3. Threatened Abortion Threatened abortion is defined as vaginal bleeding before 20 weeks of gestation It occurs in about 30% to 40% of all pregnancies.
5. Physical examination Vital signs Abdomen usually is not tender Cervix is closed Bleeding can be seen coming from the os, and usually there is no cervical motion or adnexal tenderness.
8. Treatment There are no effective therapies for threatened abortion. Bedrest, although often prescribed, does not alter its course. Progesterone or sedatives should not be used Acetaminophen-based analgesia may be given to help relieve discomfort All patients should be counseled and reassured so that they understand the situation.
32. congenital uterine anomalies (Unicornuate and bicornuateuter), cervical incompetence, submucousleiomyomas, abnormalities due to DES exposure in utero
47. Not termination -Uterine size remains unchanged, and then gradually becomes smaller. -Mammary changes usually regress -Often lose a few pounds. -Have no symptoms during this period except persistent amenorrhea.
61. STATESTICS 10% of all pregnancies end into abortion. 10% of all abortions admitted to hospital are septic. % of maternal mortality is due to septic abortions. Septic abortion
62. CAUSES 1. Predisposing factors• Poor socio-economic condition• Incomplete abortion• Criminal abortion2. Exciting factorsPresence of blood, blood clots & a dead ovum or fetus micro-organisms to grow. Septic abortion
64. Definition Any abortion associated with clinical evidences of infection of uterus and its contents is called as septic abortion. Clinical evidences of infection are : Fever 38 C or more for at least 24 hr. Offensive or purulent vaginal discharge Lower abdominal pain, tenderness or mass. Tachycardia of more than 100 per min. Septic abortion
65. Septic abortion Clinical Grading of septic abortion Grade 1 Infection localized to uterus Grade 2 Infection beyond uterus to parametrium, tubes, ovaries or pelvic peritoneum Grade 3 Generalized peritonitis and or endotoxic shock or ARF
66. Septic abortion Symptoms High fever, usually above 101 °F Chills Severe abdominal pain and/or cramping Prolonged or heavy vaginal bleeding Foul-smelling vaginal discharge Backache A cold or UTI may mimic many of the symptoms.
67. Septic abortion As the condition becomes more serious, signs of septic shock may appear, including: Hypotension Hypothermia Oliguria Respiratory distress (dyspnea) Septic shock may lead to kidney failure, bleeding tendency and DIC. Intestinal organs may also become infected, potentially causing scar tissue with chronic pain, intestinal blockage, and infertility.
68. Septic abortion Investigation1. CBC • Anemia, Plt count 2. Coagulogram • Coagulation, DIC, Bleeding & Clotting time.3. Urine analysis and Urine culture • Bacteriological study for pus cells & culture. 4. Uterine discharges gram stain and culture• Gram staining-aerobic & anaerobic culture & sensitivity determination.
69. Septic abortion 5. Blood culture • Blood culture prior to antibiotic therapy.6. Serum electrolyte • Fluid & electrolytes disturbances. 7. Chest X-ray • Pneumonia associated with spontaneous abortion • Air underneath the dome of diaphragm is an indication of perforation of uterus or intestines.
89. Tubal Pregnancy at USG Detailed view of ectopic (thick, brightly echogenic, ringlike structure outside the uterus) Tubal pregnancy circled in red 4.5 mm fetal pole (between cursors) in green Pregnancy yolk sac in blue
90.
