Early Pregnancy Complications
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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 abortion
incomplete abortion
inevitable abortion
complete 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 inevitablecervical 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 effect 1-8
9-40
potential adverse miscarriage,structura malformation
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
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 abortion
incomplete abortion
inevitable abortion
complete 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 inevitablecervical 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 effect 1-8
9-40
potential adverse miscarriage,structura malformation
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
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