ACKNOWLEDGEMENT

This project would not be made possible without the help and guidance of our

AlmightyFather, who conveyed our group adequate knowledge, sufficient vigor and

bravery toface innovative and peculiar defy during the entire course of this project.

Our never-ending thanks to Almighty Father the most High for the love and care he

showered upon us.

Our genuine gratitude to our beloved parents for always supporting us

physically,mentally, emotionally and financially in regards to this venture. Warmth

thanks forentrusting to us their confidence and understanding not only in times of

need but ineveryday of our lives. They used to complain that we are getting too

sovereign andmatured; however we live in the ideology that letting go of their

children is the hardestpart of being a parent. Though it is not easy for us to

acknowledge the fact that we aregetting old bit by bit, we have to separate from

them in order to understand the trueessence of being a human, and still our love for

them remains the same. To our dearparents, rest guaranteed that what we are doing

right now will serve as a stepping stonetowards a philosophical future and sagacious

life, and that is being a nurse.

INTRODUCTION

Pregnancy is an exciting time in any parent's life. It's a time of change, growth,

discoveryand a lot of questions. One of the most important factors of having a

healthy baby is themother’s health especially during the 9 months where the child’s

development hasalready started. The mother’s nutrition, activity etc. greatly affect

the developing fetusinside her womb such that any move could put the child at risk

resulting toabnormalities, poor health or even death to the precious being anytime or

even duringpregnancy if mother’s health is being taken for granted.

Complications may occur at any time during pregnancy and can result from pre-
existing
maternal medical problems or from the pregnancy itself. Early and consistent
prenatal

care results in improved fetal and maternal outcomes, regardless of complications

thatmay occur. One of these complications,threatened abortion is a condition of

pregnancy,occurring before the 20th week of gestation, that suggests potential

miscarriage maytake place.

Approximately 20% of pregnant women experience some vaginal bleeding, with

orwithout abdominal cramping, during the first trimester. This is known as a

threatenedabortion. However, most of these pregnancies go on to term with or

without treatment.Spontaneous abortion occurs in less than 30% of the women who

experience vaginalbleeding during pregnancy.

In the cases that result in spontaneous abortion, the usual cause is fetal death.

Suchdeath is typically the result of a chromosomal or developmental abnormality.

Otherpotential causes include infection, maternal anatomic defects, endocrine

factors,immunologic factors, and maternal systemic disease.

Estimates report that up to 50% of all fertilized eggs abort spontaneously, usually

beforethe woman knows she is pregnant. Among known pregnancies, the rate is

approximately10%. These usually occur between 7 and 12 weeks of gestation.

Increased risk isassociated with women over age 35, women with systemic disease

(such as diabetes orthyroid dysfunction), and those with a history of 3 or more prior

spontaneous abortions.

During our duty in the Ob ward at Ospital Ning Angeles (ONA) , we decided to take

thecase of Mrs. X in which she was diagnosed with threatened abortion v/s

incompleteabortion because we would like to have a deeper understanding about this

condition sothat we could render the care the patient needed to arrive with a good

prognosis.Management should therefore always be based on appropriate clinical

judgment. Wewould like to apply all the things that we’ve learned through our

lectures for the benefitof our patient and to enhance our skills as well.

We hope that this case study will enable us, student nurses to better

understandingabout the disease process and that we will be more sensitive in

attending to our patient’sneed. For the community, we hope that this will increase

the level of awareness among

the members of the community so that it could help in the prevention of further
pregnancy complications.
OBJECTIVES
General
This case study aims that the students and the readers will gain knowledge and
further
understanding about Threatened Abortion

Specific to be able to:

1. Establish rapport with our client including her family members
2. Gather all necessary information regarding her and her family members as may be

related to our case study

3. Ascertain client’s past and present health history

4. Trace her genogram or family tree

5. Trace the development data of the client

6. Perform physical assessment on client’s condition so as to attain baseline data

7. Present the definitions of the complete diagnosis that would explain the illness of
our

client

8. Study the anatomy and physiology of female reproductive system

9. Trace the Pathophysiology of Threatened Abortion

10. Determine the diagnostic tests our client has undergone including their
implications
and nursing responsibilities
11. Identify the drugs prescribed to our client, their action, side effects, indications,

