SlideShare una empresa de Scribd logo
1 de 60
Descargar para leer sin conexión
Bleeding during pregnancy
Thursday, April 5, 2018
Dr. Soad Abd El salam Ramdan 1
‫الرحيم‬ ‫الرمحن‬ ‫هللا‬ ‫بسم‬
َ‫ل‬ َ‫ك‬َ‫ن‬‫ا‬َ‫ح‬ْ‫ب‬ُ‫س‬ ْ‫ا‬‫و‬ُ‫ل‬‫ا‬َ‫ق‬‫آ‬َ‫ن‬َ‫ل‬ َ‫م‬ْ‫ل‬ِ‫ع‬ّ‫ل‬ِ‫إ‬
ُ‫م‬‫ي‬ِ‫ل‬َ‫ع‬ْ‫ال‬ َ‫ت‬ْ‫ن‬َ‫أ‬ َ‫ك‬ّ‫ن‬ِ‫إ‬ ‫آ‬َ‫ن‬َ‫ت‬ْ‫م‬ّ‫َل‬‫ع‬ ‫ا‬َ‫م‬
ُ‫م‬‫ي‬ِ‫ك‬َ‫ح‬ْ‫ال‬
‫العظيم‬ ‫اهلل‬ ‫صدق‬
‫سورة‬‫البقرة‬‫أية‬32
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 2
3
• Chairman of obstetrics &woman health
nursing department
• Pre. Vice of dean for students &Education
Affair
Faculty of nursing
Benha University
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan
Bleeding in early pregnancy
Learning objectives:-
 Describe causes of bleeding in early pregnancy.
 Apply nursing care plan for woman with
bleeding in late pregnancy.
 Enumerate types of associated medical
problems during pregnancy.
 Describe the nurses responsibilities in relation
to various types of associated medical problems
during pregnancy.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 5
Bleeding during pregnancy
Bleeding
Late
pregnancy
Accidental
hge.
Placenta
previa
Early
pregnancy
Abortion
Ectopic
pregnancy
Vesicular
mole
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 6
1- Bleeding
in early pregnancy
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 7
1-Bleeding In Early Pregnancy
(Before 20 weeks Gestation)
Causes:-
 Abortion.
 Vesicular mole.
 Ectopic pregnancy.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 8
Related to pregnant state
 Abortion
 Ectopic pregnancy
 Molar pregnancy
Bleeding in early pregnancy
abortion ectopic Vesicular
mole
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 9
1- Abortion
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 10
1- Abortion :-
Definition
It is the termination
of pregnancy before
24 weeks, or products
of conception
weighing below
500 grams.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 11
Causes
Fetal
 Chromoso
mal
anomalies.
 Diseases of
the
fertilized
ovum.
 Hypoxia.
Maternal
General conditions:
►Infections acute febrile conditions e.g. influenza, malaria.
►Disease such as chronic nephritis.
►Drug intake during pregnancy.
►Rh and ABO incompatibility.
Local conditions:
►Conditions that interfere with embedding, development and
nutrition of the ovum.
►Implantation of the ovum in the lower uterine segment.
►Incompetent cervix.
►Uterine malformation.
►Trauma - criminal interference, accidents, violent exercises,
uterine stimulation.
►Endocrine dysfunction
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 12
Types of
Abortion
Spontaneous induced
Therapeutic
Criminal
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 13
Spontaneous
Abortion
Threatened
Pregnancy
Progresses
Birth of
Viable Infant
Missed
Carneous
Mole
Inevitable
Incomplete
Septic
Complete
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 14
Types of Abortion:-
A- Spontaneous abortion: It means
termination of pregnancy through natural causes.
 ◘ Threatened abortion: It is one of the
subdivisions of spontaneous abortion. It may go to
term, or it may become inevitable.
 ◘ Missed abortion: Occurs when the fetus dies
and is not expelled but it is retained in utero for
two months or longer.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 15
Cont.
◘ Inevitable abortion: Persistent bleeding and
cramps with dilatation of the cervix. Complete
abortion:All the products of conception are expelled.
◘ Incomplete abortion: Some parts of the
products of conception have been expelled, while
others (placenta and membranes) remain within the
uterus.
◘ Septic abortion: Incomplete abortion
complicated by infection of the uterine cavity.
◘ Habitual abortion: The patient has had three or
more successive, spontaneous abortions.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 16
B- Induced abortion
 Therapeutic abortion: It means
artificial legal termination of pregnancy by
a physician due to medical indication.
