Discharge And Home Healthcare Guidelines

PREVENTION. Use extreme caution not to make the patient feel guilty about the cause of the SAB; however, it is important that she be made aware of factors that might contribute to the occurrence of an SAB (such as cigarette smoking; alcohol and drug usage; exposure to x-rays or environmental teratogens). Preconceptual care should be encouraged, should the patient decide to become pregnant again.

COMPLICATIONS. Teach the patient to notify the physician of an increase in bleeding, return of painful uterine cramping, malodorous vaginal discharge, temperature greater than 100.4°F, or persistent feelings of depression.

HOME CARE. Teach the patient to avoid strenuous activities for a few days. Encourage the patient to use peripads instead of tampons for light vaginal discharge to decrease the likelihood of an infection. Explain that the patient should avoid intercourse for at least 1 week and then use some method of birth control until a future pregnancy can be discussed with the physician. Follow-up is suggested. A phone call to the patient on her due date will demonstrate support and provide an outlet for her to express her grief.

Abruptio Placentae DRG c^ew 372

Mean LOS: 2.7 days

Description: MEDICAL: Vaginal Delivery with Complicating Diagnosis

^Abruptio placentae is the premature separation of a normally implanted placenta before the delivery of the baby. It is characterized by a triad of symptoms: vaginal bleeding, uterine hypertonus, and fetal distress. It can occur during the prenatal or intrapartum period. In a marginal abruption, separation begins at the periphery and bleeding accumulates between the membranes and the uterus and eventually passes through the cervix, becoming an external hemorrhage. In a central abruption, the separation occurs in the middle, and bleeding is trapped between the detached placenta and the uterus, concealing the hemorrhage. Frank vaginal bleeding also does not occur if the fetal head is tightly engaged. Since bleeding can be concealed, note that the apparent bleeding does not always indicate actual blood loss. If the placenta completely detaches, massive vaginal bleeding is seen. Abruptions are graded according to the percentage of the placental surface that detaches (Table 3). Visual inspection of an abrupted placenta reveals circumscribed depressions on its maternal surface and is covered by dark, clotted blood. Destruction and loss of function of the placenta result in fetal distress, neurological deficits such as cerebral palsy, or fetal death.

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