gestational conditions Flashcards
different gestational conditions
Ectopic Pregnancy, Incompetent Cervix, Abortion, Placenta Previa, Abruptio Placenta
PROBLEMS WITH THE PASSAGE
• Abnormal shape of the pelvis
• Cephalopelvic disproportion
• Shoulder Dystocia
PROBLEMS WITH THE POWERS
Dystocia, Premature labor, Precipitate labor and birth, Uterine prolapse, Uterine rupture
defined as the rapid loss of more than 1% of body weight in blood
hemorrhage
First Trimester bleeding indicates
Abortion and ectopic pregnancy
Second trimester bleeding indicates
Hydatidiform mole and incompetent cervix
Third trimester bleeding indicates
Placenta previa and abruption placenta
the most common bleeding disorder of early pregnancy. the termination of pregnancy before viability
abortion
a fetus that is aborted before it is 500 grams in weight
abortus
a small macerated fetus, sometimes there is no fetus, surrounded by a fluid inside an open sac.
blighted ovum
a zygote that is surrounded by a capsule of clotted blood.
carneous mole
a dead fetus undergoing necrosis
maceration
a fetus compressed upon itself and desiccated with dried amniotic fluid.
fetus Compressus
a fetus that is so dry that it resembles a parchment
fetus papyraceous
a calcified embryo
lithopedion
the termination of pregnancy before 12 weeks
early abortion
abortion between 12 to 20 weeks.
late abortion
refers to an infant having a birth weight between 500 to 1000 grams.
immature Infant
refers to an infant born between 38 to 42 weeks.
full term infant
refers to zygotes that were aborted before pregnancy is diagnosed or recognized.
occult pregnancy
refers to those pregnancies that were diagnosed.
clinical pregnancy
COMPLICATIONS OF ABORTION
Hemorrhage, Infection, Disseminated intravascular coagulation
the ending of pregnancy By removing a fetus or embryo before it can survive outside the uterus, if the fetus or wt is less than 500gm at 20 weeks of gestation
abortion
Abortion may be may be _ or _.
induced ; spontaneous
MATERNAL CAUSES OF ABORTION
- Maternal infections
- Maternal disease
- Drugs
- Hormonal imbalance
FETAL CAUSES OF ABORTION
- Chromosomal anomalies
- Blighted ovum
- Hydatidiform moles
- Congenital defect
OTHER CAUSES OF ABORTION
- Retroversion
- Fibromyoma of uterus
- Surgery during pregnancy
- Toxins
- Trauma
It is a clinical entity where choriodecidual hemorrhage has begun, but not progressed to the stage of irreversibility, this means the cervix is not open and the product of conception, is not expelled. Baby’s survival is possible.
threatened abortion
Pregnancy loss that cannot be prevented. Continuation of pregnancy is impossible.
INEVITABLE ABORTION/miscarriage:
Clinical manifestations of inevitable abortion
- cervix started to dilate
- vaginal bleeding with clot
- pregnancy tissue is in the process of being expelled
Painless vaginal bleeding without uterine contraction, cervix is soft.
threatened abortion
Heavy vaginal bleeding and dilatation of the cervix WITHOUT expulsion of any POC
inevitable abortion
In spite of uterine contractions and cervical dilatation, only the fetus and some membranes are expelled
incomplete abortion
The type of abortion wherein the placenta remains partly attached and bleeding continues.
incomplete abortion
When the products of conception are completely expelled, it is called _ abortion.
complete
an abortion that occurs when the fetus dies and is retained in utero, together with the placenta and membranes.