contraindications and nursing responsibilities

12. Identify and prioritize the need of our patient

13. Formulate an appropriate nursing care plan based on the assessment

identify needs and problems of the patient

14. Render health teachings as part of our holistic care to alleviate problems

identified

15. Evaluate complications to nursing practice, education and research

PATIENT’S DATA

Name: Mrs. X

Address: Mt. View Balibago Angeles City

Age: 27 y/o.
 Birthday: July 09, 1982

Birthplace: Angeles City

Civil Status: Single

Religion: Iglesia Ni Cristo

Nationality: Filipino

Educational Attainment: High School Graduate

Occupation: Housewife

Date Admitted: February 08, 2010

Time Admitted: 11:00 PM

Ward: OB

Bed no.: 22

Admitting Diagnosis: Pregnancy uterine 8 weeks 3 days AOG G2P1 (1001)

Threatened Abortion v/s Incomplete Abortion

After the completion of the case study, the student nurse shall be able to:
•
Present a comprehensive and detailed report regarding the patient’s illness
•
Have a complete picture of the patient’s physical, psychosocial and mental status
through daily assessment
•
Have a well-structured nursing diagnosis of the client’s status based from an
integration of data gathered
•
Understand the factors that might have contributed to the development of the
disease
•
Provide organized and structured nursing interventions as a response to the patient’s
anticipated needs
•
Provide relevant information on available alternative therapies and management

III. Nursing Process

A. Assessment
1. Personal History
a. Demographic Data

Mrs. X is a 27 years old Single Mother. She was born on July 09, 1982 in Mt.

ViewBalibago Angeles City, she is a Filipino Citizen and a Iglesia Ni Cristo. She is the

4thchild among the 8 children. This is her 2nd Pregnancy on her G2P1 8 weeks and 3
daysAge of Gestation. She has a 1 daughter 7 years of age. During my initial

assessment toher she told me that they living in a good and peaceful community,

there surroundingsare clean and she has a good knowledge about what happening to

her.

b.Socio Economic and Cultural Factors

Mrs. X is a plain housewife, they are residing at Mt. View, Balibago Angeles City

herhusband is currently working as a welder at Ben Side Car earning P 250 a

day.Theylived in a commuted place together with her daughter and niece, during her

first timepregnancy she is always submitting herself for pre natal check up. Including

her 2nd pregnancy because she has experience in her first pregnancy that she

alwaysexperiencing vaginal bleeding during her 1st trimester. She is always aware

whathappening to her that’s why she never miss to consult the health center near at

her place.

Mrs. X blaming her daily activity that all the household choir she is doing that,causing
her to bleed. All her activity in everyday to washing dishes, clothes, cleaning
thehouse, cooking and walking about 2 kms just to bring her daughter in school at
the DonGueco Elementary School.She believes that she really needed a bed rest
during herpregnancy but because of what there is status right now that they having
difficultyfinancially that there only source of income is that her husband salary.
Sometimes thosemeds has been prescribed during her pre natal check up is difficult
for her to buybecause of lack of resources in their family.

2.Family Health – Illness History

Mrs. X diseases has a direct connection with the past illnesses. Her 1st pregnancy

shehas experience a vaginal bleeding during the 1st trimester, and also

diagnosedThreatened abortion is a vaginal bleeding other than spotting during early

pregnancy isconsidered a threatened miscarriage. (A miscarriage may also be

referred to as aspontaneous abortion.) Vaginal bleeding is common in early

pregnancy. About 1 of every4 pregnant women has some bleeding during the first

few months. About half of thesewomen stop bleeding and have a normal pregnancy.
3.History of Past Illness
 Mrs. X has a previous operation via C/S her two ovaries has been removed

anddiagnosed with Ovarian Cysts at Angeles Medical Center. Her family has a history

ofhaving an ovarian cysts.

4.History of Present Illness

According to the Client in the evening of January20, 2010, 10pm she just

finishwashing her husband clothes and preparing herself to sleep, she suddenly just

feelsomething coming out on her vaginal part and having pain in her abdomen. She

justnoticed that she having a bleeding which she think it will just diminish for the

followingdays. But the days gone by the bleeding still not stopping and accompanied

with pain onher abdominal part on the day of January 232010 she consultedDr.

Romero Clinic atBurgos Angeles City and later was ordered to take a UTZ and was

seen in Ultrasoundthat she has a minimal subchorionic hemorrhage.

