CASE STUDY OF INTRAUTERINE FETAL DEMISE MA. ARNIE PULGA, RN BY: GROUP 25 ESPINOSA, MARIFE S. FACUN, SHALLIE MAE E. FERNANDO, MONIKA V. GORIOSO, GERMAIN B. Biographical data Name: Mrs. C. B Status: Widow Birthday: 05/05/1968 Birthplace: Bacolod Religion: Catholic Admitting diagnosis: Intrauterine Fetal Demise 39 weeks AOG G5P4 (4014) Attending Physician: Dr. Isabel Hayag Operation procedure: NSD with Mer (3) Final Diagnosis: Intrauterine Fetal Demise 39 weeks AOG G5P4 (4014) Reason of Admission: Abdominal Enlargement, labor pain History of present illness:
Few hours prior to admission patient had on set sudden of abdominal enlargement, Patient was in denial of pregnancy on examination revealed pregnancy (+) PHYSICAL EXAMINATION 1. ) GENERAL INFORMATION NAME;C. B. AGE: 41 yrs. old CC: Abdominal Enlargement ADMITTING DIAGNOSIS: Intrauterine fetal demise ADMITTING PHYSICIAN: Dr. Isabel Hayag 2. ) VITAL SIGN BP: 150/100 Temp: 36 C RR: 20 cycles/min PR: 88 bpm 3. ) GENERAL SURVEY The patient show with signs of distress Coherent, oriented to time, place and person The pt. is ectomorph. Well- developed. Looks according to age. Emotional state is haggard. 4. SKIN The general color is pale. Smooth to touch. Has a fair skin turgor. Warm and dry. 5. ) HEAD The pt. head is normocephalic. Fine hair and clean scalp Lids are symmetrical Peri orbital region has no edema. Conjuctiva are pale. Anicteric scalera. Cornea and lens are smooth. Pupil size are equal. Reaction to light are brisk. Has uniform constriction. Convergence are intact. Visual acuity is grossly normal. 6. ) EARS External pinnae are normoset. No discharge. Gross hearing are symmetrical. 7. ) NOSE Nasolabial fold is symmetrical. Septum is in midline. Mucosa is pale. Gross smelling are summetrical.
Both patent. Non-papable. 8. ) MOUTH Lips are pale. Tongues is in midline. Gums and mucosa are pale 9. ) PHARNYX Uvula is in midline. Mucosa is pale. Tonsils are not inflamed. 10. ) NECK Trachea is in midline. Non-palpable lympnodes and thyroids. 11. ) CHEST AND LUNGS Breathing pattern is regular. Lung expansion are symmetrical. Vocal premitus are symmetrical. Bronchial sound heared over trachea Bronchovesicular sound heared over mainstem bronchi Vesicular heared over lung periphery 12. ) HEART Normo-dynamic precordium Heart sound is regular 13. ) BREAST AND AXILLE Equal in size, engorge
Shape is symmetrical Pinkish In color Smooth surface 14. ) ABDOMEN Configuration symmetrical Normo active bowel sounds 15. ) GENITO URINARY SYSTEM Not able to assess 16. ) BACK AND EXTREMITTIES Peripheral pulses are symmetrical Nails and nail beds is pale The pt. have full range of motion Spine is in middle INTRAUTERINE FETAL DEMISE (IUFD) Intrauterine fetal demise is the clinical term for the death of a baby in the uterus during pregnancy and before birth. The term is usually used for pregnancy losses that happens after 20th week of gestation. Also known as: stillbirth. ANATOMY AND PHYSIOLOGY
During pregnancy (female reproductive) • Vagina: A muscular passageway that leads from the vulva (external genitalia) to the cervix. • Cervix: a small hole at the end of the vagina through which sperm passes into the uterus. Also serves as a protective barrier for the uterus. During childbirth, the cervix dilates (widens) to permit the baby to descend from the uterus in to the vagina for birth. • Uterus: A hallow organ that houses the baby during pregnancy. During childbirth, the uterine muscles contract to push out the baby. Each month, unless a fetus has been conceived, the uterine wall sheds its lining. Amniotic fluid: is the nourishing and protecting liquid contain bu the amnion of a pregnant woman. • Fetus: is a developing mammal or other viviparous vertebrate, after the embryonic stage and before birth. • Umbilical cord: is the connecting cord from the developing embryo or fetus to the placenta. The umbilical veins supplies the fetus with oxygenated, nutrient-rich blood from the placenta. • Placenta: is an organ unique to mammals that connect the developing fetus to the uterine wall. The placenta supplies the fetus with oxygen and food, and allows fetal waste to be dispose via the material kidney. • Uterine wall: the wall of the uterus
PATHOPHYSIOLOGY RISK FACTOR Some material conditions which are known to increase the risk to fatal death, but in most cases, risk factor are unknown. • Multiple pregnancy • History of small for gestational age infant • Paternal age SIGN AND SYMTOMS Sign and symptoms of pregnancy may subside No symptoms may occur in the early stages of pregnancy. The diagnosis is based on the absence of fetal heart tones, the lack of uterine growth or ultrasound studies during prenatal examinations. In later stages of pregnancy, a woman may be aware of changes in the fetal movement ( kick ) or that the movement stop. LABORATORY EXAMINATION
HEMATOLOGY Before blood transfusion | |RESULTS |NORMAL VALUES | |Hemoglobin |9. 1 |12-16 g/dl | |Erythrocytes |26. 1 | | |Leucocytes |32,500 |4,000-11,000 | |Segmenters |76 | | |Eosinophil |3 |1. | |Lympocytes |20 |20-40% | |Monocytes |0. 7 |2-8% | |Platelet Count |433,000 |150,000-500,000/mm | After Blood Transfusion | |RESULTS |NORMAL VALUES | |Hemoglobin |12. |12-16 g/dl | |Erythrocytes |36. 9 | | |Leucocytes |12,300 |4,000-11,000 | |Segmenters |7 | | |Eosinophil |0. |1. 4 | |Lympocytes |20 |20-40% | |Monocytes |0. 7 |2-8% | |Platelet Count |433,000 |150,000-500,000/mm | URINALYSIS |RESULTS |NORMAL VALUES | |Color |light yellow |amber yellow | |Reaction |6. 5 | | |Transparency |hazy | | |Secific Gravity |1. 1 |1. 010-1. 025 | |Albumin |negative |negative | |Sugar |negative |negative | |Pus Cells |5-8% |0-1/hpf | |RBC |1-2/hpf |4. -5. 1 million/mm | |Epithelial cells |few |rare | |Bacteria |few |rare |