missed abortion
Signs and symptoms of missed abortion
- Disappearance of symptoms of pregnancy
- Size of the uterus is less than the duration of gestation
- U/S shows no signs of fetal life
Any abortion associated with clinical evidence of infection of the uterus and its contents is called septic abortion
septic abortion
Abortion usually considered septic if
• Rise of temperature of at least 38°C for 24 hours or more
• Offensive or purulent vaginal discharge
• Other evidences of pelvic infection
Presentation of septic abortion
Fever, abdominal pain, vaginal discharge, vaginal bleeding
Treatment for septic abortion
- Ampicillin-Sulbactam 3 g IV OR Clindamycin 600 mg IV
- GENTAMICIN 1-2 mg/kg IV
spontaneous abortion characterized by infection of the uterus. uterus is tender to palpation and there is purulent cervical discharge.
septic abortion
It’s also known as induced abortion. It is the medical way to get rid of unwanted pregnancy.
medical termination of pregnancy act (1971)
The termination of a pregnancy by the removal or expulsion of an embryo or fetus from the uterus.
medical termination of pregnancy act (1971)
INDICATION FOR MTP
• Abnormalities in fetus
• Pregnancy caused by rape
• Contraceptive failure
METHOD OF TERMINATION in the 1st trimester
- mifepristone + misoprostol
- suction evacuation
METHOD OF TERMINATION in 2nd trimester
- misoprostol, carboprost
- hysterectomy
Used to remove products of conception; missed abortion; suction evacuation
Karman cannula – Metallic
COMPLICATIONS of Karman cannula - Metallic
- Injury to the cervix
- Hemorrhage and shock
- Menstrual disturbance
Implantation of the zygote outside the uterine cavity
ectopic pregnancy
Symptoms of ectopic pregnancy
dizziness, nausea, loss of appetite, pelvic pain
Signs of a ruptured ectopic pregnancy
- sudden, severe pelvic pain
- dizziness
- shoulder pain
- lower back oain
A developmental anomaly of the placenta resulting in proliferation and degeneration of the chorionic villi
Hydatidiform mole
What does this indicate?
- Vaginal bleeding
- Large for dates uterine size
- Bilateral theca lutein cysts
- hCG often >100,00 mlU/mL 15 to 20%
complete mole
What does this indicate?
- hCG rarely > 100,000 mlU/mL< 5%
partial mole
risk factors of Hydatidiform mole
• Maternal age above 40 and below 19 years old
• Malnutrition
Signs and symptoms of Hydatidiform mole
- Excessive frequent vomiting
- No fetal movements, no fetal parts
- Vaginal bleeding
- High blood pressure
complications of Hydatidiform mole
Hemorrhage, Shock, Perforation, Uterine sepsis, choriocarcinoma
The inability of the uterine cervix to retain a pregnancy in the absence contractions, labor or both in the second trimester.
cervical incompetence
_ _ is characterized by painless cervical dilation in the second or early third trimester with ballooning of the amniotic sac into the vagina followed by rupture of membranes and expulsion of usually the live fetus.
Cervical incompetence
usual timing of cervical incompetence
16-24 weeks
Signs and symptoms of cervical incompetence
painless vaginal bleeding, cervical dilation, rupture of membranes
Cone shaped portion of the cervix is removed
conization if cervix
Medical procedure that uses heat, cold, or chemicals to destroy abnormal tissues
cauterization of cervix
Removing of elongated part of the cervix
fothergill’s operation
Advanced cervical dilation and effacement before week 24 of pregnancy without painful contractions, vaginal bleeding, water breaking (ruptured membranes) or infection.
cervical incompetence
A cervical length less than _ and a internal os diameter more than _ is suggestive of cervical incompetence.
30mm ; 20mm
It is a treatment that involves sewing the cervix closed with stitches.
cervical cerclage
Cervical cerclage is usually delayed up to - weeks so that miscarriage due to other causes can be eliminated or it should be done at least 2 weeks earlier than the lowest period of earlier wastage(not earlier than 10 weeks).