In February 08,2010 at 11:00 pm she submitted herself at ONA and upon

assessingher upon admission she has a minimal vaginal bleeding prior to admission

and the UTZconfirm that it has presence of blood cloth in her intrauterine segment.

She wasdiagnosed with Threatened Abortion v/s Incomplete Abortion.

5. Physical Examination
PHYSICAL EXAMINATION
February 08, 2010
Upon Admission
Appearance and Behavior: Appears well when not moving but shows slight facial
grimaces upon movement and approachable

Mental Status: Conscious and Coherent

Language:Kap am p angan

Posture: On a Semi Fowlers position

Vital Signs:
T:
36.6OC
PR:
80 BPM
RR:
20 CPM
BP:
100/70 mmhg

Skin: with no pallor; no jaundice

Head: No lesions noted, no palpable nodules, symmetrical

Hair: Shoulder length, black and curly hair. No presence of dandruff

Eyes: Anictenic Sclerae, Pink Conjunctiva

Abdomen: Flabby, soft & non tender

Genitalia: dosed cervix x 1(4) Spotting

February 09, 2010

Actual Physical Examination
Appearance and Behavior: Appears well when not moving but shows slight facial
grimaces upon movement and approachable

Mental Status: Conscious and Coherent

Language:Kap am p angan

Posture: On a Semi Fowlers position

Vital Signs:
T:
37.3OC
PR:
85 BPM
RR:
18 CPM
BP:
90/70 mmhg
Skin: with no pallor; no jaundice

Head: No lesions noted, no palpable nodules, symmetrical

Hair: Shoulder length, black and curly hair. No presence of dandruff

Eyes: Anictenic Sclerae, Pink Conjunctiva

Chest & Lungs: SCE, with retractions

Abdomen: Flabby, soft & non tender

Genitalia: Minimal Vaginal Bleeding

Extremities: full and equal pulses

Diagnostics and Laboratory Tests:
A.)Urinalysis:

Nursing Responsibilities:
Tell the patient that the test is for the detection of renal and urinary tract disorders
and
assessment for body function.
Notify the patient that the procedure requires a urine sample. Urine must be acquired
most likely on the first void in the morning.
Notify the laboratory and physician of any drugs that the patient has taken that may
affect the results.
Physical tests
The physical tests measure the color, transparency (clarity), and specific gravity of a
urine sample.
 COLOR. Normal urine is straw yellow to amber in color. Abnormal colors
include bright yellow, brown, black (gray), red, and green. These pigments may
result from medications, dietary sources, or diseases. For example, red urine may
be caused by blood or hemoglobin, beets, medications, and some porphyrias.
Black-gray urine may result from melanin (melanoma) or homogentisic acid
(alkaptonuria, a result of a metabolic disorder). Bright yellow urine may be
caused by bilirubin (a bile pigment). Green urine may be caused by biliverdin or
certain medications. Orange urine may be caused by some medications or
excessive urobilinogen (chemical relatives of urobilinogen). Brown urine may be
caused by excessive amounts of prophobilin or urobilin (a chemical produced in
the intestines).
 TRANSPARENCY. Normal urine is transparent. Turbid (cloudy) urine may be
caused by either normal or abnormal processes. Normal conditions giving rise to
turbid urine include precipitation of crystals, mucus, or vaginal discharge.
Abnormal causes of turbidity include the presence of blood cells, yeast, and
bacteria.
 SPECIFIC GRAVITY. The specific gravity of urine is a measure of the
concentration of dissolved solutes (substances in a solution), and it reflects the
ability of the kidneys to concentrate the urine (conserve water). Specific gravity
varies with fluid and solute intake. It will be increased (above 1.035) in persons
with diabetes mellitus and persons taking large amounts of medication. It will
also be increased after radiologic studies of the kidney owing to the excretion of x
ray contrast dye. Consistently low specific gravity (1.003 or less) is seen in
persons with diabetes insipidus. In renal (kidney) failure, the specific gravity

