Incomplete Abortion

Republic of the Philippines
City of Olongapo GORDON

COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports Complex, Donor st. East Tapinac, Olongapo City, 2200
A Case Study of 20years Old G2 P1 (1-0-1-1) PU 17 5/7 Weeks AOG

Incomplete abortion, non-septic, non-induced completion curettage AV
sedation
In partial fulfillment of the Subject Clinical Practicum 205
Mary Chynna T.
Villanueva
2023
1
COLLEGE
INTRODUCTION
Incomplete abortion refers to a situation in which the termination of a

pregnancy is not fully completed, resulting in the retention of fetal or placental tissue
in the uterus. It is a critical obstetric condition that can lead to complications if not
properly addressed (Ashley Redinger; Hao Nguyen).
In a normal abortion or miscarriage, the uterus expels all the pregnancy tissue
naturally. However, in cases of incomplete abortion, some portion of the tissue
remains inside the uterus, necessitating further medical intervention. This retained
tissue can cause persistent bleeding, increase the risk of infection, and potentially
lead to future fertility issues if not managed appropriately.
There can be various causes of incomplete abortion. Hormonal imbalances,

structural abnormalities of the uterus, infections, or errors during medical procedures
are some common factors that contribute to this condition. Understanding the
underlying cause is crucial for tailoring the most effective treatment plan for each
individual case.
The clinical presentation of incomplete abortion typically involves symptoms

such as persistent or heavy vaginal bleeding, abdominal pain or cramping, passing
of tissue or blood clots from the vagina, and a decrease in pregnancy-related
symptoms. These signs indicate the need for medical evaluation and intervention to
ensure complete evacuation of the uterus and prevent potential complications.
In this case study, we will explore a specific patient scenario where

incomplete abortion is suspected based on the clinical presentation and diagnostic
findings. We will delve into the patient's history, symptoms, physical examination
results, and relevant laboratory or imaging investigations. This comprehensive
evaluation will aid in confirming the diagnosis and determining the appropriate
management approach.
Throughout the case study, we will analyze the treatment options available for
managing incomplete abortion, considering factors such as the gestational age,
patient preferences, and overall health status. We will explore both medical and
surgical interventions, discussing the benefits, risks, and potential outcomes
associated with each option.
Furthermore, we will address the emotional and psychological aspects of

incomplete abortion in this case study. Understanding the impact this condition can
have on the patient's well-being is crucial for providing compassionate care and
support during their journey.
By examining this case study, we aim 2 to deepen our understanding of

incomplete abortion, refine diagnostic skills, and explore effective management
strategies. The knowledge gained from this analysis will contribute to improved
patient outcomes and the delivery of comprehensive, patient-centered care.
COLLEGE
PATHOPHYSIOLOGY OF ABORTION
ABORTION
SPONTANEOUS INDUCED
(Miscarriage) (Deliberate)
ISOLATED RECURRENT LEGAL MTP ILLEGAL