12-14
TYPES OF CERCLAGE
History indicated cerclage, Ultrasound indicated cerclage, Rescue cerclage
CONTRAINDICATIONS of cerclage
Intrauterine infection, Ruptured membranes, H/O vaginal bleeding, Severe uterine irritability
early complications if cerclage
infections, bleeding, premature labor
late complications of cerclage
fistula formation, cervical stenosis, preterm delivery
Placenta overlaps and implants on the cervix, covering the internal os to varying organs.
placenta previa
Placenta which has implanted partially or wholly in the lower uterine segment.
placenta previa
Signs and symptoms of placenta previa
• Painless vaginal bright red bleeding
• Relaxed soft uterus
• Episodes of bleeding
• Visible bleeding
• Intercourse post bleeding
• Abnormal fetal position
Placenta Previa Care
• Painless bright red bleeding
• Replace blood loss
• Evident in lower segment
• Vitals indicate shock
• Inspect FHR
• Avoid vaginal exam
Key Aspects of Placenta Previa Care
• Diagnosis and monitoring
• Activity restrictions
• Hospitalization
• Blood transfusion
• Delivery planning
Premature separation of the implanted placenta from the uterine wall.
placental abruption
Painful vaginal bleeding but bleeding is not always present (may be internal).
placental abruption
RISK FACTORS of placental abruption
HTN, cocaine use, trauma, multiparity, smoking
SIGNS AND SYMPTOMS of placental abruption
Vaginal bleeding, abdominal pain, uterine irritability, back pain, fetal distress
what classification of placental abruption is this
- uterine tenderness
- no to mild vaginal bleeding
- normal V/S
class 1
what classification of placental abruption is this
- moderate hemorrhage
- moderate to severe contractions
- tetanic contractions
- maternal tachycardia
class 2
what classification of placental abruption is this
- heavy vaginal bleeding
- painful tetanic uterus
- maternal shock
- coagulopathy
class 3
MANAGEMENT of placental abruption
monitor VS and FHT, bed rest, monitor and treat hypovolemia
A condition which involves extreme morning sickness, including nausea, vomiting, and weight loss as its major symptoms. It is thought to be a result of high levels of pregnancy hormones, but the exact cause is not known at this time.
Hyperemesis Gravidarum
Some early signs if hyperemesis gravidarum:
Persistent and severe nausea, frequent vomiting, weight loss, signs of dehydration, ketosis
MANAGEMENT of Hyperemesis Gravidarum
• Fluid and electrolyte replacement
• Nutritional support
• Medications
• Hospitalization
• Emotional support
1st line for Hyperemesis Gravidarum
Vit. B6 (pyridoxine), Doxylamine
2nd line for Hyperemesis Gravidarum
Ondansetron, Promethazine, Metoclopramide
medications for severe cases of Hyperemesis Gravidarum
Dexamethasone, Prednisolone
Occurs when the membranes of the amniotic sac and chorionic rupture before labor begins (when a mother’s “water breaks” before labor starts).
PREMATURE RUPTURE OF MEMBRANES (PROM)
When PROM occurs in conjunction with premature birth (delivery before 37 weeks), it is known as _ _ _ _ _
preterm premature rupture of membranes
Causes of Premature Rupture of Membranes
- Low socioeconomic conditions
- STI
- Previous preterm birth
- Vaginal bleeding
- Cigarette smoking during pregnancy
When the rupture of the membrane occurs beyond 37th wks but before the onset of labor is called Term PROM.
TERM PROM
When rupture of membrane occurs before 37 completed wks is called preterm PROM
PRETERM INFANT
occurs when the amniotic sac surrounding the fetus ruptures before the onset of labor, typically resulting in the leakage of amniotic fluid.
Premature rupture of membranes (PROM)
Signs and symptoms of PROM
• Fluid leakage
• Wet sensation
• Fluid pooling
• Increased vaginal discharge
• Contractions
A diagnostic test used to detect the presence of amniotic fluid in vaginal secretions. It is commonly performed when there is suspicion of premature rupture of membranes (PROM) during pregnancy.