remains equal to that of blood plasma (1.008–1.010) regardless of changes in the

patient's salt and water intake.
Biochemical tests
 pH: A combination of pH indicators (methyl red and bromthymol blue) react
with hydrogen ions (H+ ) to produce a color change over a pH range of 5.0 to 8.5.
pH measurements are useful in determining metabolic or respiratory
disturbances in acid-base balance. For example, kidney disease often results in
retention of H+ (reduced acid excretion). pH varies with a person's diet, tending
to be acidic in people who eat meat but more alkaline in vegetarians. pH testing is
also useful for the classification of urine crystals.
 Protein: Albumin is important in determining the presence of glomerular
damage. The glomerulus is the network of capillaries in the kidneys that filters
low molecular weight solutes such as urea, glucose, and salts, but normally
prevents passage of protein or cells from blood into filtrate. Albuminuria occurs
when the glomerular membrane is damaged, a condition called
glomerulonephritis.
 Glucose (sugar): The glucose test is used to monitor persons with diabetes.
When blood glucose levels rise above 160 mg/dL, the glucose will be detected
inurine. Consequently, glycosuria (glucose in the urine) may be the first indicatorthat
diabetes or another hyperglycemic condition is present.
 Blood: Red cells and hemoglobin may enter the urine from the kidney or lower
urinary tract. Testing for blood in the urine detects abnormal levels of either red
cells or hemoglobin, which may be caused by excessive red cell destruction,
glomerular disease, kidney or urinary tract infection, malignancy, or urinary tract
injury.
Microscopic examination
 The presence of bacteria or yeast and white blood cells helps to distinguish
between a urinary tract infection and a contaminated urine sample. White bloodcells
are not seen if the sample has been contaminated. The presence of cellularcasts
(casts containing RBCs, WBCs, or epithelial cells) identifies the kidneys
WBC (White Blood Cell): Also referred to as leukocytes, a fluctuation in the
number of these types of cells may indicate the presence of infections and disease
states dealing with impaired immune system status (cancer, excess
stress/catabolism)
 RBC (Red Blood Cell): called erythrocytes, their primary function is to carry
oxygen (via the hemoglobin contained in each RBC) to various tissues as well as
giving our blood that cool "red" color. A decrease in the number of these cells can
result in anemia which could stem from dietary insufficiencies. An increase in
number can occur when androgens are used. This is because androgens increase
EPO (erythropoietin) production and red blood cell division, increasing RBC
count. This can increase blood pressure and result in stroke (called a
cardiovascular accident, or CVA).
 Hemoglobin: Hemoglobin is a carrier of dissolved gases, oxygen and carbon
dioxide, in blood, an important part of each red blood cell surface. An increase in
hemoglobin can be an indicator of congenital heart disease, congestive heart
failure, sever burns, or dehydration. Being at high altitudes, or the use of
androgens, can cause an increase as well. A decrease in number can be a sign of
anemia, lymphoma, kidney disease, sever hemorrhage, cancer, sickle cell anemia,
etc.
 Hematocrit: The hematocrit is used to measure the percentage of the total
blood volume that's made up of red blood cells. An increase in percentage may be
indicative of congenital heart disease, dehydration, diarrhea, burns, etc. A
decrease may be indicative of anemia, hyperthyroidism, cirrhosis, hemorrhage,
leukemia, rheumatoid arthritis, pregnancy, malnutrition, a sucking knife wound
to the chest, etc.
Nursing Responsibilities
1.)Explain to the patient the necessity of undergoing the test that it helps detect
occurrence of anemia and polycythemia.
2.) Notify the patient that the test requires blood samples as well as the person
who will perform the venipucture and time.
3.) Inform the patient that the procedure is slight discomfort and he/she may feel
a little pain.
4.) After the procedure, apply direct pressure to the venipuncture until bleeding
stops.
5.)Refer if venipuncture develops hematoma and monitor the pulses distal to sites
 GENERAL

The organs of the reproductive systems are concerned with the general process of

reproduction, and each is adapted for specialized tasks. These organs are unique in

that

their functions are not necessary for the survival of each individual. Instead, their

functions are vital to the continuation of the human species. In providing maternity

gynecologic health care to women, you will find that it is vital to your career as a
practical nurse and to the patient that you will require a greater depth and breadth of

knowledge of the female anatomy and physiology than usual. The female

reproductive

system consists of internal organs and external organs. The internal organs are

located

in the pelvic cavity and are supported by the pelvic floor. The external organs are

located

from the lower margin of the pubis to theperineum. The appearance of the

externalgenitals varies greatly from woman to woman,since age, heredity, race, and

the number of children a woman has borne determines the size, shape, and color.

