UNCIANO COLLEGES

STA. MESA MANILA

RESEARCH PAPER THREATENED ABORTION

SUBMITTED BY:
MIDWIFERY II BATING, RACHEL C. FERNANDEZ, MERVRICK R. REYES, JACKLYN R.

SUBMITTED TO:
RN.MAN

MS.LORNA MELOSANTOS

INTRODUCTION:
Threatened abortion refers to the possible loss of the product of conception. All vaginal bleeding in early pregnancy without cervical changes is considered a threatened abortion. About 25% to 30 % of all pregnancies have some bleeding during the pregnancy but only less than one half proceed to a complete abortion or miscarriage.

PROFILE OF PATIENT:
Mrs. X is a 22 yrs old woman,she was resided at B 286 L.-11 Aguila St. Barangay Rizal. She was born on November 9, 1989 in Lipa Batangas. This is her first pregnancy but she was confined in Unciano Medical Hospital on February 5, 2012. Mrs. X diagnosed as THREATENED ABORTION.

HISTORY OF PATIENT:
Name of patient: LMP: AOG: EDC: MRS. X November 1, 2011 13 WEEKS August 8, 2012

PAST MEDICAL HISTORY;

Allergy Hypertension UTI positive negative negative

FAMILY MEDICAL HISTORY:

Kidney disease Hypertension Heart disease Diabete Mellitus positive positive positive positive mother side both parents father side father side

PERSONAL AND SOCIAL HISTORY:

Smoking Alcohol negative occasional

OB-GYNE HISTORY:
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G1P0

PRIOR ADMISSION:
MRS. X came to emergency room last February 5, 2011 her chief complain are abdominal pain and spotting associated with dysuria. She seen and examined by her attending physician DR. Y where she was admitted.

THE PREPARATION SUCH AS:

>Vital sign >skin test of vit. B >getting the FHT >laboratory test MRS. X endorsed to the ward for continuity of care. She transferred to the private room with wheel chair safely and assised to her bed.

PHYSICAL ASSESSMENT:
BP: 100/60 BT: 36.5 PR: 67 RR: 16

LABORATORY TEST:
RESULT NORMAL VALUE
WBC 5-10 X 10 g/l RBC male 4.5- 6.0 X 10 g/l Female 4.5 - 5.5 X g/l HEMOGLOBIN male 130 60 g/l Female 120 140 g/l HEMATOCRIT male .40 - 20.50 Female .37 - .47 ESR male 011 mm/hr Female 0 -20 mm/hr PLATELET: 150 -350 X 10 g/l DIFFERENTIAL COUNT: SEGMENTERS 40-60 LYMPHOCYTES 20-40 .77 .23 .34 89 6.7 3.1

MONOCYTES 01-4 BASOPHIL 02-04 STAB 00- 01 CLOTTING TIME 2-4 min. BLEEDING TIME 2-4 min. BLOOD TYPE

HEMATOLOGY:
PLATELET 150-350 X g/l 219

ASSESSMENT:
Ask the patient for: LMP If the woman will more than 20 weeks gestational,the bleeding can ba placenta previa and not abortion,do not do internal exam. PRESENCE OF CLOT The presence of clots suggest hevy bleeding. Vehicles of H-MOLE and fetal tissues may be mistaken by patient as blod clots. ABDOMINAL PAIN Is the next common complaint of woman suffering from abortion next to vaginal bleeding. The pain usually is in suprapubic area,but reports for pain in one or both lower quadrants are not common. The pain may radiates in the lower back buttocks,genitalia,and perineum. If the pain is persistently occurring only on one side,consider as an ectopic pregnancy or a ruptured ovarian cyst as possible caused. Ask the patient when the pain started and stopped if it did.

MEDICATION:
The medication of MRS. X are:

- Cefazolin 500 mg. tiv q8- Isoxsuprine HCI 10 mg.

MANAGEMENT:
1. Instruct the patient to save all pads for examination. 2. Instruct The patient to have bedrest until 3 days after bleeding has stopped. In majority of cases, bleeding usually stopped within 48 hours. 3. Advise the couple not to engage in coitus up to 2 weeks after bleeding stopped.

RESEARCH:
Threatened Abortion:
Threatened abortion is a condition that occurs during the first 20 weeks of pregnancy, in which vaginal bleeding suggests an increased risk of miscarriage. Threatened abortion is common, with about 20-30% of pregnancies being complicated by bleeding in the first 20 weeks. About 10%-15% of all established pregnancies ultimately abort (miscarry). The possible risk factor are: Infection, Trauma, Certain medicines, Advancing maternal age.

SIGN AND SYMPTOMS:

- vaginal spotting or bleeding - bleeding that progresses from light to heavy - pain, cramps, or discomfort in the abdomen or lower back - clot-like fluid or tissue passing through the vagina - fever, - weakness or vomiting

DIAGNOSIS:

>Threatened Abortion

MANAGEMENT:
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Threatened abortion can be avoid or restrict some forms of activity, or you may need complete bed rest. Not having sexual intercourse is usually recommended until the warning signs have disappeared. The use of progesterone is controversial. It might relax smooth muscles, including the muscles of the uterus. However, it also might increase the risk of an incomplete abortion or an abnormal pregnancy.

PREVENTION:
There is usually no way to prevent a threatened abortion. But things you can do to increase your chance of having a healthy pregnancy include: - Avoid alcohol, cigarettes, and illegal drugs - Limit caffeine intake - Control any medical conditions such as diabetes and hypothyroidism - Talk with your doctor before taking medications to ensure they are safe during pregnancy - Diagnose and treat infection (eg. bacterial vaginosis , gonorrhea ) as early as possible - Get regular prenatal care

MEDICATIONS:
1. Generic Name: Cefazolin Brand Name: Ancef

ACTIONS:
Bind to bacterial cell wall membrane, causing cell death. Active against many gram-positive cocci including: Streptococcus pneumoniae, Group A beta-hemolytic streptococci; Penicillin as-producing staphylococci.

INDICATION:
Treatment of: Skin structure infections; pneumonia; urinary tract infections; bone & joint infections

SIDE EFFECTS/ ADVERSE EFFECTS

Seizures (high doses) Pseudomembranous colitis, diarrhea, nausea, vomiting, cramps Interstitial nephritis Rashes, urticaria Blood dyscrasias, hemolytic anemia Pain at IM site, phlebitis at IV site Allergic reactions including Anaphylaxis and Serum sickness, superinfection consulting healthcare professional.

2. Brand name: Isoxsuprine Generic name; Vasodilan/Isoxsuprine

ACTIONS:
Isoxsuprine is used during pregnancy to prevent premature labor.

INDICATION:
Uterine hypermotility disorders and threatened abortion

SIDE EFFECTS:
- dizziness 10

- flushing (feeling of warmth) - upset stomach - vomiting - stomach pain

Others side effects:

- rash - fast heartbeat - chest pain

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