So baby HOLD ON to me

Whatever will be ,will be

The future is ours to see
When you hold on to me…

Baby HOLD ON to me
CLINICAL CASE :

This is a case of 32years old female, Gravida 2

Para 1 + 0,17 weeks with chief complaints of
vaginal bleeding for 24hrs and lower abdominal
pain . With history of GDM on diet .
LABORATORY INVESTIGATIONS:
RADIOLOGY REPORT :
THREATENED
ABORTION
THREATENED
ABORTION
It is a clinical entity where
the process of miscarriage
has started but has not
progressed to a state from
which recovery is impossible.
It is the most common
complication in the first
trimester of pregnancy .
OBJECTIVES:
•to asses the outcome
of threatened
abortion following treatment.
• to evaluate the effect of
threatened abortion on early
pregnancy
• to determine whether
patients with first-trimester
threatened abortion are at
increased risk for poor
pregnancy outcome
 ANATOMY
AND
PHYSIOLOGY
PATHOPHYSIOLOGY
 CLASSIFICATION
OF ABORTION

SPONTANEOUS INDUCED

LEGAL ILLEGAL
ISOLATED RECURRENT

SEPTIC

THREATENED INEVITABLE COMPLETE INCOMPLETE MISSED SEPTIC

 CAUSES:
*age common among women over 35y/o
PRECIPITATING FACTOR: *Maternal factors
>8 weeks AOG *chromosomal abnormalities
*sepsis
* Lifestyle
*

During egg implantation, egg slightly separates

or tears from the uterus

Blood collects between the chorionic membranes and the wall of

the uterus

Blood leaks in the cervix

Blood uterine Minimal vaginal

cramping spotting /bleeding
(lower abdomen)
Subchorionic hemorrhage

Severe bleeding can lead to

rupture of subchorionic
membrane

Risk for miscarriage

(threatened
abortion)
STATISTICAL DATA
 STATISTICAL DATA BASED ON CLINICAL
RESEARCH EVIDENCES:

 This study was conducted in the department of Obstetrics and

Gynecology, from January 2010 to December 2010. Total of 89 cases
were included in the study and had ultrasound after presenting with
symptoms of threatened abortion at or below 20 weeks of gestation.
 The diagnostic criteria for threatened miscarriage was based on
documented fetal cardiac activity on ultrasound with a history of vaginal
bleeding in the presence of a closed cervix and gestational age at 20.
The overall adverse pregnancy outcomes was significantly higher in
women with threatened miscarriage than the control group (p=015).
PROGNOSIS:

More than half of women who bleed during the first 12

weeks of pregnancy will stop bleeding and continue to
have a healthy pregnancy . For other half of these
women, cramping and bleeding worsen and they will
eventually miscarry. A wowan may not know whether
she is going to miscarry when she leaves the emergency
department.
WORLD HEALTH
ORGANIZATION
40-50 MILLION
ABORTIONS
 125,000
ABORTIONS
PER DAY
 DALLAH HOSPITAL-NAMAR

FROM APRIL- DECEMBER, 2018

5 CASES

FROM JANUARY-JUNE 2019

3 CASES
NURSING CARE
PLAN
 ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Subjective : Short term goal INDEPENDENT
Deficient fluid volume After 8 hours of nursing 1. Monitor vital signs and compare 1.Changes in blood pressure MET
“I am twelve weeks related to bleeding intervention the patient with patient normal or previous may be rough estimate of The patient was able to
pregnant have had during pregnancy will demonstrate improve readings. blood loss demonstrate improve fluid
cramping and bleeding fluid volume balance as volume balance as evidence
since last night” as evidence by stable vital 2. Note patients individual 2. Symptomalogy maybe by stable vital signs, good
verbalized by patient signs, good skin turgor and physiological response to bleeding useful in gauging severity or skin turgor and prompt
prompt capillary refill such as changes in mentation, length of bleeding episode, capillary refill.
weakness, restlessness and pallor. worsening of symptoms may
be reflect continued bleeding
Objective : Long term goal 3. Monitor Intake and Output and or inadequate fluid
Delayed capillary refill After 24 hrs days of correlate with weight changes. replacement
Restlessness nursing intervention the Measure the maternal blood loss by 3. Provides guideline for fluid
changes in mentation patient will demonstrate saving and weighing the used pads. replacement.
Vital signs sufficient fluid volume > if bleeding is profuse place the
T- 36.8 balance woman flat in bed on her side and 4 Activity increases intra
P- 90 monitor uterine contraction and fetal abominal pressure and can
R- 20 heart rate through external monitor. predispose
BP- 110/70
4 Maintain bed rest rest , schedule
activities to provide undisturbed rest
periods.
1. Fluid replacement with
DEPENDENT isotonic depends on the degree
and duration of bleeding
1.Administer fluid as indicated.
2. Aid in establishing blood
2. Monitor hemoglobin, hemotocrit replacement needs and
and RBC. monitoring efficiency of
therapy
 ASSESSMENT NURSIN DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
INDEPENDENT
Subjective Anxiety related to Short term goal 1. Monitor maternal and fetal 1. To identify physical MET
“This is the first time I have complication in pregnancy After 8 hours the client will vital signs. responses associated with both
this kind of pregnancy, I am be able to verbalize decrease medical and emotional
afraid of what will happen”as anxiety, appear relaxed and conditions, The client was able to
verbalized by patient comfortable, use 2.Use presence or verbalization 2. Being supportive verbalize decrease anxiety,
communication and to encourage expressions or and approachable encourages appear relaxed and
relaxation technique in order clarifications of needs, concerns communication. comfortable, use
to alleviate the anxiousness unknowns and questions. Take communication and relaxation
time to listen and understand. technique in order to alleviate
Long term goal the anxiousness.
Objective After 24hrs of nursing 3.To assist client to identify
poor eye contact intervention the patient will 3. Establish a therapeutic feelings and begin to deal with
restlessness be able to relieve from relationship conveying empathy problems.
uneasiness anxiety and unconditional positive
regard.