See figure 1-1 for the female reproductive organs.

TERMS AND DEFINITIONS

These are only a few terms and definitions that will be used in this lesson. Other
terms and definitions will be dispersed throughout the lesson.

A. Broad Ligaments. Two wing-like structures that extend from the lateralmargins of

the uterus to the pelvic walls and divide the pelvic cavity into ananterior and a

posterior compartment.
B. Corpus Luteum. The yellow mass found in the graafian follicle after the ovum
has been expelled.
C. Estrogen. The generic term for the female sex hormones. It is a steroid

hormone produced primarily by the ovaries but also by the adrenal cortex.

D. Fimbriae. Fringes; especially the finger-like ends of the fallopian tube.

E. Follicle. A pouch like depression or cavity.

F. Follicle Stimulating Hormone. The follicle stimulating hormone (FSH) is a

hormone produced by the anterior pituitary during the first half of the menstrual
cycle. It stimulates development of the graafian follicle.
G. Graafian Follicle. A mature, fully developed ovarian cyst containing the ripe
ovum.
H. Hormone. A chemical substance produced in an organ, which, being carried to

an associated organ by the bloodstream excites in the latter organ, a functional

activity.
I. Lactation. The production of milk by the mammary glands.
J. Luteinizing Hormone. A hormone produced by the anterior pituitary that
stimulates ovulation and the development of the corpus luteum
K. Oocyte. A developing egg in one of two stages.

L. Ovum. The female reproductive cell.

M. Progesterone. The pure hormone contained in the corpora lutea whose

function is to prepare the endometrium for the reception and development of the
fertilized ovum.
N. Reproduction. The process by which an off- spring is formed.
Anterior view of the uterus and related structures
Wall of the uterus
 INTERNAL FEMALE ORGANS
The internal organs of the female consist of the uterus, vagina, fallopian tubes and
ovaries

A. Uterus. The uterus is a hollow organ about the size and shape of a pear. It
serves two important functions: it is the organ of menstruation and during
pregnancy it receives the fertilized ovum, retains and nourishes it until it expels
the fetus during labor.
(1) Location. The uterus is located between the urinary bladder and the rectum. It
is suspended in the pelvis by broad ligaments.

(2) Divisions of the uterus. The uterus consists of the body or corpus, fundus,

cervix, and the isthmus. The major portion of the uterus is called the body or

corpus. The fundus is the superior, rounded region above the entrance of the

fallopian tubes. The cervix is the narrow, inferior outlet that protrudes into the
vagina. The isthmus is the slightly constricted portion that joins the corpus to the

cervix.

(3) Walls of the uterus (see figure 1-3). The walls are thick and are composed of

three layers: the endometrium, the myometrium, and the perimetrium. The

endometrium is the inner layer or mucosa. A fertilized egg burrows into the

endometrium (implantation) and resides there for the rest of its development.

When the female is not pregnant, the endometrial lining sloughs off about every

28 days in response to changes in levels of hormones in the blood. This process is

called menses. The myometrium is the smooth muscle component of the wall.

These smooth muscle fibers are arranged. In longitudinal, circular, and spiral

patterns, and are interlaced with connective tissues. During the monthly female

cycles and during pregnancy, these layers undergo extensive changes. The

perimetrium is a strong, serous membrane that coats the entire uterine corpus

except the lower one fourth and anterior surface where the bladder is attached.
B. Vagina.

(1) Location. The vagina is the thin in walled muscular tube about 6 inches long

leading from the uterus to the external genitalia. It is located between the bladder

and the rectum.

2) Function. The vagina provides the passageway for childbirth and menstrual

flow; it receives the penis and semen during sexual intercourse.

C. Fallopian Tubes (Two).

(1) Location. Each tube is about 4 inches long and extends medially from each
ovary to empty into the superior region of the uterus.
(2) Function. The fallopian tubes transport ovum from the ovaries to the uterus.
There is no contact of fallopian tubes with the ovaries.

(3) Description. The distal end of each fallopian tube is expanded and has finger-

like projections called fimbriae, which partially surround each ovary. When an

oocyte is expelled from the ovary, fimbriae create fluid currents that act to carry

the oocyte into the fallopian tube. Oocyte is carried toward the uterus by
combination of tube peristalsis and cilia, which propel the oocyte forward. The

most desirable place for fertilization is the fallopian tube.