 ◘ Criminal abortion: The illegal
termination of pregnancy.There are no
medical or obstetrical indications.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 17
pes Types of abortion
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 18
Signs and Symptoms of
Abortion
1-Threatened abortion:
Cervical os is closed.
Membranes are intact.
Pain and backache may or may
not be present.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 19
2- Incomplete abortion:
 Parts of the products of conception are
expelled (fetus is expelled from uterus,
placenta and membranes are still inside).
 Severe bleeding.
 Cervical os partly closed.
 No uterine involution.
 Pain may or may not be present.
 Uterus is soft and smaller than the
expected period of pregnancy
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 20
3- Septic abortion:
 Tender and painful uterus.
 Offensive vaginal bleeding.
 High temperature.
 Rapid pulse.
 Chills.
 Unstable blood pressure.
 Shock.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 21
4- Inevitable abortion:
 Bleeding is excessive (more than 10 days).
 Blood is red in color with clots.
 Severe colicky lower abdominal pain.
 Cervical os is dilated and rupture of
membranes has occurred.
 Uterus will be firm.
 There is severe blood loss and the woman
becomes shocked.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 22
5- Missed abortion:
 Fetus dies and is retained in the uterus.
 Some signs of pregnancy disappear.
 Pregnancy test will be negative.
 Fundal height does not increase in size.
 The breasts may secrete milk due to
hormonal changes/(Prolactin). FHR are
absent.
 No fetal movement.
 A sonar test confirms fetal death.
 Some brownish vaginal discharge.
 Cervix os is closed.
Thursday, April 5, 2018
Dr. Soad Abd El salam Ramdan 23
Treatment
◘Threatened abortion:
 Complete bed rest.
 All vaginal pads and stained linen should
be kept to estimate the amount of blood
loss.
 Good personal hygienic care.
 Sedatives such as phenobarbital 60 mg. is
usually ordered, for pain, pethidine 30-60
mg is ordered.
 Checking ofTPR and BP twice daily, or
every 4 hours according to the condition
of the mother.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 24
Cont. :-
 Avoid enema and purgatives.
 Avoid constipation and diarrhea.
 Rich protein diet with supplementary iron
and vitamin should be provided.
 Advise no sexual intercourse.
 Administration of prescribed drugs.
 Accurate observation of blood loss, color,
odor, amount and content.
 Intake and output chart should be kept.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 25
Treatment of incomplete abortion:
 Go to hospital for assessment and proper
intervention.
 If no heart beats are detected a dilute
solution of oxcytocin may be given as the
doctor orders to help in the expulsion of
the contents of the uterus.
 Dilatation and curettage should be done.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 26
Treatment of Septic abortion:
 Isolation.
 Clinical bacteriological and hematological investigation
to identify the infectious organisms.
 Administration of antibiotics as doctor orders.
Electrolyte control.
 Accurate observation of renal functions.
 Intake and output chart should be kept.
 General hygienic care.
 The soiled pads should be properly collected and
burned.
 Accurate observation of TPR and BP.
 Understanding and supporting.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 27
6- Recurrent (Habitual)
Abortion
 Definition:
Three (two by some authors) or
more consecutive abortions.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 28
Recurrent (Habitual)
Abortion>Aetiology:
 1. Chromosomal abnormalities: Can be
detected in
o Foetus: e.g. autosomal trisomy, sex
chromosome monosomy (X), and
polyploidy.
o Parents: e.g. balanced translocation.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 29
Recurrent (Habitual)
Abortion>Aetiology:
 2.Uterine abnormalities:
o Congenital anomalies: e.g. hypoplasia, bicornuate, septate
and subseptate uterus.
o Intrauterine synechiae (Asherman’s syndrome).
o Cervical incompetence: whether congenital or acquired.
o Uterine myomas.
o Deficiency of endometrial oestradiol and progesterone
receptors: leads to failure of implantation or early abortion
o Divided uterine artery: uterus with two ascending uterine
arteries may fail to provide adequate blood flow to the
developing placenta and the growing foetus.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 30
Recurrent (Habitual)
Abortion>Aetiology:
 3.Infections:
oToxoplasma.
o Mycoplasma hominis.
o Ureaplasma urealyticum.
o Listeria monocytogenes.
o Brucella.
o Chlamydia.
o Syphilis.
Dr. Soad Abd El salam Ramdan
Thursday, April 5, 2018 31
Recurrent (Habitual)
Abortion>Aetiology:
 4. Hormonal:
o Hypothyrodism,
o Diabetes.
o Luteal phase deficiency.
