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Pregnancy

complication
Department of
gynaecology and
obstetrics
 Early pregnancy complication
 Late pregnancy complication
Early pregnancy
complication

 Spontaneous abortion
 Ectopic pregnancy
Spontaneous abortion
 It defined as delivery occurring before 20th
completed week of gestation.

 It implies delivery of all or any part of the


products of conception,with or without a
fetus weighing less than 500 grams.
spontaneous abortion
 Threatened abortion
 inevitable abortion
 complete abortion
 incomplete abortion
 missed abortion
 septic abortion
 Definition
 Etiology
 Pathology
 Clinical findings
 Laboratory findings
 Complications
 treatment
 Essentials of diagnosis
spontaneous abortion
 Threatened abortion is
bleeding of intrauterine origin
occurring before the 20th
completed week , with or
without uterine
contractions , without
dilatation of’ the
cervix , and without
expulsion of the products of
spontaneous abortion
 inevitable abortion
refers to bleeding of
intrauterine origin
before the 20th
completed week , with
dilatation of the cervix
without expulsion of the
products of
conception 。
spontaneous abortion
 complete abortion is the
expulsion of all of the
products of conception
before the 20th
completed week of
gestation ,
 incomplete abortion is
the expulsion of
some , but not all , of
the products of
conception 。
 Time

 Contraction of uterine

 Cervix condition

 Product of conception
Threatened inevitable
abortion abortion

complete
incomplete abortion
abortion
pregnancy
Threatene
d abortion Complete
abortion

Inevitable
abortion
incomplet
e abortion
 missed abortion ,
 the embryo or fetus dies
in uterus , but the
products of conception
are retained in uterus
 septic abortion ,
 infection of the uterus and
sometimes surrounding structures
occur 。
 Definition
 Etiology
 Pathology
 Clinical findings
 Laboratory findings
 Complications
 treatment
 Essentials of diagnosis
Etiology
 1.Morphologic and genetic
abnormalities
 2. Maternal factors
 1 ) systemic disease
 ( 1 ) maternal infection
 ( 2 ) Other disease--endocrine
disorders hyperthyroidism or poorly
controlled diabetes mellitus
 2 ) uterine defects--Congenital
anomalies size of the uterine cavity
 3 ) immunologic disorders
 Blood group incompatibility due to
ABO,RH
 4) malnutrition
 3 toxic factors
 radiation,antineoplastic
drgus,anesthetic gases,alcohol,and
nicotine
 4. trauma
 Direct trauma, indirect trauma
 Definition
 Etiology
 Pathology
 Clinical findings
 Laboratory findings
 Complications
 treatment
 Essentials of diagnosis
Pathology
 hemorrhage
 Necrosis and inflammation
 pregnancy becomes partially or entirely
detached.
 Definition
 Etiology
 Pathology
 Clinical findings
 Laboratory findings
 Complications
 treatment
 Essentials of diagnosis
Clinical findings
 Threatened abortin
 first trimester bleeding.
 the cervix remains closed and
slight bleeding
 cramping -with or without
cramping may be noted.
 inevitable abortion
 Abdominal or back pain

 bleeding

 open cervix indicate impending

abortion.
 abortion is inevitable-

cervical effacement ,cervical


dilatation,and or rupture of the
 complete abortion
 complete abortion is identified by
passage of the entire conceptus
.Slight bleeding may continue for a
short time,although pain usualy
ceases.
 incomplete abortion
 1.the products of conception have
partially passed from the uterine cavity
 less than10 week’duration,the fetus
and placenta are usually passed
togerher
 after 10 weeks, they may be passed
separately with a portion of the
products retained in the uterine cavity .
 2.cramp are usually present
 3.bleeding generally is persistent and is
often severe.
 missed abortion
 Missed abortion implies that the
pregnancy has been retained
following death of the fetus
 Definition
 Etiology
 Pathology
 Clinical findings
 Laboratory findings
 Complications
 treatment
 Essentials of diagnosis
Laboratory findings
 1.complete blood count
 Anemia blood cell count and the
sedimentatin rate
 2 pregnancy test
 Failling or abnormally low plasma
level ofβ- HCG
Ultrasonography
Ultrasonography
 threatened abortion
 ultrasound will reveal a normal gestational

sac and viable embryo.


