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Abnormal Pregnancy

Abnormal Pregnancy. CAPT Mike Hughey, MC, USNR. Incidence of Miscarriage. 1 in every 6 pregnancies Risk of subsequent miscarriage 1/6 Bedrest will not prevent miscarriage but may postpone it. Causes of Miscarriage. 60% chromosome abnormalities 30% placental malformation

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Abnormal Pregnancy

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  1. Abnormal Pregnancy CAPT Mike Hughey, MC, USNR

  2. Incidence of Miscarriage • 1 in every 6 pregnancies • Risk of subsequent miscarriage 1/6 • Bedrest will not prevent miscarriage but may postpone it

  3. Causes of Miscarriage • 60% chromosome abnormalities • 30% placental malformation • 10% miscellaneous, but not: -trauma -climbing mountains -intercourse -medication -too much activity, etc.

  4. Threatened Abortion • 1 in every 4 pregnancies • 1st TM bleeding/cramping • Half will abort, Half will be OK • Bedrest will not prevent abortion but may postpone it.

  5. Complete Abortion • Passage of all tissue • Rest for a day or two • Ergotrate, Oxytocin • Antibiotics • Rhogam • D&C? 9-week spontaneous complete abortion

  6. Incomplete Abortion: Diagnosis • Some tissue remains behind • Continuing bleeding/cramping • Tissue in cervical os • Uterus tender • Fever if infection present • Ultrasound helpful if available

  7. Incomplete Abortion: Treatment • Convert it to a Complete Abortion • If tissue visible in the os, remove it • Ergotrate, Oxytocin • Antibiotics • Rhogam • D&C Tissue removed from os Tissue still inside uterus

  8. Inevitable Abortion • No tissue has been passed • Cervix dilated or hemorrhage • Ergotrate, Oxytocin • Antibiotics • Rhogam • D&C

  9. Septic Abortion • Any abortion complicated by infection • Fever, Tenderness • Ergotrate, Oxytocin • Antibiotics • MEDEVAC • D&C

  10. Septic Abortion: Antibiotics • Clindamycin & Gentamicin IV • Flagyl & Gentamicin IV • Cefoxitin IV

  11. Unruptured Ectopic Pregnancy • + HCG • Unilateral pelvic pain and tenderness • ±Pelvic mass? • DD: CL cyst, Appy, PID • Lie still • MEDEVAC

  12. Ruptured Ectopic: Diagnosis • Pelvic & right shoulder pain • Sudden onset • Shock • Positive pregnancy test • Rebound & Rigidity late • Ultrasound • Culdocentesis

  13. Ruptured Ectopic: Treatment • Surgery • MEDEVAC • IVs, oxygen, lie still • Maintain urine output(Foley) • MAST suit?

  14. Blood Transfusion • O Negative blood • Blood collection bags • Direct Donor to Patient #16 needle 3-4 feet gravity feed 10 minutes • Have a plan before you need it

  15. Placental Abruption • >20 weeks • Uterine pain, tenderness, and contractions • ±Bleeding • Coagulopathy • Lie still, IV Fluids • MEDEVAC, Cesarean Section

  16. Placenta Previa • >20 weeks • Painless vaginal bleeding • No pelvic exam unless instructed by an OB-GYN • Pelvic exam may cause torrential hemorrhage, exsanguination and death within minutes • Rest, IVs, MEDEVAC

  17. Toxemia of Pregnancy • Elevated BP (>140/90) • Proteinuria (>300 mg in 24 hours) • Weight Gain (>2 pounds/week) • Swelling (?) • Increased reflexes (Clonus)

  18. Pre-Eclampsia • BP, Protein • Stable and unstable • Risk of IUGR • Risk of Abruption • Risk of maternal seizures • Risk of HELLP syndrome • Hemolysis • Elevated Liver Enzymes • Low Platelets Naval Hospital Jacksonville

  19. Eclampsia • Siezures • Risk of maternal death • Risk of HELLP syndrome • Hemolysis • Elevated Liver Enzymes • Low Platelets Naval Hospital Guam

  20. Treatment of Toxemia of Pregnancy • Delivery is definitive treatment • If delivery is to be postponed (prematurity), then consider hospitalization for unstable patients • Magnesium sulfate • Watch for HELLP syndrome

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