HEALTH TEACHING

 Advised the mother to avoid certain foods that can

make her ill and harm the baby.

 Advised the patient with her partner to avoid

strenuous and stressful activities that may aggravate

her condition.

 Advised the patient to avoid exposure to toxic

chemicals or harsh cleansing solutions.

 Instructed the patient to take vitamins such as folic

acid to decrease the risk of certain birth defects.

 Advised the patient to avoid drinking alcohol and

other vices that can cause harm to her and the baby.

 Informed patient to have a bed rest and avoid doing

heavy works.

 Instructed the patient for the scheduled follow up

check-up and report any signs or symptoms that may

occur.

 Informed patient regarding the purpose, action and

side effect of the medication with regards to the

patient health.

60
 Instructed the patient to take a bath every day, have

an oral care every meal, keep her fingernails short

and practice proper hand washing technique together

with the significant others especially when handling

foods. Washing hands thoroughly and often can help

reduce the risk of possible acquiring infections.

 Encouraged the mother to eat a variety of healthy

foods that can help her get extra protein, water and

calories such as fruits, vegetables, whole-grain

breads, low fat dairy products, beans, lean meats and

fish. Avoid raw or undercooked meat and fish.

 Instructed the mother to return to the emergency

department in the following cases:

 Cramping worsens

 Bleeding worsens (requiring one pad per hour)

 Passage of tissue

 Fever

 Anything else alarming

 Instructed the mother to avoid sexual intercourse

until the bleeding stops, and for 2 weeks following

the last evidence of bleeding.

61
 Instructed the mother not to douche or insert anything

(including tampons) into the vagina.

62
 CASE ANALYSIS

Vaginal bleeding before 20 gestational weeks is the

commonest complication in pregnancy occurring in about a

birth of cases Abortion 1-6 times as likely 17% are

expected to present complications later in pregnancy,

although general practitioners and gynaecologist often see

this condition management of threatened abortion is mostly

empirical. Bed rest is routinely recommended and about a

third of women presenting with threatened abortion.

In this review we present available evidence on the

initial evaluation and management of threatened abortion.

Focusing mainly on the first trimester of pregnancy and

Primary HealthCare Setting.

Bleeding of the first trimester of pregnancy is a

common phenomenon, associated with early pregnancy loss. In

many instances a sub-chorionic hematoma is found

sonographycally to evaluate the possible benefit of bed

rest in women with threatened abortion and sonographycally

prevent sub-chorionic hematoma and to examine the possible

63
relationship of duration of vaginal bleeding. Hematoma size

and gestational age at diagnosis care to pregnancy outcome.

Progesterone is prescribed in 13-40% of women with

threatened abortion as prescribed by the physician.

Progesterone is the main product of corpus luteum and

giving progesterone is expected to support a potentially

corpus luteum gravidarum and induce relaxation of a

cramping uterus.

In case of threatened abortion with or without the

presence of sub-chorionic hematoma progress the outcome is

better following treatment with bed rest, uterine

sedatives, folic acid supplementation and hormonal

treatment.

64
 CHAPTER
IV
 SUMMARY

 CONCLUSION

65
 SUMMARY

A threatened abortion is vaginal bleeding that occurs

in the first 20 weeks of pregnancy. The bleeding is

sometimes accompanied by abdominal cramps. These symptoms

indicate that miscarriage is possible, which is why the

condition is known as a threatened abortion or threatened

miscarriage. The actual cause of threatened abortion is

unknown, however there are certain factors that may

increase the risk of having one, like…..

 A bacteria or viral infection during

pregnancy.

 Trauma to the abdomen

 Advanced maternal age(over age of 35)

 Exposure to certain medications or chemicals

 Other risk factor for a threatened abortion

include of obesity and uncontrolled

diabetes.

 Stress and depression

66
 A threatened abortion is fairly common among pregnant

woman about 20 to 30 percent of women will experience

bleeding during the first 20 weeks of pregnancy.

Approximately 50 percent of those women will carry their

baby to term. It’s more common among women who have

previously had a miscarriage.

67
 CONCLUSION

Threatened Abortion occurs often and is a serious

emotional burden for mother. Sonographic evaluation at

presentation can usually differentiate between intrauterine

and extra uterine pregnancy and offer some prognostic

clues. Demonstration of fetal heart activity is generally

associated with a successful pregnancy rate of 85-97%,where

an empty large gestational sac or a discrepancy between

menstrual or sonographic age of more than a week,

indicates a poor prognosis advance maternal age and

increasing number of previous abortion deteriorates

prognosis.