 However,a large or irregular sac , the

presence of a large retrochorionic bleed,


and/or a slow fetal heart rate (<85bpm)
 incomplete abortion
 the gestational sac is usually deflated ,and
irregular,echogenic material representing
placental tissue is seen in the uterine cavity.
 complete abortion
no visible products of conceprtion
in uterus cavity 。
 missed abortion,
An embryo or fetus without heart
motion is consistent with a missed
abortion,
 ectopic pregnancy may cause similar
symptoms of miscarriage,namely
menstrual abnormality and abdominal
or pelvic pain.
 an adnexal mass may or may not be
present.
 ultrasound can virtually exclude an
ectopic pregnancy by documenting an
intrauterine pregnancy.
 Definition
 Etiology
 Pathology
 Clinical findings
 Laboratory findings
 Complications
 treatment
 Essentials of diagnosis
Complications
 Severe or persistent hemorrhage
during or following abortion may
be life threatening
 Sepsis develops most frequently
after selfinduced abortion .
 infection,intrauterine synechia
,and infertility are other
complications of abortion.
 perforation of the uterine wall may occur
during dilatation and curettage because of
the soft and vaguely outlined uterine wall
and may be accompanied by injury the
bowel and bladder,hemorrhage,
infection,and fistula formation.
 Definition
 Etiology
 Pathology
 Clinical findings
 Laboratory findings
 Complications
 treatment
 Essentials of diagnosis
treatment
 So the successful management of
spintaneous abortion depends upon early
diagnosis
 a complete history should be taken
 every patient should receive a general
physical examination 。
 laboratorys study should include a complete
blood count,blood typing 。
treatment
 threatened abotion
 If the diagnosis of threatened abotion is
made, bed rest is typically recommended,
 although neither has been shown to be
helpful in preventing subsequent
miscarriage.
 prognosis is good when bleeding and/or
contraction resolve
 dilatation and curettage(DandC) may be
necessary if significant bleeding persists or
if products of conception are retain
inevitable or incomplete abortion

 If the diagnosis of inevitable or incomplete


abortion is made ,evacuation of the uterus
by D&C should be promptly performed.
inevitable or incomplete abortion
 A type and cross-match for possible blood
transfusion and determinatin of Rh status
should be obtained.
 the prognosis for the mother is excellent if
the retained tissue is promptly and
completely evacuated
complete abortion
 If the diagnosis of complete abortion is
made, the patient should be observed for
further bleeding.
 the products of conception should be
examined.
 as with the inevitable and incomplete
abortion ,the prognosis for the mother is
excellent.
 Oxytocics are helpful in contracting
the uterus,limiting blood loss,and
aiding In expulsion of clots and
tissue .

 D&C ( dilation and curettage )


may be necessary if significant
bleeding persists or if products of
conception are retained.
Essentials of diagnosis
 1.suprapubic pain , uterine cramping and /or back pain
 2.vaginal bleeding
 3.cervical dilatation
 4.Extrusion of products of conception
 5.Disappearance of symptoms and signs of pregnancy
 6.Negative pregnancy test or quantitative β-HCGthat is
not properly increasing
 7.abnormal ultrasound findings
 Recurrent abortion
Recurrent abortion
 Is defined as 3 or more
consecutive pregnancy losses
before 20 weeks gestation , each
with a fetus weighing
less than 500g.
Etiology
 1.genetic error
 2.uterine abnormalities
 3.hormonal causes
 4.infection
 5.systemic disease
 6.immunologic factors
 Septic abortion
Septic abortion
 Clinical finding
 manifested by fever,
 malodorous vagianl discharge,
 pelvic and abdominal pain,
 cervical motion tenderness.
 peritonitis and sepsis may be seen
 trauma to the cervix or upper vagina may be
recognized
Laboratory findings
 A completely blood count,
 urinalysis,endometrial cultures
 chest-xray,and abdominal x-ray to rule out
uterine perforation should be obtain.
 ultrasound may be helpful in ruling out
retained products of conception.
Treatment
 Involves hospitalization and intravenous
antibiotic therapy.selection of antibioc
agents should provide for both anaerobic
and aerobic coverage.
 a D&Cshould be done.
 a hysterectomy may have to be performed
if the infection dose not respond to
treatment.
Exposure to fetotoxic
agents
 Many harmful agents are
responsible for altering the biologic
process of human development
 Timing of fetotoxic exposure.
 the route of exposure,
 the length of time that the exposure
occurred ,
 total dose received
 weeks since ovulation potential adverse
effect
1-8 miscarriage,structura
malformation

9-40 central nervous system


abnormalities
growth restrictions,
neurobehavioral
abnormaloties,
Teratogenicity drug labling now required by
FDA(food and drug administration)

 Category A:well-controlled human studies have


not disclosed any fetal risk.

 Category B:animal studies have not disclosed


any fetal risk;or have suggested some risk not
confirmed in controlled studies in women ;or
there not adequate studies in women
 Category C:animal studies have revealed adverse
fetal effcts;there are no adequate controlled studies
in women
 Category D;some fetal risk,but benefits may
outweigh risk (eg.life-threatening illness ,no safer
effective drug)
 categoryX;fetal abnormalities in animal and
human studies; risk not outweighed by benefit.
contraindicated in pregnancy