D. Ovaries (2) (see figure 1-4).
(1) Functions. The ovaries are for oogenesis-the production of eggs (female sex
cells) and for hormone production (estrogen and progesterone).
(2) Location and gross anatomy. The ovaries are

about the size and shape of almonds. They lie against the lateral walls of the
pelvis, one on each side. They are enclosed and held in place by the broad
ligament. There are compact like tissues on the ovaries, which are called ovarian
follicles. The follicles are tiny sac-like structures that consist of an immature egg
surrounded by one or more layers of follicle cells. As the developing egg begins to
ripen or mature, follicle enlarges and develops a fluid filled central region. When
the egg is matured, it is called a graafian follicle, and is ready to be ejected from
the ovary.

3) Process of egg production--oogenesis (see figure 1-5).

(a) The total supply of eggs that a female can release has been determined by

thetime she is born. The eggs are referred to as "oogonia" in the developing fetus.

Atthe time the female is born, oogonia have divided into primary oocytes,

whichcontain 46 chromosomes and are surrounded by a layer of follicle cells.

(b) Primary oocytes remain in the state of suspended animation through
childhood until the female reaches puberty (ages 10 to 14 years). At puberty, the

anterior pituitary gland secretes follicle-stimulating hormone (FSH), which

stimulates a small number of primary follicles to mature each month

(c) As a primary oocyte begins dividing, two different cells are produced, each

containing 23 unpaired chromosomes. One of the cells is called a secondary

oocyte and the other is called the first polar body. The secondary oocyte is the

larger cell and is capable of being fertilized. The first polar body is very small, is

nonfunctional, and incapable of being fertilized.

(d) By the time follicles have matured to the graafian follicle stage, they contain

secondary oocytes and can be seen bulging from the surface of the ovary. Follicle

development to this stage takes about 14 days. Ovulation (ejection of the mature

egg from the ovary) occurs at this 14-day point in response to the luteinizing

hormone (LH), which is released by the anterior pituitary gland.

(e) The follicle at the proper stage of maturity when the LH is secreted will

rupture and release its oocyte into the peritoneal cavity. The motion of the

fimbriae draws the oocyte into the fallopian tube. The luteinizing hormone also
causes the ruptured follicle to change into a granular structure called corpus
luteum, which secretes estrogen and progesterone.

(f) If the secondary oocyte is penetrated by a sperm, a secondary division occurs

that produces another polar body and an ovum, which combines its 23

chromosomes with those of the sperm to form the fertilized egg, which contains

46 chromosomes.
(4) Process of hormone production by the ovaries.

(a) Estrogen is produced by the follicle cells, which are responsible secondary sex

characteristics and for the maintenance of these traits. These secondary sex

characteristics include the enlargement of fallopian tubes, uterus, vagina, and

external genitals; breast development; increased deposits of fat in hips and

breasts; widening of the pelvis; and onset of menses or menstrual cycle.

(b) Progesterone is produced by the corpus luteum in presence of in the blood. It

works with estrogen to produce a normal menstrual cycle. Progesterone is

important during pregnancy and in preparing the breasts for milk production

EXTERNAL FEMALE GENITALIA

abia majora, labia minora, vestibule, perineum, and the Bartholin's glands. As a

group, these structures that surround the openings of the urethra and vagina

compose the vulva, from the Latin word meaning covering. See Figure 1-6.
a. Mons Pubis. This is the fatty rounded area overlying the symphysis pubis and
covered with thick coarse hair.

b. Labia Majora. The labia majora run posteriorly from the mons pubis. They arethe 2

elongated hair covered skin folds. They enclose and protect other

externalreproductive organs.
c. Labia Minora. The labia minora are 2 smaller folds enclosed by the labia
majora. They protect the opening of the vagina and urethra.
d. Vestibule. The vestibule consists of the clitoris, urethral meatus, and the
vaginal introitus.
(1) The clitoris is a short erectile organ at the top of the vaginal vestibule whose
function is sexual excitation.

2) The urethral meatus is the mouth or opening of the urethra. The urethra is
a
small tubular structure that drains urine from the bladder.