UNSAFE
SEPTIC COMMON
THREATENE INEVITABLE COMPLETE INCOMPLETE MISSED

D
SEPTIC LESS
COMMON
3
COLLEGE
PATIENT PROFILE
This is the case of Patient M, 20 years old G2P1 (1001) 17 5/7 weeks AOG, Female,
Filipino, Roman Catholic, currently lives in Sta. Rita, Olongapo City , admitted for vaginal
bleeding(spotting) in James L. Gordon Memorial Hospital on February 2023 around 9:30am
1 day prior to admission, vaginal bleeding/spotting with headache characterized as
crampy abdominal pain. Paracetamol 500 mg was taken to relieve the symptoms few hours prior
to admission, vaginal bleeding, hypo gastric pain that prompted her for hospitalization.
The patient M has no previous hospitalization or any surgeries noted. No medical history
and family history of cancer, Tb, asthma, diabetes, hypertension and etc.
Patient M lives with her children and husband. The patient is a Senior High School
graduate, currently not working. Patient is a smoker consuming 5 sticks per day, occasional
drinker consuming 1 bottle of any alcohol beverages. Diet consists mainly of fish, meat, eggs,
vegetables and rice.
Patient M menarche started when she was 13 years old, her menstrual duration is 10
days, regular cycle of 28, with heavy menstrual flow consuming 4 to 5 pads in in first 4 days. The
patient reported of having severe dysmenorrhea on every first day of her menstruation. The
patient reported that the dysmenorrhea is severe with a pain scale of 6/10 and mefenamic acid
2x a day was taken to relieve the pain.
Her coitarche when she was at the age of 15years old and has had 1 partner. Patient
M is weight 60kg and her height is 160cm . No history of sexually transmitted disease, urinary
incontinence, and post coital bleeding.
Her Admitting diagnosis is 20 years Old G2P1 (1-0-0-1). Incomplete Abortion, non-
induced, non-septic, 17 5/7week AOG
4
COLLEGE
COURSE IN WARD
Day 1
At 9:30am
Patient M, a 20-year-old female with an obstetric score of G2P1 (1-0-0-1) and a
resident of Sta. Rita, Olongapo City, was admitted to James L. Gordon Memorial Hospital on
February 2023 at exactly 9:30 am. The patient was transferred to the Emergency Room (ER)
triage area via a wheelchair, accompanied by a nurse on duty. She presented with a chief
complaint of vaginal bleeding, leading to the need for assessment. The scheduled
completion of curettage was planned due to the initial findings suggestive of an incomplete
abortion.
Upon admission, Patient M was placed under the care of Dr. Sangalang, who advised her to
be NPO (nothing by mouth) and initiated intravenous fluid (IVF) therapy with D5LRS
(Dextrose 5% in Lactated Ringer's Solution) at a rate of 20 gtts/min. The patient's initial vital
signs were recorded as follows: blood pressure (BP) of 110/70 mmHg, heart rate (HR) of 90
beats per minute (bpm), respiratory rate (RR) of 20 breaths per minute (bpm), and a
temperature of 36.8°C.
Considering the chief complaint of vaginal bleeding and the patient's obstetric history
(G2P1), Dr. Sangalang suspected an incomplete abortion as the likely cause. An incomplete
abortion occurs when some fetal or placental tissue remains in the uterus after a pregnancy
termination, leading to persistent bleeding and potential complications. To confirm this
diagnosis and assess the severity of the condition, laboratory tests were conducted on the
same day. These included a complete blood count (CBC) to evaluate blood parameters,
Hepatitis B surface antigen (HbsAg) to screen for Hepatitis B infection, and bleeding time
(BT) to assess coagulation status.
Regarding how the patient knows that she is pregnant, it would typically be based on her
own awareness of missed menstrual periods, changes in her body, or the use of a
pregnancy test. However, specific details about the patient's pregnancy awareness are not
provided in the given information.
At 11:30am
Patient C, Laboratory result was received

5
COLLEGE
HEMATOLOGY
Examination Result Ref. Value
Blood Type “O” Rh(t)
Hemoglobin 131 M:140-180 F:120-150
Hematocrit 0.44 M:0.40-0.50 F:0.30-0.40
WBC 8.59 5.0-10x10^9/L
Neutrophils 0.73 0.30-0.70
Lymphocytes 0.24 0.20-0.40
Monocyte 0.05 0.02-0.10
Eosinophils 0.02 0.02-0.06
Platelet 230 150-350x10^9/L
RBC 4.14 Pedia: 3.8-5.4x10^9/L
Adult: 4.6-5.0x10^9/L
Interpretation: Patient C neutrophils is above the reference value.
IMMUNULOGY AND SEROLOGY

