Spontaneous Abortion

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Spontaneous Abortion


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Spontaneous Abortion And Rh Sensitization GROUP MEMBERS: Alo-ot, Karen Joy G. Camins, Ariane C. Miñoza, Charomae B. Orong, Divine Grace D.

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Abnormal Fetal Formation Immunologic Factors Infection Teratogenic Factors (smoking, alcohol, drugs) Rejection of the embryo through immunologic response Crosses placenta Fetus fails to grow Decrease estrogen and progesterone production Endometrial sloughing Release of prostaglandin which causes uterine contractions and cervical dilatation Spontaneous Miscarriage Schematic Diagram of Spontaneous Abortion

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Clinical Manifestations Uterine cramping, low back pain. Vaginal bleeding usually begins as dark spotting, then progresses to frank bleeding as the embryo separates from the uterus. ß-hCG level may be elevated for as long as 2 weeks after loss of the embryo.

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Nursing Diagnosis Risk for fluid volume deficit r/t maternal bleeding Nursing Interventions Report any tachycardia, hypotension, diaphoresis, or pallor, indicating hemorrhage and shock. Draw blood for type and screen for possible blood administration. Establish and maintain an IV with large-bore catheter for possible transfusion and large quantities of fluid replacement.

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Anticipatory grieving r/t loss of pregnancy, cause of abortion, future childbearing Nursing Diagnosis Nursing Interventions Assess the reaction of patient and support person, and provide information regarding current status, as needed. Encourage the patient to discuss feelings about the loss of the baby’ include effects on relationship with the father. Do not minimize the loss by focusing on future childbearing; rather acknowledge the loss and allow grieving. Providing time alone for the couple to discuss their feelings.

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Nursing Diagnosis Risk for infection r/t dilated cervix and open uterine vessels Nursing Interventions Evaluate temperature q 4H if normal, and every 2H if elevated. Check vaginal drainage for increased amount and odor, which may indicate infection. Instruct on and encourage perineal care after each urination and defecation to prevent contamination.

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Pain r/t uterine cramping and possible procedures Nursing Diagnosis Nursing Interventions Instruct patient on the cause of pain to decrease anxiety. Instruct and encourage the use of relaxation techniques to augment analgesics. Administer pain medication as needed and as prescribed.

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Nursing Diagnosis Nursing Interventions Knowledge deficit r/t signs and symptoms of possible complications Teach the woman to observe for signs of infection (fever, pelvic pain, change in character and amount of vaginal discharge), and advise to report them to provider immediately. Deal with client’s anxiety. Present information out of sequence, if necessary, dealing first with material that is most anxiety producing when the anxiety is interfering with the client’s learning process. Teach client of the complications for a mother has reason to be especially worried about her infant’s health.

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Nursing Assessment Evaluate the amount and color of blood that is present; determine the time bleeding began and any precipitating factors. Determine whether a positive pregnancy test has previously been obtained, also the date of the last menstrual period. Monitor maternal vital signs for indications of complications such as hemorrhage, infection. Evaluate any blood or clot tissue for the presence of fetal membranes, placenta, or fetus.

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Therapeutic Management Depending on the symptoms and the description of the bleeding a woman gives, the physician or nurse-midwife will decide whether she needs to be seen and, if so, seen in an ambulatory setting or the hospital.

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Schematic Diagram of Rh Sensitization Rh (+) Father with D antigen Rh (-) Mother (no D antigen) Rh (+) Baby Mother’s system perceives D antigen as “non self” Mother’s system forms antibodies Transfusion of Rh (+) blood to Rh (-) blood of the mother

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Antibodies cross placenta and cause fetal hemolysis Hemolytic Disease of the Newborn Insufficient Oxygen Supply Deficient RBC’s Occasional villus ruptus (interaction between fetal and maternal circulation) Amniocentesis Placental separation

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All women should be tested for blood group, Rh factor Hx of previous miscarriage Blood transfusion Infants experiencing jaundice(hyperbilirubenemia) If mom Rh(-), father should be tested to determine Rh status(+ or -). Rh(-) dad + Rh(-) mom = Rh(-) baby Indirect Coomb’s test on maternal blood to check if mom has developed antibodies to Rh antigen. Serial body antibody screening should continue throughout pregnancy to identify increase antibody production. Direct Coomb’s test done on infants blood after birth to identify maternal antibodies attached to fetal RBC. Amniocentesis is the preferred method of assessment after 27 weeks but may be combined with ultrasound examination and fetal blood sampling when severe disease is suspected before this.

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Clinical Manifestations Maternal Elevated anti D antibody Fetal Jaundice Anemia Hyperbilirubinemia

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Nursing Diagnosis Deficient Knowledge r/t fetal condition Note personal factors such as age, sex, cultural background, religion, life experiences, and level of education and sense of powerlessness. Provide positive reinforcement. Discuss to client regarding her condition according to her level of understanding Nursing Interventions

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Anxiety r/t loss of pregnancy and future childbearing Nursing Interventions Identify client’s perception of the threat represented by the situation. Observe behavior indicative of level of anxiety. Tell client to express her concerns regarding the situation and be there to listen to client. Nursing Diagnosis

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Nursing Diagnosis Nursing Interventions Risk for Injury Provide information regarding disease condition Encourage client to discuss with physician on proper therapeutic regimen to follow regarding client’s condition Demonstrate/encourage use of techniques to reduce or manage stress and vent emotions such as anger, and hostility

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Nursing Interventions Nursing Diagnosis Ineffective Tissue Perfusion r/t decreased RBC’s Determine factors related to individuals situation Note for signs of respiratory distress Comply with therapeutic regimen and appropriate safety measures as ordered by the physician

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Nursing Diagnosis Nursing Interventions Anticipatory Grieving r/t loss of pregnancy Determine client’s perception of anticipated loss and meaning to her Note emotional responses such as withdrawal, angry behavior and crying Give information that feelings are OK to be expressed appropriately

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Medical and Surgical Management Medical RHOGAM- prevents mother from forming antibodies. Given at I.M, dose 500 i.u. within 72 hours of delivery. Similarly, when invasive procedures such as Amniocentesis are carried out Anti D is given. Gamma globulin (IVIG) - administered in high doses. Helps reduce antibody count and the chance of fetal involvement.

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Surgical Exchange Transfusion- withdrawal of blood through the umbilical vein and is replaced with healthy compatible blood. It thus correct anemia and reduces high levels of circulating bilirubin. Intrauterine Transfusion- to restore fetal red blood cells, blood transfusion can be performed on the fetus in utero. Injecting RBCs directly into a vessel in the fetal cord or depositing them in the fetal abdomen using amniocentesis technique. Blood use for transfusion in utero is either the fetus’s own type (determined by percutaneous blood sampling) or group O negative if the fetal blood type is unknown.

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