First trimester, vaginal bleeding is an independent

risk factor for adverse obstetric outcome that is directly

proportional to the amount of bleeding.

68
 CHAPTER
V
 RECOMMENDATION

69
 RECOMMENDATION

1. A woman who is pregnant who experiences cramping or

bleeding at any time should call her health care

professional.

2. A pregnant woman who experiences these symptoms but

does not have a doctor should go to the closest

hospitals emergency department to be examined.

3. A pregnant woman should go to the hospital if she

experiences the following symptoms:

 Heavy bleeding (soaking more than one pad per

hour)

 Passing something that looks like tissue (place

this tissue in a container and take it with you

to the hospital)

 Severe cramping (like a menstrual period)

 Cramping or bleeding accompanied by fever

 Bleeding or abdominal pain in a woman who has had

a previous ectopic pregnancy (tubal pregnancy)

 Vomiting so severe she can’t keep anything down

70
4. Get regular prenatal visits to a physician, maternity

clinics and follow the advice of your health care

professional for a safe, healthy pregnancy, delivery,

and post partum period.

5. Delay return to work if heavy work and lifting is

required. Frequent rest periods and light work

activities may be required.

6. Avoid alcohol, cigarettes, and street drugs,

especially cocaine.

7. Avoid or reduce caffeine intake.

8. Control high blood pressure and diabetes.

9. Get treatment for infections.

10. Avoid strenuous and stressful activities that may

affect the pregnancy.

71
 CHAPTER
VI
 LIST OF ABBREVIATIONS

 DEFINITION OF TERMS

 REFERENCES

72
 LIST OF ABBREVIATIONS:

q- every

NPO- Nothing Per Orem

BID- Twice a Day

TID- Three Times a Day

OD- Once a Day

EDC- Expected Date of Confinement

AOG- Age Of Gestation

LMP- Last Menstrual Period

T- Temperature

RR- Respiratory Rate

PR- Pulse Rate

BP- Blood Pressure

mmHg- Millimetre/s of Mercury

IM- Intra Muscular

IVF- Intra Venous Fluid

IVT- Intra Venous Tubing

73
DAT- Diet As Tolerated

CBC- Complete Blood Count

U/A- Urinalysis

ANST- After Negative Sensitivity Test

STAT- At Once

D5LRS- 5% Dextrose in Lactated Ringer’s Solution

MGH- May Go Home

HCG- Human Chorionic Gonadotropin

WBC- White Blood Count

cpm- Cycle/s Per Minute

bpm- Beat/s Per Minute

ºC- Degrees Celsius

ROM- Range Of Motion

74
 DEFINITION OF TERMS

THREATENED ABORTION- Possible loss the product of

conception. Vaginal bleeding in early pregnancy without

cervical changes.

AMNIOTIC SAC- Commonly called the bag of water. Sometimes,

the membranes is the sac in which the fetus develop in

amniotes.

AMNIOTIC FLUID- Is a clear, slightly yellowish liquid that

surrounds the unborn baby (fetus) during pregnancy.it is

contained in the amniotic sac.

TRANSVAGINAL ULTRASOUND- Is a test used to look at a

woman’s reproductive organs, including the uterus, ovaries,

and cervix. Transvaginal means across or through the

vagina. The ultrasound probe will be placed inside the

vagina.

FETUS- A human being in the later stages of development

before it is born.

75
PROBE- Uses high frequency sound waves to create images of

your reproductive organs, allowing your doctor to see them

in more detail.

GENITALIA- The male or female reproductive organs. The

genitalia include internal and external structures of the

female.

PERINIUM- The area between the anus and the scrotum in the

male and between the anus and the vulva (The labial opening

to the vaginal).

MORTALITY- Is the condition of one day having to die or the

rate of failure or loss.

MORBIDITY- Describe in how often a disease occurs in a

specific area or is a term used to describe a focus on

death.

MENARCHE- The beginning of the menstrual function,

especially the first menstrual period of an individual.

76
MISCARRIAGE- It means loss of an embryo or fetus before the

20th week of pregnancy. Most of miscarriage occur during the

first 14 weeks of pregnancy. The medical term of

miscarriage is spontaneous abortion

VIRAL INFECTION- Is a disease that can be caused by

different kinds of virus. It can be indifferent places in

the body, some viruses are mainly in the intestine, while

others prefer the lung and airway.

PERINEAL PAD- A cushion of soft material used to cover the

perineum to absorb the menstrual flow or to protect a wound

or incision.

SUPRAPUBIC- Situated occurring, or performed from above the

pubis.