(3) T e. Perineum. This is the skin covered muscular area between the vaginal

opening (introitus) and the anus. It aids in constricting the urinary, vaginal, and

anal opening. It also helps support the pelvic contents.

f. Bartholin's Glands (Vulvovaginal or Vestibular Glands). The Bartholin's glandslie on

either side of the vaginal opening. They produce a mucoid substance, whichprovides

lubrication for intercourse.

 BLOOD SUPPLY

The blood supply is derived from the uterine and ovarian arteries that extend

from the internal iliac arteries and the aorta. The increased demands of

pregnancy necessitate a rich supply of blood to the uterus. New, larger blood

vessels develop to accommodate the need of the growing uterus. The venous

circulation is accomplished via the internal iliac and common iliac vein.
 FACTS ABOUT THE MENSTRUAL CYCLE

Menstruation is the periodic discharge of blood, mucus, and epithelial cells from

the uterus. It usually occurs at monthly intervals throughout the reproductive

period, except during pregnancy and lactation, when it is usually suppressed.

 The menstrual cycle is controlled by the cyclic activity of follicle

stimulating hormone (FSH) and LH from the anterior pituitary and

progesterone and estrogen from the ovaries. In other words, FSH

acts upon the ovary to stimulate the maturation of a follicle, and

during this development, the follicular cells secrete increasing

amounts of estrogen (see figure 1-7).

Hormonal interaction of the female cycle is as follows:

(1) Days 1-5. This is known as the menses phase. A lack of signal from a fertilized

egg influences the drop in estrogen and progesterone production. A drop in

progesterone results in the sloughing off of the thick endometrial lining which is

the menstrual flow. This occurs for 3 to 5 days.

(2) Days 6-14. This is known as the proliferative phase. A drop in progesterone

and estrogen stimulates the release of FSH from the anterior pituitary. FSH

stimulates the maturation of an ovum with graafian follicle. Near the end of this

phase, the release of LH increases causing a sudden burst like release of the

ovum, which is known as ovulation.

(3) Days 15-28. This is known as the secretory phase. High levels of LH cause the

empty graafian follicle to develop into the corpus luteum. The corpus luteum

releases progesterone, which increases the endometrial blood supply.

Endometrial arrival of the fertilized egg. If the egg is fertilized, the embryo

produces human chorionic gonadotropin (HCG). Thehuman chorionic

gonadotropin signals the corpus luteum to continue to supply progesterone to

maintain the uterine lining. Continuous levels of progesterone prevent the release

of FSH and ovulation ceases.

 Additional Information.
(1) The length of the menstrual cycle is highly variable. It may be as short as 21
days or as long as 39 days.
(2) Only one interval is fairly constant in all females, the time from ovulation to
the beginning of menses, which is almost always 14-15 days.
3) The menstrual cycle usually ends when or before a woman reaches her fifties.
This is known as menopause

Ovulation

Ovulation is the release of an egg cell from a mature ovarian follicle (see figure 1-

5 for ovulation). Ovulation is stimulated by hormones from the anterior pituitary

gland, which apparently causes the mature follicle to swell rapidly and eventually

rupture. When this happens, the follicular fluid, accompanied by the egg cell,

oozes outward from the surface of the ovary and enters the peritoneal cavity.

After it is expelled from the ovary, the egg cell and one or two layers of follicular

cells surrounding it are usually propelled to the opening of a nearby uterine tube.

If the cell is not fertilized by union of a sperm cell within a relatively short time, it

will degenerate.

MENOPAUSE

As mentioned in paragraph 1-6c (3), menopause is the cessation of menstruation.

This usually occurs in women between the ages of 45 and 50. Some women may

reach menopause before the age of 45 and some after the age of 50. In common

use, menopause generally means cessation of regular menstruation. Ovulation

may occur sporadically or may cease abruptly. Periods may end suddenly, may

become scanty or irregular, or may be intermittently heavy before ceasing

altogether. Markedly diminished ovarian activity, that is, significantly decreased

estrogen production and cessation of ovulation, causes menopause.

