PATHOLOGIC OB

A. ABORTION
 Termination of pregnancy before c. Passage of tissues or products of
the age of viability usually before conception
20 to 24 weeks gestation.
1. Causes of Spontaneous Abortion d. Signs related to blood loss/shock
a. Defective ovum/congenital ( air hunger/dyspnea,
defects – most common cause hypotension, pallor, tachycardia,
b. Maternal causes tachypnea, cold clammy skin,
restlessness, oliguria
 Viral infection Malnutrition
Trauma (physical and mental) TREATMENT
 Congenital defects of the a. Surgery: Dilatation and suction
reproductive tract Incompetent curettage
cervix – most common cause of b. Antibiotic for especially for septic
habitual abortion type
 Hormonal – decreased c. Blood, plasma, fluid replacement
progesterone production d. For Habitual Abortion, determine
Systemic diseases of the mother etiology; treatment of underlying
(DM, Anemia, Thyroid causes;
Dysfunction)  Cerclage/cervical closure for
 Environmental Hazards Incompetent Cervix/ purse string
 Rh Incompatibility suture
 McDonald surgery: temporary
TYPES OF ABORTION closure of the cervix and requires
stitch removal set at the time of
labor
a. Spontaneous – without medical
 Shirodkar-Barter surgery:
or mechanical intervention
permanent closure of the cervix;
b. Induced – with medical or
delivery by Cesarean Section
mechanical intervention (for
mechanical intervention, this may
lead to septic abortion if done in
unsterile environment and
condition)

SIGNS OF ABORTION

a. Vaginal bleeding or spotting

(mild, moderate, profuse)
b.D.Uterine/abdominal
INCOMPETENT CERVIX
cramps
 at term in preparation for a vaginal
 A condition characterized by a
delivery.
mechanical defect in the cervix
causing cervical effacement and
dilatation and expulsion of the
products of conception in mid-
trimester of pregnancy
RISK FACTORS
a. Congenital defects of the cervix
b. Trauma to the cervix as in forceful
dilatation
c. Cervical lacerations/procedures
(cauterization)
ASSESSMENT FINDINGS
a. Painless contractions resulting in
delivery of a dead fetus or non-
viable fetus
b. History of abortions
c. Findings of a relaxed cervical os on
pelvic examination
TREATMENT
a. Cerclage procedure during the 14th to
16th week of gestation or prior to next
pregnancy; suture or ribbon is placed
beneath the cervical mucosa to close the
cervix
b. Shirodkhar procedure – permanent
suturing of the cervix; subsequent
deliveries by CS
c. McDonald – temporary purse string
suturing of the cervix, suture removed
D. PLACENTA PREVIA
 Abnormal implantation of the
placenta in the lower uterine
segment.
1. Incidence: most common cause
of bleeding in the third trimester
of pregnancy; occurs in 1:200
pregnancies
2. Risk Factors
a. Multiparity: the single
most important factor
b. Decreased vascularity in
the upper uterine segment
as in scarring or presence
of tumor
c. Increased age: above 35
years
d. Multiple Pregnancy
TYPES
a. Low-lying – placenta at the
lower third of the uterus but
does not cover the internal os
b. Marginal - placenta lies over
the margins of the internal os
 c. Partial – placenta partly covers
the internal os c. DOUBLE SETUP ( one set for
d. Complete or Total – placenta vaginal delivery and another for
completely covers the internal classical CS); prepared for IE in
os suspected Placenta Previa in the
following conditions:
ASSESSMENT FINDINGS c.1 Term gestation
a. Painless vaginal bleeding (fresh bright c.2 Mother in labor and
red blood in the third trimester progressing well
c.3 Mother and fetus are stabl
b. Uterus soft, flaccid to intermittent
hardening if in labor c. Intermittent pain d.
if it happens in labor secondary to
uterine contractions

d. Bleeding may be slight of profuse

which may come after an activity, coitus
or internal exam

DELIVERY: If conditions for

watchful waiting are absent:

DIAGNOSIS
 Ultrasonography gives 95%
accurate result – detects site of
placenta

TREATMENT
a. Watchful waiting if mother is not
in labor, fetus is premature but
stable and not in distress and
bleeding is not severe.
b. Amniotomy: artificial rupture of
the bag of waters; causes fetal
head to descend causing
mechanical pressure at the
placental site controlling
bleeding
 d.1 Vaginal delivery if birth
canal is not obstructed
 d.2 Cesarean Section if
placental placement prevents
vaginal delivery. Classical
CS is indicated as the lower
uterine segment is occupied
by the placenta. Future
pregnancies will be
terminated by another CS
because a classical CS scar is
contraindicated for a vaginal
delivery; it may cause
uterine rupture

