Therapeutic Management: HG & Abortion & Ectopic & H.Mole & IC Flashcards
Hyperemesis Gravidarum
a. NPO for the first 24 hours
b. Administer 3L of IV fluid (Lactated Ringers + Vitamin B1)
c. Metoclopramide – anti-emetic
d. Strict monitoring of intake and output
e. If no vomiting after 24 hours of NPO, progress diet to small
amounts of clean fluid, dry toast, crackers to soft diet then to
regular diet
Threatened Miscarriage
a. Assess FHR and fetal well-being
o Withdraw blood to check for serum hCG level
▪ If hCG increased after 48 hours: Placenta is still
intact
▪ If hCG do not increase after 48 hours: poor
placental function; suspected loss of pregnancy
b. Check what activity causes the event
c. Avoid strenuous activity for 24 to 48 hours – bed rest
d. Need for sympathetic and supportive person
e. Restrict coitus for 2 weeks after bleeding episode
Imminent / Inevitable abortion
a. Save any tissue fragments and bring to the hospital for
examination
b. Assess FHR and fetal well being
c. If no FHR, D&E (dilation and evacuation) is advised
d. Administer oxytocin after D & C
e. Inform the patient that pregnancy is lost
o Dapat iparinig na walang FHT
Incomplete Abortion
a. D & C or suction curettage is performed
b. Inform the patient that pregnancy is lost
Missed abortion
a. Dilation and evacuation (D&E) are commonly done
b. if > 14 weeks:
o Labor is induced by Prostaglandin vaginal
suppository or Misoprostol (Cytotec); oxytocin
stimulation
c. Provide emotional support and accepting attitude
d. Refer patient to counselling
Septic Abortion
a. Check for signs and symptoms of infection
b. Assist patient during intensive treatment
o CBC, electrolyte evaluation, urine culture
c. Insert indwelling catheter as prescribed
d. Initiate IV insertion and monitoring as prescribed
e. Administer antibacterial medications as ordered
f. Assist in D&E or D&C procedure
g. Inform the patient of possible risks if this is present
h. Refer patient to counseling
Ectopic Pregnancy: Conservatory Therapy Therapeutic Management
a. Goal: Remove ectopic pregnancy and preserve reproductive
function through single dose of Methotrexate
b. Single-dose parenteral methotrexate has been shown to
be safe, effective, and associated with minimal costs
when used in carefully selected patients
Ectopic Pregnancy: Surgical Intervention Therapeutic Management
a. Initiate IV line with a large bore catheter
o G16/G18 for blood transfusion
b. Maintaining fluid volume
c. Assist in obtaining blood sample (CBC, blood typing)
d. Monitor VS, I&O, blood loss
e. Prevent and treat hemorrhage which is the main danger of
ectopic pregnancy
f. Blood transfusion
g. Place patient flat in bed with legs elevated
h. Provide comfort
i. Administer analgesics
j. Promote relaxation techniques
k. Provide support during grief
o Provide emotional support
o Refer patient to counseling
o Listen to concerns
Hydatidiform Mole
a. Suction curettage to evacuate the abnormal trophoblast cells
o Hysterectomy – done if patient is above 40 y/o; removal
of uterus
▪ TAH – Total abdominal hysterectomy
▪ TAHBSO – Total abdominal hysterectomy bilateral
salpingo-oophorectomy
b. Baseline pelvic examination
c. hCG serum test is monitored every 2 weeks until levels reach
normal count
o Every 2 weeks x 6 months
o Every 4 weeks x 6-12 months
o Plateau suggests malignant transformation
d. The woman is advised not to get pregnant for 1 year and
advised to use reliable contraceptives
e. Hysterectomy is the method of treatment for women above
40 years old because of the higher incidence of malignancies
& to clients who have completed childbearing & require
sterilization
f. Chest X ray every 3 months for 6 months.
o The lungs are the most common site of metastasis
of choriocarcinoma
g. Chemotherapy (Methotrexate) if:
o HCG titers are increased for 3 consecutive weeks or
double at anytime
o HCG titers remain elevated 3-4 months after
delivery/evacuation of H. Mole
Incompetent Cervix
a. Cervical Cerclage (Shirodkar/McDonald technique)
o 14-16 weeks of gestation
o Purse string sutures are placed in the cervix by the
vaginal route under regional anesthesia
o To strengthen cervix and prevent it from dilating
o Prevents premature birth
b. Shirodkar Cerclage:
o Permanent: Sterile tape is the threaded in a purse-string
manner under the sub-mucus layer of the cervix & sutures in place to achieve a closed cervix
o Closed, then bubuksan kapag near labor
c. McDonald Cerclage:
o Temporary: Nylon sutures are placed horizontally &
vertically across the cervix and pulled tight to reduce the
cervical canam to a few millimeters in
o Puputulin kapag near labor na para mag-open si cervix
