- First Trimester Bleeding: Evaluation and Management
- The Diagnosis and Treatment of Ectopic Pregnancy
- How to Write a SOAP Note With Obstetric Examples
- Ectopic pregnancy: A 5-step plan for medical management
- Ectopic Pregnancy
First Trimester Bleeding: Evaluation and ManagementCaitlin Goodwin is a Certified Nurse-Midwife and birth nerd with 12 years in obstetric nursing. Proper charting is an essential form of communication among healthcare professionals. Healthcare providers need to be fluent in SOAP notes because it provides concise and complete documentation that should describe what you observed, what data you collected, and what you did. Take full credit for your hard work! General appearance: Is the patient alert and oriented? Is the patient in mild, moderate, or severe distress? Does the patient appear healthy and well-nourished? Labs: Write down the results of any labs that are relevant and available today Urinalysis, blood sugar, labs and available from the prior visit. Imaging: Include any imaging results from the prior visit like the dating, Nuchal Translucency NTAnatomy or growth ultrasounds. The diagnosis can be as simple as intrauterine pregnancy and gestational age or specific to a disease process. If you are concerned about differentials, these should be listed too. CC: Unintended pregnancy, pt is accepting but overwhelmed. Unmarried, FOB involved. Presenting for OB care as a new patient, first antepartum visit. Unsure intercourse timing. Amenorrhea, increased frequency of urination, fatigue and breast tenderness began about four weeks ago. Denies dizziness, HA, visual disturbances, edema. Denies vaginal discharge, odor, bleeding, and cramping. Eats fruits and hydrates appropriately. Pt is not currently exercising. Never smoker. Christian, non-denominational No domestic violence. Does not have a cat, no litter box. Personal — Denies History of abuse, mental illness, depression, anxiety, or eating disorders. The sinuses are nontender. Pupils are equal and reactive. The nares are patent. The oropharynx is clear without lesions. Fetus: Bimanual exam presents as approximately 9 wks gestation.
The Diagnosis and Treatment of Ectopic Pregnancy
Patient information: See related handout on bleeding in early pregnancywritten by the authors of this article. Approximately one-fourth of pregnant women will experience bleeding in the first trimester. The differential diagnosis includes threatened abortion, early pregnancy loss, and ectopic pregnancy. Pain and heavy bleeding are associated with an increased risk of early pregnancy loss. Treatment of threatened abortion is expectant management. Bed rest does not improve outcomes, and there is insufficient evidence supporting the use of progestins. Ultrasound findings diagnostic of early pregnancy loss include a mean gestational sac diameter of 25 mm or greater with no embryo and no fetal cardiac activity when the crown-rump length is 7 mm or more. Treatment options for early pregnancy loss include expectant management, medical management with mifepristone and misoprostol, or uterine aspiration. Established criteria should be used to determine treatment options for ectopic pregnancy, including expectant management, medical management with methotrexate, or surgical intervention. Physical examination findings, laboratory testing, and ultrasonography can be used to diagnose the cause of first trimester bleeding and provide appropriate management. A glossary of terms used in this article is available in Table 1. A meta-analysis evaluating the accuracy of a single progesterone test to predict pregnancy outcomes for women with first trimester bleeding showed that a progesterone level less than 6 ng per mL Guidelines for ultrasound diagnosis of early pregnancy loss have been established to decrease the likelihood of false diagnosis and of intervening in a desired viable pregnancy. Oral mifepristone Mifeprexmg, followed 24 hours later by misoprostol, mcg vaginally, is the most effective regimen for medical management of early pregnancy loss and, when available, should be recommended over misoprostol alone. Rh o D immune globulin Rhogam should be administered to Rh-negative women with early pregnancy loss, especially when it occurs later in the first trimester. Early pregnancy loss can be definitively diagnosed in women with ultrasound findings of a mean gestational sac diameter of 25 mm or greater and no embryo or embryonic cardiac activity when the crown-rump length is at least 7 mm. Bed rest or progestins should not be recommended to prevent early pregnancy loss in patients with first trimester bleeding because these interventions have not been proven effective. Expectant management, medical management, and uterine aspiration are safe methods for treating anembryonic gestations and fetal demise. Patient preference should guide treatment decisions. Treatment for incomplete abortion should rely on shared decision making. Transvaginal ultrasonography shows intrauterine gestational sac with no embryonic cardiac activity and no findings of definite pregnancy failure [ Table 2 ]. Pregnancy that cannot result in live birth e. Positive urine or serum pregnancy test with no intrauterine or ectopic pregnancy shown on transvaginal ultrasonography.
How to Write a SOAP Note With Obstetric Examples
Ectopic pregnancy: A 5-step plan for medical management
Pregnancy is an occasion worth celebrating. The formation of a new life inside of a woman is a miracle to behold and should be experienced by women who want to seek the fulfillment you have always wanted. However, no matter how you handle a pregnancy with care there are still instances that it is compromised. Nurses promote life and well-being, so it is a must for us to educate our clients with regards to the complications they could experience during pregnancy. It is important for both the pregnant woman and the health care provider to identify any signs and symptoms of an ectopic pregnancy before rupture occurs. However, most ectopic pregnancy does not show any unusual signs and symptoms at the time of implantation, so it would be difficult to identify them at first. Tests to determine the possibility of ectopic pregnancy must be performed first before the diagnosis. The medical management of a woman with an ectopic pregnancy should be initiated the moment she is brought to the emergency room. Just a few moments of interval for action would cause a big difference in the safety of the patient. Surgical interventions would be performed after the rupture of the ectopic pregnancy to ensure that the reproductive system would still be functional and no complications would arise. Nurses must also have their own function when it comes to ectopic pregnancy, even without a direct order from the physician. Ectopic pregnancy is a menace for both the mother and the zygote. However much we want to save the zygote, it would be impossible because it has grown outside the usual site of implantation. This article helps me a lot in making my case analysis in ectopic pregnancy. A lot of useful informations are cited. A lot information on ectopic pregnancy is being found here. Thank you very much. May Allah reward you. The information on ectopic pregnancy is very useful here. Since we started inNurseslabs has become one of the most trusted nursing sites helping thousands of aspiring nurses achieve their goals. Our ultimate goal is to help address the nursing shortage by inspiring aspiring nurses that a career in nursing is an excellent choice, guiding students to become RNs, and for the working nurse — helping them achieve success in their careers. Sign in. Log into your account.