Abortion Ectopic Pregnancy Hyperemesis Gravidarum

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AbortionEctopic PregnancyHyperemesis Gravidarum
Women Hospital , School of Medical,
ZheJiang University Yang
Xiao Fu
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Abortion
Spontaneous abortion
Induced abortion
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Abortion

• Defined as delivery occurring before the 28th
  completed week of gestation
• Fetus weighing less than 1000g
• US ( before the 20th completed week of gestation)
• Early abortion and late abortion
• 15 of clinically evident pregnancies
• 80 of abortions prior to 12 weeks gestation

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Etiology

• Abnormal karyotype 50
• Maternal factors infection (TORCH)
  
• endocrine factors
• immunologic
  factors
• maternal systemic
  disease
• anatomic defects
• trauma
• Toxic factors

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anatomic defects
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Pathology

• Hemorrhage into the decidua basalis
• Necrosis and inflammation
• Uterine contractions and cervical dilatation
• Expulsion of most or all of the products of
  conception

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Clinical Findings
Amenorrhea
Bleeding
Pain
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Clinical Findings
Threatened Abortion
Without cervical dilatation Without extrusion of
products of conception
Inevitable Abortion
Cervical dilatation Without extrusion of
products of conception
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Clinical Findings
Bleeding severe
Incomplete Abortion
Expulsion of some, but not all, of the products
of conception
Complete Abortion
Expulsion of all of the products of conception
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Clinical Findings
Missed Abortion
Embryo or fetus death, products of conception in
utero
Pain
Septic Abortion
Infection of the uterus
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Clinical Findings
Habitual Abortion
three times abortion
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Laboratory Findings
Gestational sac and viable embryo with heart
motion
Ultrasonography
Pregnancy tests
HCG
Blood count
Anemic
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Complication
Life threatening
Severe hemorrhage
Infection Intrauterine synechia Perforation
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Diagnosis
Medical history
Physical examination
?
Accessory examination
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Threatened Abortion
Inevitable
Incomplete
Missed
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Treatment
Threatened Abortion
Bed rest
Forbid sexual life
Progesterone
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Treatment
pathological examination
Dilatation and curettage
InevitableAbortion
Oxytocin
Ultrasound
Antibiotics
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Treatment
Dilatation and curettage
Promptly
IncompleteAbortion
Blood type and cross-match
Fluid infusion
Antibiotics
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Treatment
Products of conception
Examine
Complete Abortion
Ultrasound
Bleeding
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Treatment
DIC
Estrogen
Missed Abortion
Dilatation and curettage
Second
Oxytocin
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Treatment
Genetic error Anatomic defect Hormonal
abnormalities Infection Systemic
disease Immunologic factors
Habitual Abortion
Cause
Cervical cerclage
Progesterone
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Treatment
Antibiotics
Septic Abortion
Dilatation and curettage
Cervical cultures
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Ectopic pregnancy
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Definition

• A fertilized ovum implants in an area other than
  the endometrial lining of the uterus.

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Animation of intrauterine implantation
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Animation of ectopic implantation
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Sites of ectopic pregnancy

• gt95 ectopic
• pregs in fallopian
• tubes
• 70 ampulla
• 12 isthmic
• 11.1 fimbrial
• 3.2 ovarian
• 2.4 interstitial
• 1.3 abdominal

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Etiology

• Tubal Factors (salpingitis, previous tubal
  surgery)
• Zygote Abnormalities (chromosomal abnormalities)
• Ovarian Factors (ovum into contralateral tube)
• Exogenous Hormone (oral contraceptives)
• Other Factors (endometriosis, IUD)

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Pathology

• Lackage of resistance to invasion by the
  trophoblast
• Abdominal pregnancy -115000 pregnancies
• Enlarged uterus and endometrium changes

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Termination of the pregnancy

• Abortion

Rupture
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Temination of the pregnancy

• Tubalabortion or missed abortion
• Interstitial,Angular,Cornualrupture into the
  uterine cavity,the broad ligament or the
  peritoneal cavity.
• Cervicalrupture into the cervical canal
• Abdominalrupture into the peritoneal cavity,into
  the retroperitoneal space
• Ovarianrupture into the peritoneal cavity

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Clinical Findings

• Symptoms of early pregnancy (amenorrhea, breast
  tenderness, and nausea)
• Bleeding (usually spotting)
• Diffuse lower abdominal pain
• Over 15 of ectopic pregnant as surgical
  emergencies.