CEPHALIC PRESENTATION- The presenting part during delivery

is the head.

77
 REFERENCES

1. American College of Obstetrician and Gynecologists.

ACOG Committee opinion no. 462: Moderate caffeine

consumption during pregnancy. Obstet gynecol. 2010

Aug.116(2 Pt 1):467-8. PMID: 20664420

www.ncbi.nlm.nih.gov/pubmed?20664420

2. Applegate M, Gee RE, Martin Jr JN. Improving maternal

and infant health outcomes in Medicaid and the

children’s health insurance program. Obstet Gynecol.

2014;124:143-9. PMID: 24901270

www.ncbi.nlm.nih.gov/pubmed/24901270

3. Cunningham FG, Leveno KL,Bloom SL, et al,eds. Williams

Obstetrics. 23rd ed. New York, NY: McGraw-Hill;

2010:chap 9.

4. Gaskins AJ< Rich-Edwards JW< Hauser R, et al. Maternal

prepregnancy folate intake and risk of spontaneous

abortion and stillbirth. Obstet Gynecol. 2014

Jul;124(1):23-31. PMID: 24901281

www.ncbi.nlm.nih.gov/pubmed/24901281

5. Katz VL. Spontaneous and recurrent abortion: etiology,

diagnosis, treatment. In: Katz VL, Lentz GM, Lobo RA,

78
 Gershenson DM, eds. Comprehensive gynecology. 6th ed.

Philadelphia, PA: Elsevier Mosby; 2012: chap 16.

6. Adele Pilitteri,Maternal and Child Health Nursing 5th

edition.

7. DOH, Community Health Nursing

8. Marilyn Doenges, Mary Moorhouse, Alice Murr, Nurses

pocket guide.

9. www.healthline.com/health/miscarriage-

threatened#RiskFactors

10. www.emedicinehealth.com/threatened_miscarriage/page1-

4_em.htm

79
REPORTERS
PROFILES

80
NAME: AGNAS, JULLYVEE GAANO
NICKNAME: “ELIE”
AGE: 21 y/o
DATE OF BIRTH: NOVEMBER 28, 1994
ADDRESS: CAWAGAYAN PINUKPUK,

KALINGA
STATUS: SINGLE
FATHER’S NAME: JULIO AGNAS
MOTHER’S NAME: TEODORA GAANO AGNAS
RELIGION: ROMAN CATHOLIC
ALUMNUS OF: CAWAGAYAN NATIONAL HIGH SCHOOL

MOTTO:

PERFECTION IS NOT ATTAINABLE, BUT IF WE CHASE

PERFECTION, WE CAN CATCH EXCELLENCE.
DEDICATION:

THIS CASE STUDY IS DEDICATED TO OUR VERY CARING AND

SUPPORTIVE INSTRUCTOR, SIR GIBSON M. RADAM AND MOST
ESPECIALLY TO MY FAMILY FOR THEIR SUPPORT, LOVE AND
ENCOURAGEMENT THROUGHOUT MY CASE STUDY. I WOULD ALSO LIKE
TO THANK GOD FOR GIVING ME WISDOM, COURAGE AND STRENGHT TO
FACE THE TRIALS THAT COME IN MY WAY UPON DOING THIS CASE
STUDY.
GOAL IN LIFE:

EVERY PERSON HAS ITS OWN GOAL OR AIM IN LIFE:

AS A STUDENT, I WANT TO FINISH MY STUDIES IN ORDER FOR ME
TO ACHIEVE MY DREAM WHICH IS TO HAVE A STABLE JOB SO THAT I
CAN BE ABLE TO REPAY ALL THE SACRIFICES OF MY PARENTS.

81
NAME: JENNIFER CALBUYAO
NICKNAME: “JHEN”
AGE: 24 y/o (by Legal)

25 y/o (NSO)
DATE OF BIRTH: JUNE 2, 1991 (NSO)
ADDRESS: NEW TANGLAG, TABUK CITY,

KALINGA
STATUS: MARRIED
FATHER’S NAME: FAUSTINO CALBUYAO
MOTHER’S NAME: ROSE CALBUYAO
RELIGION: ROMAN CATHOLIC
ALUMNUS OF: TABUK NATIONAL HIGH SCHOOL

MOTTO:

THE BEST PPREPARATION FOR TOMORROW IS DOING YOUR BEST

TODAY.
DEDICATION:

I WOULD LIKE TO DEDICATE THIS CASE STUDY TO OUR

BELOVED C.I. SIR GIBSON RADAM WHO ALWAYS HELPS US IN OUR
ACTIVITY. TO OUR ALMIGHTY GOD WHO IS CONSTANT AND PROVIDER
AND TO MY FAMILY WHO WERE ALWAYS THERE FOR ME NO MATTER
WHAT. THEY ARE ALWAYS AT MY SIDE GUIDING AND SUPPORTING ME.
GOAL IN LIFE:

TO BE SUCCESSFUL CHILD OF ALMIGHTY GOD.

