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Bleeding causes in the first trimester pregnancy

Bleeding causes in the first trimester pregnancy. Threatened abortion Ectopic pregnancy Cervical polyps Hydatidiform mole Cervicitis. Abortion. Threatened abortion Inevitable abortion Complete abortion Incomplete abortion Missed abortion. Threatened abortion.

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Bleeding causes in the first trimester pregnancy

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  1. Bleeding causes in the first trimester pregnancy • Threatened abortion • Ectopic pregnancy • Cervical polyps • Hydatidiform mole • Cervicitis

  2. Abortion • Threatened abortion • Inevitable abortion • Complete abortion • Incomplete abortion • Missed abortion

  3. Threatened abortion Bleeding and uterine cramping without cervical dilation

  4. Inevitable abortion • Profuse haemorrhaging, rupture of the membranes, cramping with a dilated cervical os

  5. Incomplete abortion • When some products of conception are expelled but some tissue remains in the uterine cavity.

  6. RECURRENT PREGNANCY LOSS (RPL) • The loss of tree or more spontaneous and consecutive pregnancies, occuring before the period of viabity PRIMARY RPL SECONDARY RPL

  7. Causes of RPL • Chromosomal 1,8- 4,6% • Anatomic 1-28% • Immunologic 6-65% • Hormonal 5- 29% • Infectious • Unexpained 15-50%

  8. Genetic causes • Trisomy 40-50% • Monosomy 15-25% • Triploidy 15% • tetraploidy 5%

  9. Anatomic abnormalities • Uterine congenital abnormalieties ( septate uterus, bicornuate or unicornuate uterus) • Intrauterine adhaesiones • Leiomyomata • Cervical incompetence

  10. Endokrinologic causes • The luteal phase deficiency • Thyroid disease • diabetes

  11. Infections • Listeria monocytogenes • Mycoplasma hominis • Ureaplasma urealiticum • Toxoplasmosis • Cytomegalia • Rubella

  12. Enviromental factors • Smoking • Alkohol • Ansthetic gases • Toxins • Radiations

  13. Missed abortion Death of the fetus or embryo without the onset of labour or the passage of tissue

  14. Diagnosis of abortion • Clinical examination ( bleeding, abdominal pain, cramping) • Ultrasonography

  15. Medical conditions associated with pregnancy loss • Collagen vascular diseases • Thyroid disease • Diabetes mellitus • Chronic active hepatitis • Infections • Endometriosis • Thrombo-embolic disease • Chronic renal disease • Chronic cardiovascular disease

  16. Immune theories of RPL • In the alloimmune theory state, the maintenance of normal pregnancy requires the immune system to recognize the implanting embryo as foreign • the autoimmune theory state, in whichwomen’s immune system may produce antiphospholipid antibodies

  17. Criteria for the antiphospholipid antiboby syndrome

  18. Laboratory findings Persistently elevated anti-phospholipid antibodies (ACA) Lupus anticoagulant (LA) Clinical findnings Thrombosis (venous or arterial) Recurrent pregnancy loss Thrombocytopenia Criteria for anti-phospholipid antibody syndrome

  19. The target cells for antiphospholipid antibodies • Endothelial cells • Throphoblastic cells • Blood platelets • Embyonic tissue cells • Coagulation factors • Proteins involved in the coagulation cascade or in antibodies bindings

  20. Molar pregnancy (microscopic features)

  21. Complete mole Marked oedema and enlargement of the villi Dissappearance of the villous blood vassels Proliferation of lining trophoblast of the villi Absence of the fetus, cord ar amniotic membrane A normal kariotype Partial mole Marked swelling of the villi with atrophic throphoblastic cells Presence of normal villi Presence of fetus, cord and amniotic membrane An abnormal karyotype Molar pregnancy (microscopic features)

  22. Symptoms: • Bleeding • The uterus is often larger than expected • Nausea and vomiting • Preeclampsia • Clinical hyperthyroidism • Abdominal pain secondary to theca lutean cysts

  23. Diagnosis • Passage of vesicular tissue • A quantitative HCG > 100 000 uIU/ml • Ultrasonography ( snow storm)

  24. Clinical classification of gestational thropfoblastic disease Molar pregnancy (hydatidiform mole) • Compete mole • Partial mole Gestational throphoblastic neoplasia

  25. Persistent gestational throphoblastic neoplasia • Histologically benign • Persistent histologically benign • Persistent histologically malignant

  26. Benign GTD • Low socioeconomic status • Older women • Spontaneous remission in 80-85% after dilatation and evacuation • Choriocarcinoma develops in 3- 5% of moles

  27. Malignant GTD • 1 : 20 000 pregnancies A/ molar pregnancy (50%) B/ normal pregnancy (25%) C/ abortion and ectopic pregnancy (25%)

  28. Management • Suction curetage • Primary hysterectomy • Prophylactic chemiotherapy

  29. Follow–up examination include • HCG determinations every 1-2 weeks until they are negative twice, then montly for 1 year • Contraception for 1year • Physical examination every 2 weeks until remission, then every 3 months for 1 year • Chest film initially and repeated if the HCG plateau or rises • Chemiotherapy should be started if the HCG titer rises or is stable if metastases are detected at any time

  30. Abortion • Spontaneous • Induced • Early ( before 12 weeks) • Late (after 12 weeks)

  31. Abortion The termination of pregnancy before viability, (22 weeks from the first day of the last normal menstrual bleeding).

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