GROUP 3

INCOMPLETE
ABORTION
Members:
Case Scenario
This is the case of Patient A.R with the age of 39 and is G7P6 (6006) 7 4/7 weeks AOG. Her nationality is Filipino
with a Roman Catholic religion. She is currently married living in Guagua, Pampanga. Patient A.R. was admitted
for vaginal bleeding in DMMH on November 28, 2020 around 12:20pm. Patient herself was the informant with a
reliability of 80%.

Past Medical History Personal and Social History

The patient denies any previous hospitalization or any
surgeries. No medical history of cancer, TB, asthma,
diabetes and hypertension
Family Medical History
Patient’s mother has hypertension, father has
rheumatoid arthritis. No pertinent medical history of
the siblings.
Patient lives in a concrete bungalow house, with 2
bedrooms and 1 restroom with her children and
husband.
The patient is a college graduate currently working
in a parlor shop.
Patient is a smoker consuming 3 sticks per day,
occasional drinker consuming 1 bottle of
Emperador lights.
Diet consists mainly of fish, meat, eggs, vegetables
and rice.

GROUP 3 - INCOMPLETE ABORTION

Case Scenario
Menstruation History
Gynecologic History
Patient A.R. menarche started when she was 18
No known history of sexually transmitted disease,
years old, her menstrual duration is 4-5 days,
fibroids, endometriosis, urinary incontinence, pap
regular cycle of 28, with lighter menstrual flow
smear, mammogram, colonoscopy and post coital
on the first day and become gradually heavier
bleeding.
towards the end of menses consuming 3 pads in
a day.
The patient reported of having severe
dysmenorrheal on every first day of her
Contraceptive History menstruation. The patient reported that the
dysmenorrhea is severe with a pain scale of
The patient reported of using contraceptive pills
7/10 and Mefenamic acid 2x a day was taken to
specifically Lady pills for 1 year however discontinued
relieve the pain.
afterward because of nausea

GROUP 3 - INCOMPLETE ABORTION

Case Scenario
Review of System Vital Signs Upon Admission
Fever Blood Pressure - 90/60 mmHg
Crampy abdominal pain Temperature - 38 C
Vomiting Respiratory Rate - 20 cpm
Headache Pulse Rate - 100 bpm
Heavy vaginal bleeding

Physical Exam Progress of Pregnancy Internal

BP: 100/80 mmHg, Exam (IE)
RR: 20cpm,
Cervix is dilated with placental fragments
Temperature: 36.3 C,
PR: 100 bpm.

Admitting Diagnosis Medications

Cephalexin 500mg,
G7P6 (6006) 7 4/7 week AOG to consider Mefenamic acid 500mg,
incomplete abortion; non septic, non-induce. Paracetamol 500mg
GROUP 3 - INCOMPLETE ABORTION
Case Scenario
History of Present Health Illness
3 Days Prior to Admission
Patient experienced crampy abdominal pain located
in the hypogastric area with a pain scale of 7/10.
Patient took mefenamic 500 mg but the symptoms
unrelieved.
2 Days Prior to Admission
While working in her parlor around 8:24 am, the
patient experienced heavy vaginal bleeding
consuming 3 napkins fully soaked, along with
abdominal pain in the hypogastric region that is
radiating to the lower back.
The patient took Cephalexin 3x a day to relieve the
symptoms.
1 Day Prior to Admission
Patient experienced vaginal bleeding with
intermittent fever and headache characterized as
crampy and bi-temporal in location.
Paracetamol 500 mg was taken to relieve the
symptoms.
Few hours Prior to Admission
Patient experienced heavy vaginal bleeding,
hypogastric pain, fever with nausea and vomiting
along with headache that prompted her for
hospitalization.
GROUP 3 - INCOMPLETE ABORTION
GROUP 3 - INCOMPLETE ABORTION
 ALISSA MAE SALES
Etiology
INCOMPLETE ABORTION

SOME, BUT NOT ALL, OF THE PRODUCTS OF CONCEPTION HAVE BEEN PASSED;
RETAINED PLACENTAL FRAGMENTS. AN INCOMPLETE ABORTION INVOLVES
HEAVY VAGINAL BLEEDING, CRAMPY ABDOMINAL PAIN (CONTRACTIONS),
CERVICAL DILATATION, AND INCOMPLETE PASSAGE OF THE PRODUCTS OF
CONCEPTION.
A WOMAN EXPERIENCING INCOMPLETE ABORTION REPORTS HEAVY VAGINAL
BLEEDING. THE CRAMPING MAY BE RHYTHMIC OR LABOR-LIKE, ALTHOUGH LESS
INTENSE THAN A FULL-TERM LABOR. AT THIS POINT, THE BABY HAS ALREADY
DIED AND HAS EITHER BEEN PASSED OR IS PART OF THE RETAINED TISSUE.
TREATMENT FOCUSES ON HELPING THE WOMAN TO RELIEVE THE PAIN WITH
THE CONTRACTIONS AND SYMPTOMS