91. Tubal Pregnancy at laparoscope A right tubal ectopic pregnancy seen at laparoscopy The swollen right tube containing the ectopic pregnancy is on the right at E The stump of the left tube is seen at L - this woman had a previous tubal ligation
107. Symptoms and signs คล้ายกับกลุ่ม complete hydatidiform mole มักมาพบแพทย์ เมื่ออายุครรภ์มากมักไม่พบภาวะ large for date /ภาวะ preeclampsia พบได้แต่น้อยกว่าและช้ากว่า อาจได้รับ การวินิจฉัยเบื้องต้นว่าเป็น missed abortion or incomplete abortion
110. 2.2. Choriocarcinoma Malignant trophoblastic and aggressive cancer characterized by early hematogenous spread to the lungs พบเกิดตามหลัง hydatidiform moles, ท้องปกติ, ท้องนอกมดลูก, แท้ง ดังนั้นจึงเป็นข้อควรนึกถึงเสมอในกรณีที่ผู้ป่วยมีเลือดไหลออกจากช่องคลอดไม่หยุดภายหลังการคลอดหรือแท้ง
115. Complications Patient suffers from mole should be controlled for one year and another one after CMT. Rise in β-hCG disturbed the follow up Teratogenic effects from CMT Relapse GTN Woman that went on CMT will experience menopause 3 years early from normal one.
118. Prophylactic CMT Only for high-risk group Not available to follow up Large for date Theca lutien cyst > 6 cm Hyperthyroidism Maternal age > 40 years hCG in blood > 100,000 mU/mL Prior molar pregnancy
The term missed abortion is contemporaneously imprecise because it was defined many decades before the advent of immunological pregnancy tests and sonography. It was used to describe dead products of conception that were retained for days, weeks, or even months in the uterus with a closed cervical os. Because spontaneous miscarriages are almost always preceded by embryofetal death, most were correctly referred to as "missed." In the typical instance, early pregnancy appears to be normal, with amenorrhea, nausea and vomiting, breast changes, and uterine growth. After embryonic death, there may or may not be vaginal bleeding or other symptoms of threatened abortion.With sonography, confirmation of an anembryonic gestation or of fetal or embryonic death is possible (Fig. 9-5). Many women choose medical or surgical termination at the time of diagnosis. If the pregnancy is not terminated and if miscarriage does not follow for days or weeks, uterine size remains unchanged, and then gradually becomes smaller. Mammary changes usually regress, and women often lose a few pounds. Many women have no symptoms during this period except persistent amenorrhea. If the missed abortion terminates spontaneously, and most do, the process of expulsion is the same as in any abortion
The term missed abortion is contemporaneously imprecise because it was defined many decades before the advent of immunological pregnancy tests and sonography. It was used to describe dead products of conception that were retained for days, weeks, or even months in the uterus with a closed cervical os. Because spontaneous miscarriages are almost always preceded by embryofetal death, most were correctly referred to as "missed." In the typical instance, early pregnancy appears to be normal, with amenorrhea, nausea and vomiting, breast changes, and uterine growth. After embryonic death, there may or may not be vaginal bleeding or other symptoms of threatened abortion.With sonography, confirmation of an anembryonic gestation or of fetal or embryonic death is possible (Fig. 9-5). Many women choose medical or surgical termination at the time of diagnosis. If the pregnancy is not terminated and if miscarriage does not follow for days or weeks, uterine size remains unchanged, and then gradually becomes smaller. Mammary changes usually regress, and women often lose a few pounds. Many women have no symptoms during this period except persistent amenorrhea. If the missed abortion terminates spontaneously, and most do, the process of expulsion is the same as in any abortion
The term missed abortion is contemporaneously imprecise because it was defined many decades before the advent of immunological pregnancy tests and sonography. It was used to describe dead products of conception that were retained for days, weeks, or even months in the uterus with a closed cervical os. Because spontaneous miscarriages are almost always preceded by embryofetal death, most were correctly referred to as "missed." In the typical instance, early pregnancy appears to be normal, with amenorrhea, nausea and vomiting, breast changes, and uterine growth. After embryonic death, there may or may not be vaginal bleeding or other symptoms of threatened abortion.With sonography, confirmation of an anembryonic gestation or of fetal or embryonic death is possible (Fig. 9-5). Many women choose medical or surgical termination at the time of diagnosis. If the pregnancy is not terminated and if miscarriage does not follow for days or weeks, uterine size remains unchanged, and then gradually becomes smaller. Mammary changes usually regress, and women often lose a few pounds. Many women have no symptoms during this period except persistent amenorrhea. If the missed abortion terminates spontaneously, and most do, the process of expulsion is the same as in any abortion
