Abortions and ectopic pregnancy (Ectopic pregnancy (Assessment and common…
Abortions and ectopic pregnancy
Laparotomy will be done to remove blood that may be free in the peritoneal cavity and repair any ruptured or tear in the fallopian tubes. where bleeding is profuse and uncontrollable, a hysterectomy may be performed.
Advise patient to have enough rest, avoid doing heavy activities. Encourage patient to do follow up and to take prescribed antibiotics to prevent infection.
ensure adequate intake of fluids
Ensure that the bladder is draining by inserting the catheter
Observe for any bleeding
Nurse patient in a comfortable position
Administer medication as prescribed
Monitor vital signs
Pain management by administering prescribed analgesia,administer intravenous fluids for patient presenting with shock and blood transfusion pre-operatively
Ectopic pregnancy is a condition where by a fertilised ovum becomes implanted implanted on any tissues other than the uterine lining for example in the Fallopian tube, ovary,abdomen or cervix. Most common is ectopic implantation is fallopian tubes
The fertilised ovum fails to reach the uterine cavity and become implanted in the fallopian tubes or pelvic cavity or misses the uterine cavity and become implanted in the cervix though it is very rare
History of STD such as gonorrhea and chiamydia
conceiving after having tubal lagation
Previous pelvic or abdominal surgery
undergoing fertility treatment or using fertility medication
Pelvic inflammatory disease
Assessment and common finding
There is history of amenorrhoea for 6 weeks , lower abdominal pain by vaginal spotting that may proceed to frank bleeding
Skin is cold and clammy, woman complain of dizziness and nausea.
Blood pressure suddenly drops
Abdomen may be distended and tender with guarding
Sharp waves of pain in the abdomen, pelvis shoulders or neck
Frequency in micturition
Severe pain that occur on one side of the abdomen
Previous surgery in pelvic area or on the tubes can cause adhesion
Abnormal growth or a birth defect can result in a abnormal in the tube shape
Teach patient about signs and symptoms of complication such as Fever, heavy bleeding and pain also advice patient on practicing safe sex and advise on doing follow up.
Pelvic examination is performed to determine uterine size.Laboratory studies before an abortion must include pregnancy test to confirm pregnancy, haematocrit to rule out anemia,Rh determination and STD screen. Patient with anemia may require iron supplement and an Rh negative may require RhoGAM to prevent isommunization.
Pre- operative care
maintain good personal hygiene
Before discharge contraceptive method should be discussed and advised patient on appropriate method
Vital signs should be monitored
Nurse should provide information about what the procedure entails to do.Th patients is scheduled for a follow up appointment 2 weeks after the procedure. The patients should be taught about signs and symptoms of complication such as fever, heavy bleeding or pain.
Dilation and evacuation
Assessment and common findings
Other screening test should be done for for STI in and tubes order to prevent introduction of infection into the uterus
Full blood count must be done to exclude infection
patient test must be done to confirm pregnancy
Induced abortion is a deliberate termination of pregnancy. It is usually done by medical persons. This type of abortion is also called artificial or therapeutic abortion
Seek medical attention if you experience pyrexia, have lower abdominal pain or have a red vaginal bleeding or offensive discharge.
Patient should avoid using tampons
Advise patient to take shower instead of tub bats.This help prevent infection.
Provide emotional support as the patient experience loss and anxiety
Quater hourly pad check inspection and record result
Nurse patient in a comfortable position on bed rest
Monitor and record uterine contractions
Monitor vital signs 4 hourly or as frequently as necessary to exclude fluid deficit
All tissues passed vaginally is saved for examination after spontaneous abortion. If patient is having heavy bleeding blood transfusion. In case of incomplete abortion oxytocin may be prescribed to cause uterine contractions before dilatation and evacuation or uterine suctioning.
Spontaneous abortion is non induced embryonic or fetal death or passage of products of conception before 20 weeks of gestation
Septic abortion is an infection of the placenta and the fetus of a previable pregnancy.
patient may present with history of bleeding, abdominal pain and tissue passage by the time the miscarriage is complete bleeding and pain usually have subside
vaginal bleeding is accompanied by dilatation of cervical canal
n vaginal bleeding may be tense and accompanied by abdominal pain
vaginal bleeding, abdominal pain of any degree represent as threatened abortion
Age above 35
History of spontaneous abortion
use of drugs such as cocaine and alcohol
High dose of cocaine
Maternal chronic illness
Acute maternal infections such as rubella and chlamydia
An incompetent cervix
Assessment and common findings
on palpation the fundus may be above symphysis pubis
Bleeding that progress from light to heavy