Obstetrics | Family Medicine Help

Special considerations in Patients with Abortion

Gynaecology, Obstetrics Comments Off

Mar 082012

Before an abortion, perform the following:

Thoroughly explain all procedures to the patient.
After the patient uses the bedpan, inspect the contents carefully for intrauterine

material. (The patient shouldn’t have bathroom privileges because she may inadvertently expel uterine contents.)

After spontaneous or elective abortion, perform the following:

Note the amount, color, and odor of vaginal bleeding. Save all the pads the patient uses, for evaluation, and provide perineal care.
Administer oxytocin and an analgesic as ordered.
Obtain vital signs every 15 minutes for 1 hour, every 30 minutes for 2 hours, every hour for 2 hours, then every 4 hours for 24 hours.
Monitor urine output.

Caring for a patient who has had a spontaneous abortion includes emotional support and counseling during the grieving process. Encourage the patient and her partner to express their feelings. Some couples may want to talk to a member of the clergy or, depending on their religion, may wish to have the fetus baptized.

The patient who has had a therapeutic abortion also benefits from support. Encourage her to verbalize her feelings. Remember, she may feel ambivalent about the procedure; intellectual and emotional acceptance of abortion aren’t the same. Refer her for counseling, if necessary.

Before the patient is discharged, perform the following:

Tell the patient to expect vaginal bleeding or spotting and to immediately report excessive Continue reading »

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Brief Summary of Abortion

Gynaecology, Obstetrics Comments Off

Nov 302011

Abortion is the spontaneous or induced (therapeutic) expulsion of the products of conception from the uterus before 20 weeks gestation (fetal weight less than 500 g [17½2 oz]). Up to 15% of all pregnancies and about 30% of all first pregnancies end in spontaneous abortion (miscarriage). At least 75% of miscarriages occur during the first trimester.

Causes

Spontaneous abortion may result from fetal, placental, or maternal factors. (See Types of spontaneous abortion.) Fetal factors usually cause abortions before the 12th week of gestation and include:

defective embryologic development resulting from abnormal chromosome division (most common cause of fetal death)
faulty implantation of the fertilized ovum
failure of the endometrium to accept the fertilized ovum.

Placental factors usually cause abortion around the 14th week of gestation, when the placenta takes over the hormone production necessary to maintain the pregnancy. These factors include:

premature separation of the normally implanted placenta
abnormal placental implantation.

Maternal factors usually cause abortion during the second trimester and include:

maternal infection, severe malnutrition, and abnormalities of the reproductive organs (especially an incompetent cervix, in which the cervix dilates painlessly and bloodlessly in the second trimester)
endocrine problems, such as thyroid dysfunction or a luteal phase defect
trauma, including any surgery that requires manipulation of the pelvic organs
phospholipid antibody disorder
blood group incompatibility
drug ingestion.

The goal of therapeutic abortion is to preserve the mother’s mental or physical health in cases of rape, unplanned pregnancy, or medical conditions, such as moderate or severe cardiac dysfunction.

Signs and symptoms

Prodromal signs of spontaneous abortion include a pink discharge for several days or a scant brown discharge for several weeks before the onset of cramps and increased vaginal bleeding. For a few Continue reading »

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Diabetic complications during pregnancy

Obstetrics Comments Off

May 052011

Pregnancy places special demands on carbohydrate metabolism and causes the insulin requirement to increase, even in a healthy woman. Consequently, pregnancy may lead to a prediabetic state, to the conversion of an asymptomatic subclinical diabetic state to a clinical one (gestational diabetes occurs in about 1% to 2% of all pregnancies), or to complications in a previously stable diabetic state.

Prevalence of diabetes mellitus increases with age. Maternal and fetal prognoses can be equivalent to those in nondiabetic women if maternal blood glucose is well controlled and ketosis and other complications are prevented. Infant morbidity and mortality depend on recognizing and successfully controlling hypoglycemia, which may develop within hours after delivery.

Causes

In diabetes mellitus, glucose is inadequately used either because insulin isn’t synthesized (as in type 1, insulin-dependent diabetes) or because tissues are resistant to the hormonal action of endogenous insulin (as in type 2, non–insulin-dependent diabetes).

Protective mechanisms

During pregnancy, the fetus relies on maternal glucose as a primary fuel source. Pregnancy triggers protective mechanisms that have anti-insulin effects: increased hormone production (placental lactogen, estrogen, and progesterone), which antagonizes the effects of insulin; degradation of insulin by the placenta; and prolonged elevation of stress hormones (cortisol, epinephrine, and glucagon), which raise blood glucose levels.

In a normal pregnancy, an increase in anti-insulin factors is counterbalanced by an increase in insulin production to maintain normal blood glucose levels. However, women who are prediabetic or diabetic can’t produce sufficient insulin to overcome the insulin antagonist mechanisms of pregnancy, or their tissues are insulin-resistant.

As insulin requirements rise toward term, the patient who is prediabetic may develop gestational diabetes, necessitating dietary management and, possibly, exogenous insulin to achieve glycemic control. The insulin-dependent patient may need increased insulin dosage.

Signs and symptoms

All women should receive diagnostic screening for maternal diabetes mellitus during pregnancy. Continue reading »

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