GROUP 3 - INCOMPLETE ABORTION

 ALISSA MAE SALES

Modifiable Risk Factors

WORKING AT THE PARLOR, EXPOSING TO THE CHEMICAL PRODUCTS AND DUST.
CIGARETTE USE
ALCOHOL USE
PATIENT'S MOTHER HAS HYPERTENSION

Non-Modifiable Risk Factors

AGE - 39 YEARS OLD
GENDER - FEMALE

GROUP 3 - INCOMPLETE ABORTION

Anatomy And
Physiology
Alexa Nicole Salvador

GROUP 3 - INCOMPLETE ABORTION

Anatomy and Physiology
The female reproductive system functions to produce
gametes and reproductive hormones, just like the
male reproductive system; however, it also has the
additional task of supporting the developing fetus and
delivering it to the outside world. Unlike its male
counterpart, the female reproductive system is
located primarily inside the pelvic cavity.

The female reproductive system has two parts:

External and Internal genitalia.
 Anatomy and Physiology
Mons pubis: A rounded mass of fatty tissue lying
over the joint of pubic bones. Its function is to
provide protection over the junction where the pubic
bones meet.

Labia majora: Two cutaneous folds extend from

mons pubis down to the perineum. Its function is to
cover and protect the inner, more delicate and
sensitive structures of the vulva, such as the labia
minora, clitoris, urinary orifice, and vaginal orifice.

Labia minora: The region of the female genital tract

buried inside the labia majora.
 External Genitalia
Mons pubis: A rounded mass of fatty tissue lying
over the joint of pubic bones. Its function is to
provide protection over the junction where the pubic
bones meet.

Labia majora: Two cutaneous folds extend from

mons pubis down to the perineum. Its function is to
cover and protect the inner, more delicate and
sensitive structures of the vulva, such as the labia
minora, clitoris, urinary orifice, and vaginal orifice.

Labia minora: The region of the female genital tract

buried inside the labia majora.
 External Genitalia
Bartholin gland: Are two small organs under the
skin in a woman's genital area. They are on either
side of the folds of skin (labia) that surround the
vagina and urethra. Its function is to secrete mucus
to ensure vaginal and vulval lubrication.

Clitoris: The vagina's pea-sized, most heavily

innervated organ that detects sensation and
stimulation. It is the human female's most sensitive
erogenous zone and generally the primary
anatomical source of human female sexual pleasure.

Vulva: The collective term for women's external

genitalia.
Internal Genitalia
Ovaries: Female reproductive organs which
produce all the ova (eggs) during a normal
menstrual cycle. The ovarian function including
follicular maturation, ovulation and corpus luteum
formation is regulated by a complex control
system composed of hypothalamus, pituitary and
the ovary itself. These organs communicate via
positive and negative feedback loops and can be
considered as a functional entity.

Fimbriae: Are small, fingerlike projections at the end

of the fallopian tubes, through which eggs move
from the ovaries to the uterus. The fimbriae are
connected to the ovary.
Internal Genitalia
Fallopian tubes: Also known as uterine tubes,
these are responsible for the transportation of ova
from the ovaries to the uterus. They are clinically
important in abortion because they are the most
common site of ectopic pregnancy (pregnancy
outside the uterus).

Uterus: The womb is a hormone-sensitive

reproductive organ where a fertilized ovum
implants. It is responsible for nurturing the
fertilized ovum and stages of development inside
the mother's body that take place in the uterus.
Internal Genitalia

Cervix: The lower part of the uterus, or the

connection between the uterus and vagina.

Vagina: The lowest part of the female genital tract,

starting from an external orifice to the cervix.
Pathophysiology
John Paul Tambor

GROUP 3 - INCOMPLETE ABORTION

Pathophysiology
Incomplete Abortion - is the partial loss of the products of conception within the first 20
weeks. It also defined as the expulsion of the fetus with retention of placenta.
Incomplete abortion usually presents with moderate to severe vaginal bleeding, which
may be associated with lower abdominal and/or pelvic pain. It occurs more frequently in
women with advanced maternal age and women with lower socioeconomic status or
those who engage in risky behaviors. It often Cause hemorrhage that may require
surgical evacuation by curettage, oxytocic’s, and blood replacement. Infection is also a
frequent complication of incomplete abortion.
Abdominal contraction that causes abdominal pain that stimulate the cervix to dilate
which leads to heavy vaginal bleeding with product of conception being passed but some
fragments are still retain to the uterus.
In this case scenario, the patient experienced heavy vaginal bleeding consuming 3
napkins fully soaked, along with crampy abdominal pain in the hypogastric region that is
radiating to the lower back, fever and (IE): Cervix is dilated with placental fragments.
P
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 Clinical Manifestation
Jamina Claire Suansing Luzielyn Tormis

