Suzette Rae D.

Tate BSN-2
CASE STUDY #1
Amaya, 20 years old, primipara, is on the 20
th
week of pregnancy, and she is experiencing vaginal
spotting with slight cramping. She went the doctor and he told her that she is having the manifestations
of threatened abortion.
1. Describe the difference between abortion and miscarriage.
Abortion refers to the termination of pregnancy by the removal of an embryo or fetus from the
uterus which results to its death. Miscarriage is also known as spontaneous abortion or
unintentional abortion. It is unintentional if expulsion of the fetus before 24
th
week of gestation.
2. Define induced abortion and spontaneous abortion.
Induced abortion is an intentional (willful or deliberate) abortion brought about by mechanical
or chemical means constitute induced abortion. Spontaneous abortion is an abortion caused by
disease or accident, it is unintentional expulsion of the fetus.
3. Contrast early miscarriage from late miscarriage.
An early miscarriage is the loss of a pregnancy in the first 12 weeks. Doctors describe a late miscarriage as
one that happens after 12 weeks and before 24 weeks of pregnancy.
4. What is the meaning of threatened abortion?
A threatened miscarriage is a condition that suggests a miscarriage might take place before the
20th week of pregnancy.
5. In terms of manifestations, what is the main difference between threatened miscarriage and
imminent abortion.
In threatened abortion there is NO cervical dilatation present on vaginal examination. While in
imminent abortion cervical dilatation will occur.
6. How can you help Amaya minimize the guilt that she felt?
Telling Amaya that event such as running up a flight of stairs, forgetting to take an iron pill, or
getting angry does not cause miscarriage.
7. What are the management that will be administered to preserve the pregnancy? Include
rationales.
In the past, estrogen in the form of diethylstilbestrol (DES) was prescribed to hold the
pregnancy, but there is no conclusive evidence that this helped and because DES could be
teratogenic, this practice is no longer advocated. If the spotting with threatened miscarriage is
going to stop, it usually does so within 24-48hrs after a woman reduces her activity. Once
bleeding stops, she can greadually resume to her normal activities. Coitus is usually restricted
for 2weeks after bleeding episode to prevent infection and to avoid inducing further bleeding.
CASE STUDY #2
Bea, 30 year old, mulitgravida, is having moderate bleeding , rupture of membranes, and cervical
dilation.
1. What is the type of abortion that is now being experienced by Bea?
Imminent (inevitable) Miscarriage
2. Why should Bea save any tissue fragments that she had passed?
So they can be examined for an abnormality such as gestational trophoblastic disease
(hydatidiform mole) or for assurance that all the products of conception have been removed
from the uterus.
3. What is the purpose of a vacuum extraction (dilatation and evacuation)?
The purpose of vacuum extraction (dilatation and evacuation) is to ensure that all the products
of conception are removed
4. How will you know that Bea is having an abnormally heavy bleeding?
Bea should assess vaginal bleeding by recording the number of pads she uses. Saturating more
than one pad per hour is abnormally heavy bleeding.
5. What is the mechanism of action of prostaglandin analogs? Give an example.




CASE #3
Marikit, G
5
P
4
is on her 2
nd
month of pregnancy, and is suffering from intense vaginal pain and heavy
vaginal bleeding. She is now at the ER of Mindanao Sanitarium and Hospital. Upon IE, the cervix is
already dilated
1. As an ER nurse, what do you suspect is happening to Marikit? Explain your answer.



2. Why is it that Marikit is at risk of having a hemorrhage?



3. Why did the doctor perform a dilatation and curettage for Marikit?



4. Compare and contrast incomplete abortion and complete abortion.
Incomplete abortion is the type of abortion in which parts of the preborn child and/or placenta
remain within the uterus. Complete abortion is when all the contents of the uterus such as the
preborn child and the placenta have been expelled from the uterus.
Resources: http://www.babycentre.co.uk/a1014773/understanding-late-miscarriage#ixzz2kR9hquhW
http://www.babycentre.co.uk/a1039515/understanding-early-miscarriage#ixzz2kR8pObC3
http://www.nlm.nih.gov/medlineplus/ency/article/000907.htm
Maternal and Child health nursing book