1 / 25

Disorder of early pregnancy

Disorder of early pregnancy. Miscarriage:. The WHO definition is the expulsion from its mother of an embryo or fetus weighting 500g or less. For WHO : before 20 weeks In the UK: less than 24 weeks. Threatened miscarriage Inevitable miscarriage Incomplete miscarriage Complete miscarriage

gibson
Download Presentation

Disorder of early pregnancy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Disorder of early pregnancy

  2. Miscarriage: • The WHO definition is the expulsion from its mother of an embryo or fetus weighting 500g or less. • For WHO : before 20 weeks • In the UK: less than 24 weeks

  3. Threatened miscarriage • Inevitable miscarriage • Incomplete miscarriage • Complete miscarriage • Missed abortion: the embryo or fetus dies in utero before the 20th ws, but the products are retained. • Anembryonic pregnancy or Silent miscarriage • Recurrent miscarriage • Septic abortion:there is infected abortion with systemic dissemination of the infection.

  4. Incidence of Miscarriage • 1 in every 6 pregnancies • 10 – 25 % of all the pregnancy • Risk of subsequent miscarriage 1/6 • The incidence increase with maternal age

  5. Causes of Miscarriage • 60% chromosome • abnormalities • 30% placental malformation • 10% miscellaneous. • First Trimester: -Chromosomal abnormalities -Progesterone deficiency . Second Trimester: -Uterine malformation -Fibroids -Cervical incompetence -placental malformation

  6. Causes: • Ovular: -Abortive egg -Trophoblastic endocrine disorder Mother: -Local: Endometritis,uterine malformation, uterine position, cervical incompetence. General:Infections, Toxic, Endocrine, Nutritional deficiency,Traumas, stress, Immunological causes (lupus anticoagulant, antiphospholipidid antibodies)

  7. General risk factor • Uncontrolled diabetes • PCOS • High blood pressure • Infection with Rubeola, Clamydia • Autoimmune disease • Cocaine, alcohol • Physical trauma • Exposure to environmental toxins • Use of IUD

  8. Threatened Miscarriage • 1 in every 4 pregnancies • Slight bleeding/cramping • Half will abort, Half will be OK • Bed rest will not prevent abortion but may postpone it. • The cervix is closed

  9. Inevitable Miscarriage: • Uterine cramping and bleeding • Cervix is open • The expulsion of the uterine contents is imminent • Sometimes rupture of the membranes • Require similar treatment to incomplete abortion.

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

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

  12. Incomplete Miscarriage: Treatment • Convert it to a Complete Abortion if tissue visible in the os, remove it • Ergotrate, Oxytocin • Antibiotics • Curetage Tissue removed from os Tissue still inside uterus

  13. Septic Abortion • Any abortion complicated by infection with systemic dissemination • Fever, Tenderness • Ergotrate, Oxytocin • Antibiotics • D&C

  14. Septic Abortion: Antibiotics Ceftriaxone, Gentamicine, Flagyl Ciprofloxacine, Gentamicine, Flaglyl.

  15. Ectopic Pregnancy: • 􀂄 Pregnancy anywhere outside uterine cavity • 􀂄 Fallopian tube most common location • 􀂄 Second leading cause of maternal mortality • 􀂄 Risk Factors: 􀂋 Pelvic inflammatory disease, Age, Previous Ectopic, Previous tubal ligation

  16. Etiology: • Tubal factors(Salpingitis,BTL, microsurgery,extrinsic adhesion,pelvic tumors, endometriosis) • Zygote abnormalities • Ovarian factors(transmigration, post-midcycle ovulation)

  17. Symptoms: • Pelvic or lower abdominal pain • Abnormal uterine bleeding • Absent of the period • Syncope

  18. Signs: • Abdominal tenderness • Adnexal tenderness • Adnexal mass • Uterine change

  19. Laffont Sign • Cullen Sign • Proust Sign

  20. Ectopic Pregnancy • Physical Findings • 􀂋 Hypotension, tachycardia(shock) • 􀂋 Adnexal mass or tenderness in adnexa • 􀂋 Uterus-normal size • 􀂋 Peritoneal Signs • Diagnostic Tests • 􀂋 HCG • 􀂋Ultrasound • 􀂋Culdocentesis • Laparoscopy

  21. Ectopic Pregnancy • 􀂄 Management-determine hemodynamic stability • 􀂋Medical Methotrexate-unruptured, small, no cardiac activity, compliant patient • 􀂋Surgical 􀀩Laparoscopy • Salpingostomy • Salpingectomy Laparotomy

  22. Prognosis for Subsequent Fertility 􀂄 Overall subsequent pregnancy rate is 60%, other 40% are infertile • One-third of pregnancies after an ectopic pregnancy are another ectopic pregnancy, one-sixth are spontaneous abortions • Only 33% of women with ectopic pregnancy will have a subsequent live birth

  23. Ectopic Pregnancy: • Ectopic Pregnancy- • Unusual Variants • 􀂄 Heterotopic Pregnancy Simultaneous IUP and ectopic gestations 􀂋Rare- 1 in 30,000 pregnancies • 􀂄 Abdominal Pregnancy-can occur anywhere in peritoneal cavity (1 in 3000) • 􀂄 Cervical Pregnancy (1 in 10,000) 􀂋May need hysterectomy • 􀂄 Ovarian Pregnancy (1 in 7,000) 􀂋Oophorectomy usually required

More Related