82
NAME: CHRISTINE C. ENCARTADO
NICKNAME: “TINTIN”
AGE: 17 y/o
DATE OF BIRTH: DECEMBER 16, 1998
ADDRESS: KINAMA RIZAL, KALINGA
STATUS: SINGLE
FATHER’S NAME: BENJAMIN G. ENCARTADO
MOTHER’S NAME: DIGNA C. ENCARTADO
RELIGION: UNION ESPIRITISTA CHRISTIANA De FILIPINAS
INCORPORADA
ALUMNUS OF: KINAMA NATIONAL HIGH SCHOOL

MOTTO:
HARDSHIP IS THE MOST INGREDIENT OF LIFE.

DEDICATION:

THIS ACCOMPLISHMENT IS ESPECIALLY DEDICATED TO MY

LOVING FAMILIES, WHO WERE ALWAYS THERE FOR ME, AND WHO
CONTINUOSLY SUPPORT IN PHYSICAL, FINANCIAL AND EMOTIONAL
NEEDS. I ALSO SHARE THIS FRUIT OF SUCCESS TO OUR INSTRUCTOR
SIR GIBSON RADAM WHO MADE SUBSTANTIAL CONTRIBUTIONS AND
IDEAS, TO OUR SUCCESSFUL OJT, FOR ALL THE HELP AND TIME
GIVEN TO US.
GOAL IN LIFE:

TO BECOME A SUCCESSFUL HEALTH PROVIDER.

83
NAME: CHRISTINA DALSEN GALLING
NICKNAME: “KALAY”
AGE: 20 y/o
DATE OF BIRTH: OCTOBER 2, 1996
ADDRESS: MANANGOL LUBUAGAN,

KALINGA
STATUS: SINGLE
FATHER’S NAME: ROBERTO MANATAO

GALLING
MOTHER’S NAME: IRENE DALSEN GALLING
RELIGION: BAPTIST
ALUMNUS OF: AGBANNAWAG NATIONAL HIGH SCHOOL
MOTTO:

DONT LIMIT YOURSELF. MANY LIMIT THEMSELVES OF WHAT

THEY CAN DO. YOU CAN GO AS FAR AS YOUR MIND LETS YOU. WHAT
YOU BELIEVE, REMEMBER, YOU CAN ACHIEVE.

DEDICATION:

I DEDICATE THIS CASE STUDY TO MY FAMILY, RELATIVES AND

FRIENDS, WHO SUPPORTED ME MORALLY AND FINANCIALLY
THROUGHOUT MY STUDY AND TO OUR C.I SIR GIBSON RADAM FOR
GIVING US ADVISES AND SUPPORTED US UNTIL WE FINISHED THIS
CASE STUDY.

GOAL IN LIFE:

TO BECOME A SUCCESSFUL MIDWIFE.

84
NAME: SHAMYR AGURIN SORIANO

NICKNAME: “AMHYRE”

AGE: 21 y/o

DATE OF BIRTH: OCTOBER 4, 1995

ADDRESS: MASABLANG TABUK CITY,

KALINGA

STATUS: SINGLE

FATHER’S NAME: EDUARDO MULANG SORIANO

MOTHER’S NAME: CRISTINA AGURIN SORIANO

RELIGION: ROMAN CATHOLIC

ALUMNUS OF: ST. THERESITA’S SCHOOL, TABUK

MOTTO:

DO NOT GO WHERE THE PATH MAY LEAD, GO INSTEAD WHERE

THERE IS NO PATH AND LEAVE A TRAIL.

DEDICATION:

THIS PIECE OF WORK IS ESPECIALLY DEDICATED TO OUR EVER

SUPPORTIVE AND KIND CLINICAL INSTRUCTOR, SIR GIBSON RADAM
FOR NOT LEAVING US THROUGHOUT THE MAKING OF THIS CASE
STUDY, ALSO TO MY FAMILY WHO SUPPORTED ME FINANCIALLY AND
MORALLY.

GOAL IN LIFE:

TO FINISH MY STUDIES AND HAVE A STABLE JOB TO REPAY

ALL THE HARDSHIP OF MY PARENTS.
85
DOCUMENTATION

86