BLEEDING IN

PREGNANCY
Group 3
Nurlina Nurul Hudaa Al- Amin
Nur Rizkha Riadi Nurwinda
Nurragoa Rahayu Arum W
Nurul Amaliah Abbas Riska Amanda
Nurul Annisani Rina Suwardi
Nurul Huda
 Pregnancy is accompanied by many new
feelings, pains, and changes, which include a lot of
strange things happening down below. It can be
scary to have bleeding or strange discharge during
pregnancy, but most of the time this is completely
normal. As long as you're informed on what to
expect, and know when to see a medical
professional, you won't have any problems. This
will help you explain your symptoms to a doctor
 Causes of vaginal
bleeding during
pregnancy:

• Abortion
• Ectopic pregnancy
• Placenta abnormalities
• Bleeding during thirdtrimester
ABORTION
 Definition : expulsion of the fetus and uterine contents
before the 20th week of gestation.

 Mostly occur during the first trimester before the placenta is

matured.

 classification :

1- Spontaneous abortion 5- Missed abortion

2- Induced abortion 6- Incomplete abortion
3- Habitual abortion 7- Septic abortion
4- Inevitable abortion
 Spontaneous abortion
 Spontaneous abortion (miscarriage) : is an abortion which
occurs naturally.
 Causes include:
a. Acute or chronic illness in the pregnant woman.
b. Maternal exposure to toxic substances.
c. Fetal abnormalities. Can
be
d. Abnormal attachment of the placenta. avoided
 Induced abortion
 Intentional , criminal or elective abortion : abortion
that is induced either for criminal or medical causes.

 as paramedics , care must be given to the patient as

usual despite of your ethical or religious believes , you
should show empathy and compassion .

You are in the business of saving

people not lecturing them
 Septic abortion
 Definition : uterus becomes infected during or shortly (
within hours) after abortion.

 Diagnosis :

a. History : fever and bad-smelling vaginal discharge.

b. Physical examination : Fever and abdominal

tenderness, Hypotension may indicate septic shock.

 Complication : can progress to septicemia and septic

shock in severe cases.
 ECTOPIC
PREGNANCY
 Definition : life threatening condition in which the
fertilized ovum is implanted outside normal site of
implantation.
 Pathology :
 Fetus can develop to term .
 Normal signs and symptoms of pregnancy are
present .
 Sites include : fallopian tube ( commonest ) , cervix
, ovary and abdominal cavity.
 Complication : rupture leading to internal
hemorrhage .
 Sites of ectopic
pregnancy

1. Tubal (commonest )
2. Cervical
3. Ovarian
4. Intraabdominal.
 Clinical presentation :
 Symptoms :
1. Symptoms of pregnancy ( amenorrhea , morning sickness )
2. Abdominal pain , which is sever with rupture ectopic
3. Syncope in case of shock
 Signs :
1. Abdominal tenderness
2. Signs of acute abdomen and internal hemorrhage in case of
rupture.
 Management : general guidelines + rapid transport + emotional
support.
 Abdominal pain
in female in child
bearing period is
ectopic pregnancy
until proved other
wise
CHORIOCARCINOMA
 Choriocarcinomas are malignant
(malignant) tumors of the trophoblast and
usually arise after a mole pregnancy,
sometimes after abortion or labor. Even from
an ectopic pregnancy, choriocarcinoma
can occur. Sometimes there is conception
that directly becomes choriocarcinoma without
going through one type of pregnancy. This is
called de nova choriocarcinoma or ab initio
choriocarcinoma.
 Causes of Choriocarcinoma
1. If a mother has an event of hydatidiform mole during
pregnancy, then she has a 50% chance of having
choriocarcinoma.
2. In the case of spontaneous abortion, 20% of cases can have
Choriocarcinoma.
3. Ectopic pregnancy (pregnancy elsewhere instead of uterus),
2% of cases can get Choriocarcinoma.
4. 30% of cases can be normal during pregnancy.
5. Only about 5% of cases of choriocarcinoma occur in the
testicular origin.
6. Lack of nutrients such as protein and vitamins during
pregnancy can cause risk of choriocarcinoma.
7. A woman who has frequent intra uterine infections.
8. Pregnancy before the age of 18 years and after age 35 can
also be a major factor in this type of cancer.
 Choriocarcinoma pathology
Microscopic signs typical for choriocarcinoma are:
1. necrose.
2. haemorrhagia.
3. infection.
Aside from that, trophoblast cells appear that penetrate the
muscles and blood vessels. Choriocarcinoma is divided into two
types:
a. Non villosum choriocarcinoma; in this type there is no villus
shape. This type is more virulent than the second type.
b. Choriocarcinoma villosum: there are still villus forms here
and there.
Choriocarcinoma carries haematogenous metastases, usually to
the vagina and lungs. Sometimes it also goes to the kidneys,
liver, ovaries and brain.
Symptoms of Choriocarcinoma

