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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

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Disorder of early pregnancy

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  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

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