COPLICATIONS

a. Hemorrhage
b. Prematurity
 E. ABRUPTIO PLACENTA amount of internal bleeding; may
be complete or incomplete
 A complication of late pregnancy
depending on the degree of
or labor characterized by
detachment.
premature partial or complete
separation of a normally
implanted placenta. Also called ASSESSMENT FINDINGS
accidental hemorrhage or ablatio
a. Painful vaginal bleeding in the
placenta.
third trimester
 INDENCE: second leading cause
of bleeding in the third trimester
b. Rigid, board like and painful
of pregnancy; occurs in 1:300
abdomen
pregnancies
c. Enlarged uterus due to concealed
bleeding; signs of shock not
PREDISPOSING FACTORS proportional to the degree of external
bleeding in type I or classic type
a. Maternal Hypertension: PIH,
Renal disease d. If in labor: tetanic contractions with the
b. Sudden uterine decompression as absence of alternating contraction and
relaxation of the uterus
in multiple pregnancy and
polyhydramnios DIAGNOSIS
c. Advance age
a. Signs and symptoms for clinical
d. Multiparity
diagnosis
e. Short umbilical cord
b. Ultrasound detects retroplacental
f. Trauma,
bleeding
TYPES c. Clotting studies reveal DIC,
clotting defects. Thromboplastin
a. Type I: Concealed, covert or
from retroplacental clots enter the
central type; the placenta
maternal circulation and
separates at the center causing
consumes free fibrinogen
blood to accumulate behind the
resulting in DIC (disseminated
placenta; external bleeding not
intravascular coagulation): small
evident; Signs of shock not
fibrin clots in circulation and
proportional to the amount of
Hypofibrinogemia: a decrease
external bleeding
normal fibrinogen results in the
absence of blood coagulation.
b. Type II: Marginal, overt or
external bleeding type; Placenta COMPLICATIONS
separates at the margin, Bleeding
a. Hemorrhagic Shock
is external and proportional to the
 b. COUVELAIRE UTERUS: The
bleeding behind the placenta
may cause some of the blood to
enter the uterine musculature
causing the uterine muscle not
to contract well once the
placenta is delivered
c. Disseminated intravascular
coagulation
d. CVA – cerebrovascular accident
from DIC
e. Hypofibrinogemia
f. Renal failure and Infection
g. Prematurity, Fetal Distress,
Fetal Demise (intrauterine fetal
demise IUFD
B. ECTOPIC PREGNANCY
 Predisposing Factors
a. Constriction or narrowing of
the fallopian tube
b. PID: Pelvic inflammatory
disease, salpingitis,
endometriosis
c. Puerperal/Postpartal Sepsis
d. Surgery of the fallopian tubes
e. Adhesions, tumors
f. Congenital anomalies of the
fallopian tube
g. IUD usage
TYPES
a. Tubal : most common, found in
90% to 95% of cases, tubal
rupture occurs before 12 weeks
b. Cervical
c. Abdominal
d. Ovarian
ASSESSMENT FINDINGS
a. Amenorrhea, spotting, abnormal
menstrual period
b. Tubal rupture signs: sudden
acute low abdominal pain
radiating to the shoulder Kehr’s
Sign referred shoulder or neck
pain
c. Nausea and vomiting
d. Bluish navel (Cullen’s Sign)
because of blood accumulating
in the peritoneal cavity
e. Rectal pressure because of blood
in the cul-de-sac
f. Positive pregnancy test
g. Sharp localized pain when the
cervix is touched
h. Signs of shock/circulatory
collapse
LABORATORY FINDINGS
a. Low hemoglobin and hematocrit
b. Low HCG (normal value at its
peak is 400,000 I.U/24 hours
c. Elevated WBC
DIAGNOSIS
 a. Pelvic Ultrasonography (no 1. Incidence: common in the Orient and
embryonic sac in the uterine in mothers of low socioeconomic status
cavity
2. Cause: unknown
b. Culdocentesis (aspiration of non
clotting blood in the cul-de-sac 3. Assessment Findings
or pouch of Douglas-positive
a. Brownish or reddish
tubal rupture
intermittent or profuse
TREATMENT vaginal bleeding by 12 weeks
b. Spontaneous expulsion of
a. Salpingectomy – surgical
molar cyst usually between
removal of ruptured tubes b.
the 16th and 18th week of
Management of shock in
pregnancy c. Rapid uterine
cases of tubal rupture
enlargement inconsistent with
b. Antibiotics
the age of gestation
COMPLICATIONS c. Signs of PIH before 20 weeks
d. Excessive nausea and
a. Hemorrhage
vomiting because of excessive
b. Infection
HCG 1- 2 million IU/L/24
c. Rh sensitization, RhoGam
hours
prevents isoimmunization;
e. Positive pregnancy test
given to Rh negative mother
f. No fetal signs
with positive Rh ectopic
g. Abdominal pain
pregnancy with a negative
Coombs’ test
DIAGNOSIS

C. Hydatidiform Mole /H-Mole

This is a benign neoplasm of the

chorion. The chorion fails to develop
into a full term placenta and instead
degenerates and become fluid-filled
vesicles. a. Passage of vesicles
 b. Triad Signs: Big uterus,
Vaginal bleeding brownish
and intermittent
c. HCG greater than one million
IU/24 hours
d. Ultrasound: no fetal parts, no
fetal sac
e. Flat plate of the abdomen
after 15 weeks – no fetal
skeleton

PROGNOSIS

 80% remission after D&C; may

progress to Cancer of the Chorion
(Choriocarcinoma)

TREATMENT
a. Evacuation by D&C or
hysterectomy if no spontaneous
evacuation, Hysterectomy of
above 45 years old and no
future pregnancy is desired or
with increased HCG levels after
D&C
b. HCG titer monitoring for one
year, no pregnancy for one
year, use of contraception
c. Medical replacement of blood,
fluid and plasma
d. Chemotherapy for malignancy
(Methotrexate)
e. Chest x-ray to detect early lung
metastasis