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ABORTION/ MISCARRIAGE, Refences, Pauline McCall Sellers Revising editors:…

- - - - Occurring in 1st and second trimester
  - - - Products of conception partly expelled
  - - - Hypothermia
      - Hypotention
      - Oliguria
      - Respiratory distress
      - Thrombocytopenia
      - Intravascular hemolysis
  - - - Vaginal bleeding
      - Cervical os closed
      - No pain/uterine contraction
  - - - Vaginal bleeding
      - Uterine contraction
      - Cervical dilatation
  - - - Mother or foetus are in danger
      - Congenital abnormalities
    - - Before 20 weeks gestation
      - Requested by the mother
      - Perfomed by midwife at 12 weeks
      - perfomed by doctors above 12weeks
- - - - Hypotension in hypovolaemic shock
      - Pyrexia in presence of infection
      - Hypothermia in blood loss and shock
- - - - Support
      - Non-judgemental
      - Privacy
      - Relieve pain
      - Replace fluid lost
      - Monitor uintake and output
      - Monitor progress and record
      - Monitor vital signs BP, Pulse ,respiration and report
      - Pad check every 15 minutes and record
      - Observe and examine products of conception
      - Provide counselling
    - - Clincal presentation
        
        Subsequent expulsion of product of conception
        
        Cervix soft and dilating
        
        Profuse vaginal bleed with clots
        
        Strong uterine contractions
        
        Vaginal bleeding mild ,moderate or severe
        
        Sudden onset of uterine contractions
      - Management
        
        Keep the patient in bed
        
        Offer privacy
        
        Monitor vital signs 4hrly
        
        Quarter hourly pad checks
        
        Monitor uterine contraction s duration and intensity
        
        Reassure the patient
        
        Prepare for vacuation
        
        Intravenous fluids as prescribed by the doctor to give oxytocin to facilitate expalsion
        
        Discard products of conception inline with hospital policy
    - - Clinical manifestation
        
        Passage of clots/ tissue
        
        Fever and shock
        
        Irregular ,persistent bleeding
        
        Foetal expulsion
        
        Pieces of placenta vaginally
      - Management
        
        Apply sanitary pad
        
        Monitor
        
        Patient condition
        
        Bleeding
        
        Vital signs
        
        Intake and output
        
        Clean and change patient linen
        
        Estimate blood loss
        
        Assist in expulsion of products of conception
        
        Prepare for Dilatation and curettage
        
        Give oxytocin 10 units imi stat
    - - Clinical manifestation
        
        Signs of pregnancy disappearance
        
        Breast return to normal
        
        Uterus return non-pregnant state
        
        Defused abdomen and dome shape
        
        Possible spotting
        
        Dark -brown offensive vaginal discharge
      - Management
        
        Wait for spontaneous evacuation
        
        Dilatation and curettage
        
        Vital signs monitoring 2hrly