Dilation and Curettage
Dilation and Curettage
Abortion
Case
Analysis
Abortion is the loss or termination of pregnancy less than the age of viability which is
20-24 weeks of gestation or if the fetus weighs less than 500 grams.
Abortus is a fetus that weighs less than 500 grams or expelled from uterus before age
of viability.
Demographic Data
This is the case of Patient IC, a 39 year old G1P0 (0010), female, Filipino, Roman
Catholic, married, currently live in Taguig City, admitted for Vaginal bleeding in Pasay
City General Hospital on January 27, 2020.
Chief Complaint
Vaginal Bleeding
3 days prior to admission, the patient experienced abdominal pain in the hypogastric
area, with a scale of 6/10. She took mefenamic 500mg.
2 days prior to admission, the patient experienced heavy vaginal bleeding consuming 3
napkins, fully soaked. Along with the the abdominal pain in the hypogastic region that is
radiating to the lower back.
1 day prior to admission, the patient experiences intermittent fever and headache. She
took Paracetamol 500 mg to relieve the symptoms.
Few hours prior to admission, heavy vaginal bleeding, hypogastric pain, fever with
nausea and vomiting along with headache that prompted her for hospitalization as she
complaint her symptoms at the PCGH.
The patient has no previous hospitalization or any surgeries noted. No medical history
of Cancer, Tuberculosis, Asthma, Diabetes Mellitus, or Hypertension.
Family History
The patient lives in Taguig City with her husband. She uses her household chores as an
exercise. Patient IC is a non smoker and an occasional drinker consuming 1 bottle of
emperador lights. Diet consists mainly of fish, meat, eggs, vegetables and rice.
Menstrual History
Patient IC menarche started when she was 13 years old, her menstrual period duration
is 4-5 days, regular cycle of 28 days, consumes 3-4 pads per day, heavily soaked at her
2nd and 3rd day period.
Medications
Her medications are Cefalexin 500mg, Mefenamic Acid 500 mg, Ferrous Sulfate.
Patient IC was admitted at Pasay City General Hospital with a chief complaint
“Dinudugo ako” as verbalized by the patient last January 27, 2020. Her admitting v/s
was Temp-36.6 C, PR-67 bpm, RR 20 cpm, BP – 110/70 mmHg. She was told to stay
for more than 10 days by the doctor for observation because she might need another
surgery because there is still a positive heavy vaginal bleeding. She will undergo a
transvaginal ultrasound at 2 pm. The patient doesn’t have any contraptions. V/S
monitored and recorded every 4 hours.
8 AM 12 PM
On the following day, Patient IC was fully awake and coherent, patient instructs diet as
tolerated. V/S was taken and recorded every 4 hours. Health teaching was done
regarding perineal care. She still doesn’t have an order of MGH yet because she’s
awaiting for her surgery for today.
7:05 AM 11 PM
Case Discussion
Patient IC is a 39 year old noted to have a heavy vaginal bleeding, and hypogastric pain
radiating to the back, had fever, headache, nausea and vomiting with a BP of 100/80
mmHg. Vaginal bleeding during pregnancy is the most predictive factor for pregnancy
loss or abortion. Classifications of abortions include spontaneous abortion, recurrent
miscarriage, incuded abortion, and contraception following miscarriage or abortion.
Rule in: the patient experience heavy vaginal bleeding, abdominal pain on her
first trimester of pregnancy.
Rule out: the clinical diagnosis of threatened abortion is presumed when a bloody
vaginal discharge or bleeding appears through a closed cervical os during the
first half of pregnancy.
Rule in: heavy vaginal bleeding, intermittent fever, nausea and vomiting.
Rule out: the patient has no severe infections noted prior to pregnancy.
Rule in: heavy vaginal bleeding with open cervical os, fever, nausea and
vomiting.
Risk Factors:
Maternal Factors
Clinically, apparent miscarriage increases with parity as well as maternal and paternal
age. The frequency doubles from 12% from women younger than 20 years to 26% in
those older than 40 years old.
Alcohol. Both spontaneous abortion and fetal anomalies may result from frequent
alcohol use during the first 8 weeks of pregnancy.
To diagnose a condition
Your doctor might recommend a type of D&C called endometrial sampling to diagnose a
condition if:
Risks
Dilation and curettage is usually very safe, and complications are rare. However, there
are risks. These include:
Most perforations heal on their own. However, if a blood vessel or other organ is
damaged, a second procedure may be necessary to repair it.
Damage to the cervix. If the cervix is torn during the D&C, your doctor can apply
pressure or medicine to stop the bleeding, or can close the wound with stitches
(sutures).
Contact your doctor if you experience any of the following after a D&C:
Bleeding that's heavy enough that you need to change pads every hour
Fever
Cramps lasting more than 48 hours
Pain that gets worse instead of better
Foul-smelling discharge from the vagina
After the procedure
You may spend a few hours in a recovery room after the D&C so that your doctor can
monitor you for heavy bleeding or other complications. This also gives you time to
recover from the effects of anesthesia.
If you had general anesthesia, you may become nauseated or vomit, or you might have
a sore throat if a tube was placed in your windpipe to help you breathe. With general
anesthesia or light sedation, you may also feel drowsy for several hours.
Normal side effects of a D&C may last a few days and include Mild cramping and
Spotting or light bleeding
For discomfort from cramping, your doctor may suggest taking ibuprofen (Advil, Motrin
IB, others) or another medication.
You should be able to resume your normal activities within a day or two.
Wait to put anything in your vagina until your cervix returns to normal to prevent bacteria
from entering your uterus, possibly causing an infection. Ask your doctor when you can
use tampons and resume sexual activity.
Your uterus must build a new lining after a D&C, so your next period may not come on
time. If you had a D&C because of a miscarriage, and you want to become pregnant,
talk with your doctor about when it's safe to start trying again.
Conclusion
Patient IC is a 39 year old G1P1 (0010), rushed and admitted to Pasay City General
Hospital last January 27, 2020 because of Vaginal bleeding. She has an incomplete
abortion and for undergoes a Dilation and Curettage procedure under the service of
Doctor Wong.
Patient IC was unstabled after the day of her procedure, she still has a positive heavy
vaginal bleeding and awaits for another surgery so the doctor cannot order an MGH.