Discharge And Home Healthcare Guidelines

Provide a complete explanation of all emergency treatments and answer the patient's and family's questions. Explain the possibility of complications to recovery, such as poor wound healing, infection, and bleeding. Explain the risks of blood transfusions, and answer any questions about exposure to blood-borne infections. If needed, provide information about any follow-up laboratory procedures that might be required after discharge. Provide the dates and times that the patient is to receive follow-up care with the primary healthcare provider or the trauma clinic. Give the patient a phone number to call with questions or concerns. Provide information on how to manage any drainage systems, colostomy, intravenous therapies, or surgical wounds.

Abortion, Spontaneous

DRG Category: 380

Mean LOS: 4.16 days

Description: MEDICAL: Abortion without

Dilation and Curettage DRG Category: 381 Mean LOS: 1.7 days Description: SURGICAL: Abortion with Dilation and Curettage, Aspiration Curettage, or Hysterotomy

Spontaneous abortion (SAB) is defined as the termination of pregnancy from natural causes before the fetus is viable. Viability is defined as 20 to 24 weeks' gestation or a fetal weight of more than 500 g. SABs are a common occurrence in human reproduction, occurring in approximately 15% to 22% of all pregnancies. If the abortion occurs very early in the gestational period, the ovum detaches and stimulates uterine contractions that result in its expulsion. Hemorrhage into the decidua basalis, followed by necrosis of tissue adjacent to the bleeding, usually accompanies the abortion. If the abortion occurs later in the gestation, maceration of the fetus occurs; the skull bones collapse, the abdomen distends with blood-stained fluid, and the internal organs degenerate. In addition, if the amniotic fluid is absorbed, the fetus becomes compressed and desiccated.

There are five types of SABs, classified according to symptoms (Table 2): threatened, inevitable, incomplete, complete, and missed. A threatened abortion occurs when there is slight bleeding and cramping very early in the pregnancy; about 50% of women in this category abort. An inevitable abortion occurs when the membranes rupture, the cervix dilates, and bleeding increases. An incomplete abortion occurs when the uterus retains parts of the products of conception and the placenta. Sometimes, the fetus and placenta are expelled, but part of the placenta may adhere to the wall of the uterus and lead to continued bleeding. A complete abortion occurs

12 Abortion, Spontaneous

• TABLE 2 Types of SABs
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