1. Bleeding which does not stop after the absence of mola,

is metrorhargia.
2. Subinvolution.
3. Metastases in the lungs, vulva or vagina.
4. Biological reactions that remain positive or even
increase quantitatively after the birth of the mole.
Occasionally there is a perforation of the uterus with
signs of intraperitoneal bleeding
Diagnosis
All patients who have given birth to a mola must be
suspected and must be watched carefully. Also
bleeding that does not stop after abortion or delivery
of the a'terme must remind us of the possibility of
choriocarcinoma. The handle is biological or
immunological reactions: the reaction must be
negative within a few days after abortion or parturition,
if the biological reaction remains positive or
qualitative, then there must be new trophoblast cell
growth.
Therapy
The treatment of choice is by giving 0A mg / kg / day for
5 days methotrexate can be given intravenose, muscular or oral.
Generally given 15-25 mg a day. This liquid is repeated between
14 days until the gonadotropin in the urine becomes normal;
sometimes it's only after 6 hours. After the negative reaction is
given one additional quur. Also can be. give 7-11 micrograms / kg
/ intravenous liver for actinomycin D for 5 days. Quurry is
repeated after 5 days. However, hysterectomy is still widely
practiced, given the high cost of methotrexate or actlnomycin D
for the people of Indonesia. Hysterectomy is absolutely
necessary for severe bleeding or resistant cases of cytostatics.
HYDATIDIFORM MOLE
Definition : A molar pregnancy can develop when a
fertilized egg does not contain an original maternal
nucleus. The products of conception may or may not
contain fetal tissue.

In a complete molar pregnancy, the growth stops a fetus

from developing. In a partial molar pregnancy, a fetus
develops but it will be abnormal and cannot survive. At
mmost, the fetus might survive for around three months.
A molar pregnancy occurs when an abnormal egg or
sperm join. We dont know why a particular woman has a
molar preganancy, but affected women have been shown
to have certain things in common. These are called risk
factors and they are :
1. Age, younger than 20 or older than 40
2. Nutrition deficiency
3. A previous molar pregnancy or other gestasional
thropobastic tumor.
• Treatment :
1. Hydatidiform moles should be treated by evacuating
the uterus by uterine suction or by surgical curettage
as soon as possible after diagnosis, in order to avoid
the risks of choriocarcinoma. Patients are followed up
until their serum human chorionic gonadotrophin
(hCG) level has fallen to an undetectable level
2. Management is more complicated when the mole
occurs together with one or more normal fetuses.
TUBA PREGNANCY
Definition : Implantation of fertilized egg within fallopian tube
Pathopysiology :
1. Occurs in women of all ages, often with a history
infertility, usually secondary to prior tubal demage
2. Often results in rupture of maternal vessels at week 8 into
gestational sac
Treatment :
1. Typically salpingectomy (usually can conserve ovary,
salpingotomy
2. Medical treatment with methotrexate may produce similar
results
• Etiology :
Risk factors :
1. Tubal demage like infections (PID) or salpingitis and
abdomial/ pelvic surgery or tubal ligation
2. Conginetal abnormality (DES)
3. History of previous ectopic pregnancy
4. Use of an intrauterine device (IUD) inserted at the time
of concaption
THANK YOU