HBsAg Non-Reactive QIA One Step Assay
Syphilis Ab Non-Reactive QIA One Step Assay
Interpretation: The results on HBsAg and Syphilis are both non-reactive which indicates
that Patient C is negative for Hepatitis B and syphilis disease
At 11:35pm
Patient M is awake and coherent. She was complaining of “dinudugo po ako” verbalized by
the patient. She was transfer from LR to DR assisted by nurse on duty, she was placed in
DR table safety and preparation for completion curettage. Initial vital sign was recorded BP
of 110/80mmHg, CR of 89bpm, and RR of 20bpm and temperature of 36.5C.
At 12:05pm
Patient M was still on a nothing per Orem diet. She has an ongoing IVF D5LRS
1Lx20gtts/min.
6
COLLEGE
At 1:15pm
The procedure of completion curettage was started. Patient M was hooked inhalated 2.3
liters per min. Hooked to a cardiac monitoring. She had an ongoing IVF D5LRS
1Lx20gtts/min under IV sedation. Evacuation of blood clots was done. The collected
specimen was sent to laboratory for Histopath. Prior to the procedure IV ampicillin 2 grams
was given thru IV nurse on duty. Initial vital sign was recorded BP of 110/80mmHg, CR of
88bpm, and RR of 20bpm and temperature of 36.4C
At 1:50pm
The procedure of completion curettage was done. No vaginal bleeding was noted. The
uterus well contracted. Patient M was transferred from DR to RR, she was oriented to
time, date and place with IVF D5LRS 1L with 1 units of oxytocin regulated at 20gtts/min.
Her vital signs were monitored and all her need were attended
TIME BP PR RR TEMP
9:30 AM 110/70 mmHg 90 bpm 20 bpm 36.8ºC

11:35 AM 110/80 mmHg 89 bpm 20 bpm 36.5ºC
1:15 PM 110/80 mmHg 88 bpm 20 bpm 36.4ºC
1:50 PM 110/80 mmHg 81 bpm 21 bpm 36.9ºC
2:00 PM 110/80 mmHg 80 bpm 21 bpm 36.5ºC
At 2:00 PM
Patient M was transferred from Recovery Room to OB Ward, she was oriented to time,
date and place with IVF D5LRS 1L with 10 units of oxytocin regulated at 20gtts/min. Her
vital signs were monitored and all her need were attended. She was endorsed to
nurse on duty.
7
COLLEGE
MEDICATIONS
INTRAPARTUM MEDICATIONS
MEDICINE DOSAGE ROUTE INDICATION APPLICATION
TO PATIENT
D5LRS 1 liter Intravenous For persons needing Restore fluids
(Dextrose regulated at extra calories, and electrolytes
5% in 30 drops source of water and lost by the
Lactated per minute electrolytes. patient after
Ringer’s delivery.
Solution.
POST UP MEDICATIONS
MEDICINE DOSAGE ROUTE INDICATION APPLICATION
TO PATIENT
Co-Amoxiclav 1 tablet 2x a Oral Used for treating Prevent infections
625mg/tablet day for 7 bacterial infections from developing
days
Mefenamic 1capsule Oral Treatment for pain in Minimizes the

Acid every 8 certain condition. patient's suffering
500mg/capsul hours from pain.
e
Ferrous 1 capsule a Oral Treatment for iron Provide elemental

Fumarate day for 90 deficiency iron, and
days or 3 essential
months component in the
formulation of
hemoglobin
Oxytocin –10 units –Incorporated Enhance uterine Facilitates in

in contractions and uterine
intravenous minimize postpartum contraction of the
– 1 ampule fluid hemorrhage. patient.
–Intramuscular8
COLLEGE
9
COLLEGE
CONCLUSION
Patient M was admitted at James L. Gordon Hospital on February 3, 2023 at exactly

