable. The products of conception are
still intact and the cervix is closed, but there is vaginal bleeding present. Inevitable/Imminent abortion. The embryo is dead with the products of
conception either intact or expelled. The cervix is already dilated and there is presence of vaginal bleeding. Complete abortion. All products of
conception are expelled and the embryo is dead. The cervix is dilated, and there is mild bleeding. Incomplete abortion. The embryo is dead but
some products of conception are still intact. The cervix is already dilated and there is severe vaginal bleeding. Missed abortion. The embryo is
already dead while inside the uterus. The products of conception are still intact and the cervix is closed. There are brown vaginal discharges present.
Recurrent/Habitual abortion. Abortion becomes recurrent once the woman has had 3 consecutive miscarriages at the same gestational age.

Signs and Symptoms of abortion are: 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 are: 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. 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.
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.

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.
 II. OBJECTIVES
General Objective: At the end of this case study, students will be able to apply proper knowledge, skills and attitude in providing care in the mother.

Specific Objectives:
Knowledge:
Identify the changes occurring in an abortion

Implement nursing care to aid the progression of physiologic and psychologic transitions occurring in abortion.

Evaluate outcome criteria for the achievement and effectiveness of care.

Provide accurate health education to the mother.

Skills:
Develop the skills in identifying the exact nursing diagnosis of the mother to formulate accurate plan of care.

Implement proper nursing interventions.

Attitude:
Actively participate in conducting a case study.
Establish rapport with the client and members of family.
Recognize client’s needs using holistic approach.
Show outmost confidence in managing client’s care
 III. NURSING
HEALTH HISTORY
A. Biographic Data B. Chief Complaint
Abdominal cramping and heavy vaginal bleeding with blood
a. Client’s name – J. M. clots
b. Address Over the past 2 days she had experienced light spotting
c. Age – 24 years old which had increase in severity that morning.
d. Sex – Female
e. Marital Status – Married
f. Occupation
g. Religion
h. Source of Information- Primary
i. Relationship
j. Admitting Impression/Final Diagnosis
k. Date and Time of Admission (if admitted in the hospital)
 IV. PHYSICAL
EXAMINATION

A. GENERAL SURVEY

Vital Signs
Temperature – 37.1
Respiratory rate – 18 breaths/min
Heart rate – 83 beats/min
BP -100/60 mmHg


Chief Complaint
Abdominal cramping and heavy vaginal bleeding with blood clots
Over the past 2 days she had experienced light spotting which had increase in severity that
morning.
 V. ANATOMY AND
PATHOPHYSIOLOGY
 Uterus
Hosts the developing fetus
Produces vaginal and uterine secretions
Passes the anatomically male sperm through to the fallopian tubes

 Ovaries
Produce the anatomically female egg cells.
Produce and secrete estrogen and progesterone

These parts are internal; the vagina meets the external organs at the vulva, which includes the labia, clitoris, and urethra. The
vagina is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the fallopian tubes. At certain
intervals, the ovaries release an ovum, which passes through the fallopian tube into the uterus.
If, in this transit, it meets with sperm, the sperm penetrates and merges with the egg, fertilizing it. The fertilization usually occurs in
the oviducts, but can happen in the uterus itself. The zygote then implants itself in the wall of the uterus, where it begins the process
of embryogenesis and morphogenesis. When developed enough to survive outside the womb, the cervix dilates and contractions of
the uterus propel the fetus through the birth canal (vagina).
The ova are larger than sperm and have formed by the time an anatomically female infant is born. Approximately every month, a
process of oogenesis matures one ovum to be sent down the fallopian tube attached to its ovary in anticipation of fertilization. If not
fertilized, this egg is flushed out of the system through menstruation.
An anatomically female’s internal reproductive organs are the vagina, uterus, fallopian tubes, cervix, and ovary.
The external components include the mons pubis, pudendal cleft, labia majora, labia minora, Bartholin’s glands, and clitoris.
 VI. DIAGNOSIS AND
LABORATORY PROCEDURE
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.
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.


WBC – 10,000/uL (normal – 4,500-11,000)

HB – 13.7g/dl (normal 12.1 - 15.1)

Hematocrit – 39.7% (normal 36% - 44%)

Blood type – B+

Beta-HCG – 9400.0mIU/mL

TV USG – Appeared to be an abnormal G.Sac near to cervical anal

Cervical Abnormalities – Malignancy, polyps or trauma

Ectopic Pregnancy

Idiopathic bleeding in a viable pregnancy

Infection of the vagina or cervix

Molar pregnancy

Spontaneous Abortion

Vaginal Trauma
VII. NURSING
PROCESS
VIII. DRUG
STUDY
 IX. DISCHARGED
PLAN TEACHING
HEALTH TEACHING
Advise client to follow up health care provider as directed
Call your healthcare provider right away if you have any of the following:

- Fever above 100.4°F (38°C) or higher, or as advised by your provider

- Chills

- Bright red vaginal bleeding or a smelly discharge

- Vaginal bleeding that soaks more than 1 menstrual pad per hour

- Belly pain that is severe or getting worse

Home care
Suggestions for care at home include:

Return to work or your daily routines when you feel ready. This might be right away, or you may want to wait a few days.

Take showers instead of tub baths. This helps prevent infection. Ask your healthcare provider when you can take baths again.

Don't do any strenuous exercise right away, such as aerobics or running. Wait until the bleeding slows to the rate of a normal period.

Don't have sex or use tampons or douches until your provider says it's OK.

Get emotional support. Ask your provider about support groups in your area. Many women find it helpful to talk with other women who have had a miscarriage.