• Hypogastric pain that is radiating to the lower back

• Heavy bleeding
• Dilated cervix with placental fragments
• Nausea & vomiting
• Headache characterized as crampy and bi-temporal in
location.
• Fever (38°C)
• Blood Pressure of 90/60 mmHg
 Diagnostic Test
SONOGRAPHY (TRANSABDOMINAL/TRANSVAGINAL)

Ultrasound imaging uses sound waves to produce

pictures of the inside of the body.
It is used to help diagnose the causes of pain, swelling
and infection in the body's internal organs and to
examine a baby in pregnant women and the brain
and hips in infants.
It's also used to help guide biopsies, diagnose heart
conditions, and assess damage after a heart attack.
Ultrasound is safe, noninvasive, and does not use
ionizing radiation.
GROUP 3 - INCOMPLETE ABORTION

Gracenel Vigonte
 Diagnostic Test
SONOGRAPHY (TRANSABDOMINAL/TRANSVAGINAL)

A sonographic diagnosis of "incomplete abortion"

was based on a bilayer endometrial thickness of more
than 8 mm.

The sensitivity and specificity of both clinical and

sonographic examinations for detecting products of
conception were assessed

GROUP 3 - INCOMPLETE ABORTION

Gracenel Vigonte
 Diagnostic Test

QUANTITATIVE hCG
BLOOD TEST

It is a hormone produced by the placenta during pregnancy, and an hCG blood test measures the
level of this hormone in your bloodstream.

Monitoring quantitative hCG levels can provide helpful information to assess whether you are
miscarrying or have other pregnancy complications such as an ectopic pregnancy.

GROUP 3 - INCOMPLETE ABORTION

Gracenel Vigonte
 Diagnostic Test

QUANTITATIVE hCG
BLOOD TEST

Since hCG levels vary from person to person, however, serial levels a few days apart give a better
idea of the status of your pregnancy.

In addition to your hCG levels, your doctor will use other information like any physical symptoms
you are experiencing and the results of an early ultrasound to determine if a miscarriage is
occurring.
GROUP 3 - INCOMPLETE ABORTION

Gracenel Vigonte
 Diagnostic Test
COMPLETE BLOOD COUNT TEST (CBC)

A CBC will help document the amount of blood loss

and whether anemia is present. If the hemoglobin and
hematocrit are very low and the patient is
symptomatic then transfusions would be warranted.

The CBC also will provide evidence regarding an

infection, which, in the case of infection, would yield
an elevated white blood cell count and a left shift on
differential.

GROUP 3 - INCOMPLETE ABORTION

Gracenel Vigonte
Medical Diagnosis
VIDANES

Incomplete abortion
Pieces of pregnancy tissue remain in the body after a
spontaneous or induced abortion, both medical and
surgical. It involves vaginal bleeding, cramping
(contractions), cervical dilatation, and incomplete
passage of the products of conception.

GROUP 3 - INCOMPLETE ABORTION

 DANICA JOY DELAPUNTA

Surgical Management
Dilation and Curettage
D&C Uterine curettage – manual aspiration in another safe therapeutic option
It is a therapeutic gynecological procedure as well as the most often used
method of trimester miscarriage or abortion.
is an operation performed on women to scrape away the uterus (womb) lining.

Indications Risks
Evidence of incomplete abortion Minimal, uterine perforation,
Heavy bleeding intrauterine adhesions,
Intrauterine sepsis cervical trauma, infection
Patient’s preference and anesthesia risks.
Documented Fetal demise or blighted ovum

GROUP 3 - INCOMPLETE ABORTION

Significant / Pertinent Findings
Earl Gerard Sabio

Fever
Abdominal Pain
Vomiting
Headache
Heavy Vaginal Bleeding
Nursing Care Plan
Jamina Claire Suansing
Luzielyn Tormis
Eizen Sabio
Alexsandra Serrano

GROUP 3 - INCOMPLETE ABORTION

Drug Study
Maricar Rae Sagun and Earl Gerard Sabio

GROUP 3 - INCOMPLETE ABORTION

Discharge Planning
Katricia Ross Tam
Rohaida Samo

GROUP 3 - INCOMPLETE ABORTION

 1.Medication
Discharge Take the medicine as prescribed by the physician

Planning
2. Environment:

•Normal room temperature

•Peaceful and quiet surroundings
•Good hygiene in the house

3.Treatment:
•Medication: take the medicine as prescribed
•Minimize strenuous activity
Discharge 4. Health Teaching:
Inspect consuming napkin everyday

Planning Inspect bleeding and Pain Scale

Practice good hygiene
Take medication and diet as directed

5. Outpatient:

•Follow up after one week with the

healthcare provider
Discharge 6. Diet:
Eat the recommended basic food groups:

Planning Fish, meat, eggs

Fruit and vegetables
Drink at least 2 cups of water each day
Drink milk and avoid caffeinated drinks
Avoid fried foods, fat rich foods, and spicy foods

7. Spiritual Advice
(Roman Catholic) A vibrant connection with God is spiritually
hydrating
Prayer is always the way to resolve the problems in life