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Abortions and ectopic pregnancy (Ectopic pregnancy (Assessment and common…
Abortions and ectopic pregnancy
Spontaneous abortion
Assessment and common findings
Severe cramps
Back pain
Bleeding that progress from light to heavy
Pyrexial
on palpation the fundus may be above symphysis pubis
Causes
maternal caues
An incompetent cervix
Acute maternal infections such as rubella and chlamydia
Hormonal imbalances
Maternal chronic illness
fetal cause
fetal abnormalities
Multiply pregnancy
Risk factors
Cigarette smoking
High dose of cocaine
use of drugs such as cocaine and alcohol
History of spontaneous abortion
Age above 35
Types
Threatened abortion
vaginal bleeding, abdominal pain of any degree represent as threatened abortion
Incomplete abortion
n vaginal bleeding may be tense and accompanied by abdominal pain
Inevitable abortion
vaginal bleeding is accompanied by dilatation of cervical canal
Complete abortion
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
Septic abortion is an infection of the placenta and the fetus of a previable pregnancy.
Definition
Spontaneous abortion is non induced embryonic or fetal death or passage of products of conception before 20 weeks of gestation
Medical management
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.
Nursing management
Monitor vital signs 4 hourly or as frequently as necessary to exclude fluid deficit
Monitor and record uterine contractions
Nurse patient in a comfortable position on bed rest
Quater hourly pad check inspection and record result
Provide emotional support as the patient experience loss and anxiety
Health education
Advise patient to take shower instead of tub bats.This help prevent infection.
Patient should avoid using tampons
Seek medical attention if you experience pyrexia, have lower abdominal pain or have a red vaginal bleeding or offensive discharge.
Induced abortion
Definiction
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
Assessment and common findings
patient test must be done to confirm pregnancy
Full blood count must be done to exclude infection
Other screening test should be done for for STI in and tubes order to prevent introduction of infection into the uterus
Types
Labour induction
mifepristone
Dilation and evacuation
methotraxate
Vacuum aspiration
misoprostol
Nursing management
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.
Pre- operative care
Vital signs should be monitored
Before discharge contraceptive method should be discussed and advised patient on appropriate method
maintain good personal hygiene
Medical manageent
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.
Health education
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.
Ectopic pregnancy
Causes
Abnormal growth or a birth defect can result in a abnormal in the tube shape
Previous surgery in pelvic area or on the tubes can cause adhesion
Assessment and common finding
Severe pain that occur on one side of the abdomen
Frequency in micturition
Sharp waves of pain in the abdomen, pelvis shoulders or neck
Abdomen may be distended and tender with guarding
Blood pressure suddenly drops
Skin is cold and clammy, woman complain of dizziness and nausea.
There is history of amenorrhoea for 6 weeks , lower abdominal pain by vaginal spotting that may proceed to frank bleeding
Risk factors
Risk factors
Pelvic inflammatory disease
undergoing fertility treatment or using fertility medication
Previous pelvic or abdominal surgery
conceiving after having tubal lagation
History of STD such as gonorrhea and chiamydia
pathophysiology
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
Definition
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
Medical management
Pain management by administering prescribed analgesia,administer intravenous fluids for patient presenting with shock and blood transfusion pre-operatively
Nursing management
Monitor vital signs
Administer medication as prescribed
Nurse patient in a comfortable position
Observe for any bleeding
Ensure that the bladder is draining by inserting the catheter
ensure adequate intake of fluids
Health education
Advise patient to have enough rest, avoid doing heavy activities. Encourage patient to do follow up and to take prescribed antibiotics to prevent infection.
Surgical management
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.