WOMEN HEALTH

1
AbortionInterruption of pregnancy before the
fetus is viable

• Spontaneous
• 2nd-3rd months of gestation
• Abnormality in the fetus
• Habitual
• 3 or more consecutive miscarries
• Chromosomal abnormalities
• Medical Management
• All tissue passed vaginally is saved for medical
  examination
• Blood transfusion
• Nursing Management
• Support (loss, anxiety)
• Pt . Opportunity to talk (Nsg. Specific care)

2

• Elective
• Dilatation Evacuation or Suction Curettage - up
  to 12 wks, some clinics up to 16.
• Hypertonic Saline Injection - used with oxytocin.
• Prostaglandins - amniotic fluid, vaginal supp. or
  IM injection.
• Laminaria - species of seaweed shaped into tampon
  inserted into cervix, dilatation in
• 4-6 hrs. Lamicel synthetic sponge with
  magnesium sulfate.
• Hysterectomy - mini C-section.
• Septic Abortion

• Medical Management
• Pre-abortion counseling
• Pelvic examination and lab test
• Use of RhoGAM for Rh-negative patient
• Types of elective abortions
• Patient teaching, including
• instructions for follow-up care and
  information on contraception
• Nsg. Management
• Pt. Education
• Pt follow-up appts. after 2 w
• Pt contraceptive methods
• Psychological support

https//www.youtube.com/watch?vnxi6vImnTf0
3
InfertilityCouples inability to achieve
pregnancy after 1 year

• Factors
• Ovarian Ovulation
• - Asses serum progesterone level ovulation
  index (Urine stick test)
• Tubal Uterine
• r/o uterine abnormalities(laparoscopy)
• Assess fibrosis (pelvic exam /sonogram)
• Male
• Semen/assess sperm quality quantity 60-100
  million sperm /ml
• Varicoceles decrease semen quality
• Retrograde ejaculation ejaculation into the
  bladder

4

• Medical Management
• Pharmacology Therapy (clomiphene/Gonadotropin)
• Artificial insemination
• In vitro fertilization
• Hormone supplements
• Timing (rhythm method)

• Nursing Management
• Assess in reducing stress in the relationship.
• Pt. Education
• No smoking, diet, exercise
• Stress reduction techniques
• Health maintenance
• Provide adoption information
• Support by National Infertility Association

http//www.resolve.org/
5
Ectopic PregnancyA leading cause of
pregnancy-related death in the first trimester

• It occurs when the fertilized ovum becomes
  implant in any other tissue other than the
  uterine lining
• Causes salpingitis, peritubal adhesions,
  structural abnormalities of the fallopian tube,
  previous ectopic pregnancy, previous tubal
  surgery, tumors, IUD, progestin-only
  contraception, and pelvic inflammatory disease
  (PID)

6

• Nsg. Process
• Diagnosis
• Acute pain
• Grieving
• Deficient knowledge

• Clinical manifestations
• Delay menstruation
• Sharp colicky pain, spot bleeding
• Pain, dizziness, faintness, NV
• Fatal hemorrhage may occur with ruptured ectopic
  pregnancy if treatment is delayed
• Women who have had an ectopic pregnancy are at
  increased risk for recurrent ectopic pregnancy
  and require teaching regarding early signs and
  symptoms

• Complications
• Hemorrhage
• Hemorrhage shock

7

• Interventions
• Supporting the grief process
• Listen and provide support.
• If appropriate, the partner should participate in
  the process.
• Referral for counseling as needed
• Management of complications
• Continuous/frequent monitoring of VS, LOC, amount
  of bleeding, IO, laboratory values
• Bed rest

• Planning
• Major goals include
• Relief of pain
• Acceptance and resolution of grief and pregnancy
  loss
• Increased knowledge about ectopic pregnancy
• Treatment and outcome, and absence of
  complications.