9:30 am for her Completion curettage. The laboratory results, number of fetuses are two,
absence of fetal heart tone and non-viable, accompanied with vaginal bleeding, hypo gastric
pain. Rule out the diagnosis of incomplete abortion when a bloody vaginal discharge or
bleeding appears during the first half of pregnancy
Proper monitoring and management helped Patient M to stabilize her condition. All
medications indicated for the patient were given by the health provider at the right scheduled
time. The patient stable and able to get discharged without complications or issues that
required referral. They were advised to continue their recovery at home.
A Case Study of 20years Old G2P1 (1-0-1-1) PU 17 5/7 Weeks AOG Completed abortion,
non-septic, non-induced completion curettage AV sedation
10
COLLEGE
RECOMMENDATION
After assessing Patient M's incomplete abortion and addressing her immediate
medical needs, it is important to provide her with comprehensive advice and
recommendations regarding her reproductive health and family planning. Here are some
suggestions:
Patient M should have a thorough discussion with her healthcare provider about
available family planning methods and their suitability for her situation. This conversation can
help her make informed decisions about contraception to prevent unintended pregnancies in
the future. The healthcare provider can provide information on various options, including
hormonal contraceptives, barrier methods, intrauterine devices (IUDs), and natural family
planning methods.
Patient M should receive detailed information about the effectiveness, usage, and
possible side effects of different contraceptive methods. This education should cover topics
such as correct and consistent usage, potential interactions with other medications, and the
importance of regular follow-ups with a healthcare provider for monitoring and adjusting the
chosen contraceptive method, if needed.
Emphasize the significance of regular check-ups with a healthcare provider,

especially during the preconception and prenatal periods. These check-ups allow for
monitoring of reproductive health, early detection of any potential issues, and the provision
of necessary support and guidance for a healthy pregnancy.
Encourage Patient M to maintain a healthy lifestyle by engaging in regular physical

activity, consuming a balanced diet, and avoiding harmful substances such as smoking and
excessive alcohol consumption. These lifestyle choices can promote her overall well-being
and increase the chances of a successful future pregnancy.
Offer resources and information about counseling services or support groups that
specialize in reproductive health and pregnancy-related issues. Coping with a miscarriage or
incomplete abortion can be emotionally challenging, and having access to a support network
can aid in the healing process.
Schedule follow-up appointments for Patient M to monitor her recovery, assess her
11 or questions she may have regarding her
emotional well-being, and address any concerns
reproductive health and future pregnancies.
COLLEGE
REFERENCES
https://www.scribd.com/document/446752831/CASE-STUDY-abortion-docx#
https://medlineplus.gov/ency/article/001488.htm#:~:text=Complete%20
abortion%3A%20All%20of%20the,and%20a%20miscarriage%20will%20happen
Lectures from Ms. Maria Sandra Rivera, RM, BSM, MCHS
12

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Republic of the Philippines

City of Olongapo GORDON

A Case Study of 20years Old G2 P1 (1-0-1-1) PU 17 5/7 Weeks AOG

In partial fulfillment of the Subject Clinical Practicum 205

Incomplete abortion refers to a situation in which the termination of a

There can be various causes of incomplete abortion. Hormonal imbalances,

The clinical presentation of incomplete abortion typically involves symptoms

In this case study, we will explore a specific patient scenario where

Furthermore, we will address the emotional and psychological aspects of

By examining this case study, we aim 2 to deepen our understanding of

ISOLATED RECURRENT LEGAL MTP ILLEGAL

THREATENE INEVITABLE COMPLETE INCOMPLETE MISSED

Patient C, Laboratory result was received

Interpretation: Patient C neutrophils is above the reference value.

IMMUNULOGY AND SEROLOGY

9:30 AM 110/70 mmHg 90 bpm 20 bpm 36.8ºC

Mefenamic 1capsule Oral Treatment for pain in Minimizes the

Ferrous 1 capsule a Oral Treatment for iron Provide elemental

Oxytocin –10 units –Incorporated Enhance uterine Facilitates in

Patient M was admitted at James L. Gordon Hospital on February 3, 2023 at exactly

Emphasize the significance of regular check-ups with a healthcare provider,

Encourage Patient M to maintain a healthy lifestyle by engaging in regular physical

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