Nitrazine test
Is a pregnancy complication in which there is an abnormal increase in the volume of amniotic fluid. Common causes include gestational diabetes and other problems that prevent the fetus from swallowing amniotic fluid.
Polyhydramnios
It means excessive amniotic fluid, more than 2 liters. By ultrasound the vertical diameter of the largest pocket of amniotic f luid measure 8 cm or more, or the amniotic fluid index (AFI) is 25 cm or more.
polyhydramnios
Largest vertical pocket diameter 8-11cm
mild polyhydramnios
Largest vertical pocket diameter 12 -15cm
moderate polyhydramnios
Largest vertical pocket diameter >16cm
severe polyhydramnios
signs of polyhydramnios
- uterus is larger than expected size
- uterus is tensed
- skin in stretched and shiny
MATERNAL COMPLICATIONS OF POLYHYDRAMNIOS
• PROM
• Uterine dysfunction
• Abnormal lie
• Cord prolapse
• CS
FETAL COMPLICATIONS OF POLYHYDRAMNIOS
• Fetal malformations
• Preterm delivery
• Nuchal cord
• Neonatal death
• Intrauterine death
Some common causes of polyhydramnios include
Diabetes mellitus, fetal anomalies, fetal anemia, maternal conditions, idiopathic
decreases fetal urinary output
indomethacin
_ occurs when the volume of f luid in the amniotic sac (amniotic fluid) is too low. Roughly 4% of pregnant women are diagnosed with oligohydramnios.
oligohydramnios
Symptoms of low amniotic fluid
• You are leaking liquid from vagina
• Your uterus is not growing properly
• Your baby is not moving enough
Signs of Low Amniotic Fluid:
• Amniotic fluid index: less than 5 cm
• Amniotic fluid volume: less than 500 mL
• Maximum vertical pocket: less than 2 cm
Some common causes of polyhydramnios include
Rupture of membranes, fetal renal anomalies, placental insufficiency, maternal dehydration, fetal growth restriction
signs of multiple pregnancy
• Multiple embryos
• Multiple heartbeats
• High hCG and AFP
• Large fundal height
symptoms of multiple pregnancy
• Intense morning sickness
• Severe breast tenderness
• Rapid weight gain
Several factors can contribute to the occurrence of multiple pregnancies:
Maternal age, family history, fertility medications, parity, ethnicity, nutritional factors
2 eggs, 2 sperms, may differ, 2 placentas
dizygotic twins
1 egg, 1 sperm, always identical, 1 placentas
monozygotic twins
Simultaneous development of two fetuses is the commonest variety of multiple pregnancy
twins
it is the most common variety of multiple pregnancy (two third) and results from the fertilization of two ova
binovular twins
results from the fertilization of the single ovum
uniovular twins
They develop from the fusion of one oocyte and one spermatozoon which after fertilization splits into two
uniovular twins (identical, monozygotic)
These twins will be of the same sex and have the same genes, blood group and physical features
uniovular twins
COMPLICATIONS of multiple pregnancies
Pre-eclampsia , malpresentation, nausea and vomiting, APH, anemia
conjoined twins (abdomen)
omphalopagus
conjoined twins (head and chest)
cephalopagus
conjoined twins (pelvis)
caudal
conjoined twins (trunk)
parapagus
conjoined twins (head)
craniopagus
conjoined twins (base of spine)
pyopagus
Fertilization of two different ova released in the same cycle.
superfecundation
Fertilization of two ova released in different cycles
superfetation
Most common fetal lie in multiple pregnancy
Longitudinal
The normal cervix length at 14 weeks is _ and the internal os diameter is less than _.
35-40 mm ; 20 mm
A cervical length less than _ and a internal os diameter more than _ is suggestive of cervical incompetence
30mm ; 20mm
major symptoms of hyperemesis gravidarum
extreme morning sickness, including nausea, vomiting, and weight loss
_ protects the baby and helps develop its limbs, lungs, digestive system, and muscles
Amniotic fluid