Description of the Disease

A threatened miscarriage is a condition that suggests a miscarriage might take place
before the 20th week of pregnancy.
A small number of pregnant women have some vaginal bleeding, with or
withoutabdominal cramps, during the first trimester of pregnancy. When the
symptomsindicate a miscarriage is possible, the condition is called a "threatened
abortion." (Thisrefers to a naturally occurring event, not medical abortions or surgical
abortions.)
Miscarriage occurs in just a small percentage of women who have vaginal bleeding
during pregnancy.
A miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy.
(Pregnancy losses after the 20th week are called preterm deliveries.)
A miscarriage may also be called a "spontaneous abortion." This refers to naturally
occurring events, not medical abortions or surgical abortions.
Other terms for the early loss of pregnancy include:
•
Complete abortion: All of the products of conception exit the body
•
Incomplete abortion: Only some of the products of conception exit the body
•
Inevitable abortion: The symptoms cannot be stopped, and a miscarriage will
happen
•
Infected abortion: The lining of the womb, or uterus, and any remaining products
of conception become infected
•
Missed abortion: The pregnancy is lost and the products of conception do not exit
the body
Most miscarriages are caused by chromosome problems that make it impossible for
the
baby to develop. Usually, these problems are unrelated to the mother or father's
genes.
Other possible causes for miscarriage include:
•
Hormone problems
•
Infection
•
Physical problems with the mother's reproductive organs
•
Problem with the body's immune response
•
Serious body-wide (system ic) diseases in the mother (such as uncontrolled
diabetes)
It is estimated that up to half of all fertilized eggs die and are lost (aborted)
spontaneously, usually before the woman knows she is pregnant. Among those
women
who know they are pregnant, the miscarriage rate is about 15-20%. Most
miscarriages

occur during the first 7 weeks of pregnancy. The rate of miscarriage drops after the
baby's heart beat is detected.
The risk for miscarriage is higher in women:
•
Older than 35
•
Who have had previous miscarriages

PATIENT TEACHINGS:
1.Avoid alcohol, cigarettes, and illegal drugs,
2.Limit caffeine intake
3.Avoid contact with toxin (ex. Arsenic, lead, heavy metals, and organic
solvents).
4.Control any medical conditions, such as diabetes and
hyperthyroidism..
5.Avoid or restricts some forms of activity, or advise a complete bed
rest.
6.Avoid having sexual intercourse is usually recommended until the
warning signs have disappeared.
7.Advise patients to return upon occurrence of symptoms such as:

 profuse vaginal bleeding

 severe pelvic pain

 temperature above 38 degree C (100.4 degree F).


8.Advise the patient to avoid intake of highly seasoned and fatty foods.
9.Talk with any physicians before taking medications to ensure they
are safe during pregnancy.
10. Advise the patient to take the full course of medications
DISCHARGE PLAN
Medications:
· Teach patient and her family or significant others the proper dosage and
the right time to take the medication.
· Emphasize to the patient the importance of obediently taking the
prescribed medications and the disadvantages or complications that may
arise if these are not taken properly.
· Inform and discuss the possible side effects and reactions that these
drugs might produce and seek medical attention immediately is these
arise
· Discourage to use of OTC medications or at least inform the physician if

she’s taking other OTC medications. This is essential to prevent any

occurrence of drug interactions.

Exercise:
· Tell client to refrain from straining activities
· Encourage ambulation as a form of light exercise that would help in the
progression of her recovery and wound healing.
· Range of motion. Encouraging the patient to do some exercises would
allow good blood circulation as well as the prevention of the occurrence of
bed sores.
· Encourage patient to do some stretching exercise to prevent stiffness of
the bone due to less activity performed.
· Encourage patient to first sit up and dangle feet before standing from a
lying position to prevent orthostatic hypotention
Treatment
· Discussing the purpose of treatments to be done and continued at home
and report to the health professional when there is bleeding to alleviate
symptoms of the patient’s condition and monitor for her recovery.
· Encourage patient to have a sufficient rest and sleep to maintain internal
equilibrium
Provide a safe and comfortable environment because it could make the

patient more relaxed which is also needed to arrived with a good

prognosis

Hygiene:
· Discuss the significance of personal hygiene and proper hand washing in
preventing infections
· Give client some lectures about proper wound care through changing the

dressing as often as possible so as to protect the wound from invasion of

microorganisms as well as to reduce the risk of microorganism

transmission to others.

Outpatient Care:
· A follow up check-up is necessary for wound evaluation and to assess the
progression of wound healing.
Diet:
· Encourage the patient to increased fluid intake and to include fruits and
vegetables rich in vitamin C for the production of milk needed for lactation.
· Taking food rich in protein is also helpful for tissue repair