4.Encourage use of relaxation 4. It enable to obtain

techniques such as deep maximum benefit from rest
breathing and music therapy. periods, prevents muscle
fatigue.
 Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

Subjective: Acute pain Short term goal Determine the Indicates

“My lower related to Within 30 extent/severity need for/ MET
abdomen hurts ” as mild uterine minutes of and location of effectiveness The Patient was
verbalized by the cramping. nursing discomfort. of intervention able to state
patient intervention, and may that the
the patient will Explain to the signal discomfort is
Objective: state the client the nature development/ minimized and
Grimacing discomfort is of discomfort resolution of or controlled
Guarding behavior minimized expected. complication. and identify
Pain score 4/10 and/or /use methods
( 10 is the highest controlled Provide comfort that provide
and 1 is the measures such as relief.
lowest) Long term goal relaxation and To relieve or
After 4 hours breathing minimize the
nursing techniques patients pain
intervention the
patient will Provide
definitely use information about
methods that the use of
provide relief. prescribed or
non prescribed
analgesics
COMPLICATIONS
AND
MANAGEMENT
FETAL RISKS MATERNAL RISK

GROWTH
RETARDATION ANTEPARTUM
HEMORRHAGE

PRETERM DELIVERY
MANUAL REMOVAL OF
PLACENTA /ERPOC

PERINATAL DEATH

LOW BIRTHWEIGHT
 TREATMENT/MANAGEMENT:
.PELVIC ULTRASOUND WEEKLY UNTIL A VIABLE PREGNANCY
IS CONFIRMED OR EXCLUDED.
.URINE ANALYSIS
.LABORATORY TEST HEMOGLOBIN AND HEMATOCRIT
.RH NEGATIVE SHOULD BE TREATED WITH RHOGAM
NON PHARMACOLOGICAL
BED REST
JUST
SAY
NO
PSYCHOLOGICAL
SUPPORT
PHARMACOLOGICAL
 DISCHARGE INSTRUCTIONS:
*Adhere on follow –up care instructions.
CONTACT YOUR HEALTH
CARE PROVIDER IMMEDIATELY IF:
 FEELING WEAK OR DIZZINESS
 PAIN OR CRAMPING IN YOUR ABDOMEN OR BACK GETS WORSE
 VAGINAL BLEEDING THAT SOAKS PADS IN AN HOUR
 PASSING OF MATERIAL THAT LOOK LIKES TISSUE OR CLOTS
 If mother holds him close and
warm ,letting him mold to the
shape of her body, he is likely to
perceive her message to him us “ I
accept and love you “.

But if she tenses up and holds him

stiffly a little away from her ,he
may read her as conveying : “I
reject you and don’t want you
close “!
THANK YOU !!!!
RERERENCES:
• Kararasli V.Kanmaz AG,Inan,AH,Budak A,Beyan E. Maternal and neonatal
outcomes of pregnancy
• Hendricks E.MacNaughton H,MacKenzie Mc.
• Salah Roshdy Ahmed
• Mohammed EL-Khatem
• www,worldometers.com
• www,scribd.com
• www.healthline.com /doc
• www.ncbi.nlm.nih.gov
• www.nurselabs.com