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Symptoms

• Pain
• Pelvic or lower abdominal pain (99)
• Generalized pain (44)
• Unilateral lower abdominal pain (33)
• Subdiaphragmatic pain or sharp shoulder pain
  (22)

Secondary amenorrhea (68)
Abnormal uterine bleeding (75)
Syncope (37)
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Signs

• Abdominal tenderness (80)
• Adnexal tenderness (75)
• Adnexal mass(a unilateral adnexal mass53)
• Uterine changes (normal size71,6-8 weeks
  size26, 9-12 weeks size3)
• Fever (only about 2 of patients)

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Laboratory Findings

• Pregnancy tests (postive-82.5)
• Hematocrit
• White blood cell count
• A negative test does not rule out an ectopic
  gestation

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Special Examinations

• Utrasonically scanning
• Culdocentesis
• Dilatation and curettage
• Exploratory laparotomy

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(No Transcript)
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Differential Diagnosis

• Appendicitis
• Salpingitis
• Ruptured corpus luteum cyst
• Uterine abortion
• Twisted ovarian cyst
• Urinary tract disease
• Degenerating leiomyomas

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Essentials of Diagnosis

• Amenorrhea followed by irregular vaginal bleeding
• Adnexal tenderness or mass
• Ultrasonographic evidence of adnexal mass and no
  intrauterine gestation
• Positive ß-hCG

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Complications

• About I in 1000 ectopic pregnancies result in
  maternal death
• Untreated or mistreated ruptured ectopic tubal
  pregnancy 8-12 of all materal deaths
• The majority of these deaths are preventable

Death
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Complications

• Chronic salpingitis
• Infertility or sterility
• Intestinal obstruction may develop after
  hemoperitoneum and peritonitis

• Tubal damage

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Treatment

• Emergency Treatment
• Immediate surgery,anti-shock(warm,oxygen)
• Surgical treatment
• laparoscopic techniques
• Medical treatmemt-MTX
• Supportive treatment
• antibiotic,iron therapy,
• a high-protein diet

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Salpingectomy
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Indications for Conservative Drug Therapy

• No signs of active intra-abdominal bleeding
• Diameter of mass lt3cm
• Serum ß-hCG lt2000U/L
• No embryonic blood vessle pounding
• No contraindication for MTX application
• Normal liver and kidney function
• Normal RBC count

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Prognosis

• Another tubal pregnancy will occur in 10-20 of
  patients treated
• Infertility develops in approximately 50 of
  patients

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Hyperemesis Gravidarum


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Prolonged and severe nausea/ vomiting associated
with dehydration, weight loss, or electrolyte
disturbances when pregnancy
Definition
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Etiology

• Unknown
• Hormonal, neurologic, metabolic, toxic, and
  psychosocial factors (underlying emotional
  disorder)
• Degree of biochemical hyperthyroidismh
• The level of beta-HCGlevel o

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Clinical Findings

• Severe nausea, Waste Away
• Ketonuria, Increased urine specific gravity
• Elevated hematocrit and BUN level
• Hyponatremia,Hypokalemia,Hypochloremia
• Metabolic acidosis
• Wernicke-Korsakoff
• Deficiency of VitaminK

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Diagnosis and Differential Diagnosis

• Urine
• Blood
• Serum Beta-HCG (Molar pregnancy)
• Thyroid function
• Ultrasound
• EKG
• Fundus oculi

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Treatment

• Indication for hospitalization
• Intractable emesis, Correction of any
• electrolyte abnormalities , Hypovolemia
• IV hydration
• Parental nutrition
• Electrolyte supplement

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Treatment

• Vitamin supplementation( B1 )Wernockes
  encephalopathy
• NaHCO3
• Oral feedings
• Terminal pregnancy

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