1. GynaecologicTumours with Pregnancy www.freelivedoctor.com

2. Fibroids with pregnancy Incidence: 1%. www.freelivedoctor.com

4. affection of the decidual development,

5. affection of the vascular supply to the implanted ovum.2. Ectopic pregnancy: if it interferes with the passage of the ovum.x www.freelivedoctor.com

6. Effect of Fibroid on Pregnancy and Labour 7. Torsion of the uterus: very rare in subserousfundalmyoma. 8. Premature labour. 9. Nonengagement. 10. Prolonged labour: Inertia may be present due to interference with normal uterine contractions. 11. Obstructed labour: in cervical myoma or pedunculatedsubserousmyoma impacted in the pelvis. www.freelivedoctor.com

7. Effect of Fibroid on Pregnancy and Labour 12. Postpartum haemorrhage: due to > interference with uterine retraction, > increased vascularity. 13. Puerperal sepsis. 14. Inversion of the uterus: rare. 15.Subinvolution of the uterus. www.freelivedoctor.com

8. Effect of Fibroid on Pregnancy and Labour > Increase in size: due to a.oedema and increased vascularity, b.hypertrophy of the uterine muscles. > Softening: due to oedema and increased vascularity. > Red degeneration. > Torsion of a pedunculatedmyoma. > Internal haemorrhage: from rupture of a surface vein. > Infection: supervenes bruising during labour. > Extrusion: of submucousmyoma may rarely occur in puerperium. www.freelivedoctor.com

9. Management During pregnancy During labour Postpartum www.freelivedoctor.com

11. Torsion of a pedunculatedmyoma.

12. Internal haemorrhage from rupture of a surface vein.www.freelivedoctor.com

13. Management>During labour a. If the myoma lies above the pelvic brim not causing obstruction: vaginal delivery is allowed and myomectomy is done after 3-6 months if indicated. b. If the myoma lies in the pelvis causing obstruction: caesarean section is indicated, but myomectomy is contraindicated. www.freelivedoctor.com

14. Management> Postpartum > Give prophylactic antibiotic. > Observe for postpartum haemorrhage. www.freelivedoctor.com

15. Ovarian tumours with pregnancy Incidence: 1:1500. The commonest is simple serous cyst followed by dermoid cyst. www.freelivedoctor.com

16. Effect of Ovarian Tumours on Pregnancy and Labour a.Abortion and preterm labour in large and complicated tumours. b.Pressure symptoms. c. Malpresentations and nonengagement. d. Obstructed labour: if a pedunculatedtumour is impacted in the pelvis. www.freelivedoctor.com

17. Effect of Pregnancy and Labour on Ovarian Tumours 1.Torsion: is the commonest complication particularly in pedunculatedtumours that lie above the pelvic brim. It is more common during puerperium than pregnancy due to; a. lax abdominal wall, b. large intra-abdominal space after birth allows free mobility of the tumour. www.freelivedoctor.com

18. Effect of Pregnancy and Labour on Ovarian Tumours 2. Rupture. 3. Infection. 4. Rapid growth. 5.Haemorrhage. www.freelivedoctor.com

19. Management>Ovarian Tumours During pregnancy: During Labour During puerperium www.freelivedoctor.com

20. Management> During pregnancy: 1. Cyst less than 6 cm in diameter: is left and followed up by periodic examination and ultrasound as it is usually a functional corpus luteum cyst. 2. Cyst of 6 cm or more in diameter: a. Discovered in the first half of pregnancy: is removed after the 12th week when the placenta is formed so there is less liability for abortion. b. Discovered in the second half of pregnancy: is left to be removed in the first week of puerperium. be removed in the first week of puerperium. 3. Complicated or malignant tumours: a. are removed immediately irrespective of the duration of pregnancy. www.freelivedoctor.com

21. Management> During Labour a. If the tumour lies above the pelvic brim- causing no obstruction: vaginal delivery is allowed and tumour is removed in the first week in puerperium. b. If the tumour is impacted in the pelvis - causing obstruction: caesarean section with immediate removal of the tumour is done. www.freelivedoctor.com

22. Management> During puerperium Tumours discovered for the first time should be removed immediately for fear of torsion. www.freelivedoctor.com

23. Cancer cervix with pregnancy www.freelivedoctor.com

24. Pre-invasive Cancer (CIN) 1. Cytological examination: can be done during pregnancy taking in consideration that some features of dysplasia as increased cells showing mitosis are normally present during pregnancy. 2. Colposcopy: is easier to be done during pregnancy due to physiological eversion of the cervix. www.freelivedoctor.com

25. Pre-invasive Cancer (CIN) 3. If CIN I or CIN II is detected: follow up only as many cases will regress. 4. If CIN III is detected: follow up is indicated till one month after delivery where conisation can be done or hysterectomy if the patient had taken the decision that she had completed her family. www.freelivedoctor.com

26. Invasive Cancer Cervix Incidence: very rare 1:10.000 because; 1.The mean age of cancer cervix is 45-50 years. 2.The associated infection prevents conception. www.freelivedoctor.com

27. Effect of invasive carcinoma on pregnancy and labour: 1. Abortion and preterm labour: due to haemorrhage, infection and general health affection. 2. Cervical dystocia, obstructed labour, cervical laceration and/or uterine rupture may occur. 3.Puerperal sepsis. www.freelivedoctor.com

28. Effect of pregnancy and labour on invasive carcinoma: 1. Rapid growth: as young patients tend to have a rapidly growing tumours. 2. Rapid spread: if vaginal delivery is allowed. www.freelivedoctor.com

29. Management: 1. Early pregnancy: a. Wertheim’s operation or b. Hysterotomy followed by radiotherapy. 2. Late pregnancy: a. Upper segment caesarean section followed by either Wertheim’s operation (caesarean hysterectomy) or radiotherapy. www.freelivedoctor.com