Dr. Soad Abd El salam Ramdan
Thursday, April 5, 2018 32
Recurrent (Habitual)
Abortion>Aetiology:
 5. Immunological:
o Human leukocyte antigens (HLA): the
difference in HLA between both parents
stimulates the maternal production of the
"blocking factors" which prevent rejection of
the conception. More sharing in HLA
between the parents causes recurrent
abortions. So the incidence of recurrent
abortions is higher if there is positive
consanguinity between the two partners.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 33
Recurrent (Habitual)
Abortion>Aetiology:
 5. Immunological:
o Antiphospholipid antibodies:These
antibodies cause placental vessels
thrombosis resulting in infarction and
placental insufficiency.
o Systemic lupus erythematosus.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 34
Recurrent (Habitual)
Abortion>Aetiology:
 6. Miscellaneous:
o Chronic malnutrition.
o Chronic anaemia.
o Chronic cardiac and renal diseases.
o Cigarette smoking and alcohol
abuse.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 35
Recurrent (Habitual)
Abortion>:Treatment
 Medical treatment:
 Treatment of the cause as:
o anaemia and malnutrition,
o diabetes,
o renal diseases,
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 36
Recurrent (Habitual)
Abortion>:Treatment
 o infections as chlamydia and
mycoplasma (tetracycline or doxycycline)
and toxoplasma (spiramycin) which may
need another coarse(s) of treatment
during pregnancy.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 37
Recurrent (Habitual)
Abortion>:Treatment
 Luteal phase defect treated by
progesterone or progestogens in the
secretory phase and up to 16th week of
pregnancy.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 38
Recurrent (Habitual)
Abortion>:Treatment
* Surgical treatment:
Cervical cerclage:
Ultrasonography is done before operation to:
# confirm foetal viability,
# exclude congenital
anomalies,
# measure the internal os.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 39
Recurrent (Habitual)
Abortion>:Treatment
 o Cervical cerclage:
+ It means encircling the cervix at
or as near as possible to the internal os by a
non-absorbable suture.
+ The best time for the operation
is about 12-14 weeks, so that the placenta is
formed and there is no possibility of
abortion due to congenital anomalies of the
early embryo.
+ The suture is removed at 38
weeks or if labour started at any time.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 40
Recurrent (Habitual)
Abortion>:Treatment
Vaginal cerclage:
# Shirodkar operation:
* Two incisions at the reflection of the
vaginal wall on the cervix are done
anteriorly and posteriorly and bladder is
dissected upwards.A nylon or silk suture
or a dacron (mersilene) tape is applied
around the internal os under the cervical
mucosa.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 41
Recurrent (Habitual)
Abortion>:Treatment
 Vaginal cerclage:
 # Mc Donald operation:
* It is the commonest operation.
* The cervix is surrounded from outside by
a nylon or silk purse- string suture.The
suture takes bites of cervical tissue at
3,6,9 and 12 o'clock then tied anteriorly
or posteriorly.
* This operation is easier and gives nearly
the same results as Shirodkar.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 42
Recurrent (Habitual)
Abortion>:Treatment
 + Abdominal cerclage:
# In case of previous high
amputation of the cervix extensive
cervical laceration or repeated failure of
vaginal cerclage.
# The isthmus uteri is
encircled by a non-absorbable suture and
the patient should be delivered by
caesarean section.
Dr. Soad Abd El salam RamdanThursday, April 5, 2018 43
2-Vesicular mole
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 44
Hydatidiform Mole (Vesicular
Mole)
Hydatidiform mole is a gross
malformation of the trophoblast
in which the chorionic villi
proliferate and become avascular.
The villi are filled with fluid forming
vesicles, which look like a bunch of
grapes.
It is an abnormal development of
the chorionic villi of conceptus.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 45
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 46
Causes:-
 The exact cause is unknown
◘ Risk factors are:-
 age ; old than 45 years or younger than
20 years
 Parity ;more with high parity
 Socioeconomic ;more in poor
 Previous obstetric performance
;common with one or more abortion .
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 47
Types:
Partial molar pregnancy:
This is where a baby starts to develop, but is
unable to survive, often being absorbed into
the vesicles that continue to multiply.
Complete molar pregnancy:
This is where a baby never develops, but the
placenta implants and grows many small
cysts, like sacs filled with fluid.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 48
Causes
◘ The exact cause is unknown.
◘ Risk factors are:
Maternal age above 40 years
or below 19 years.
Malnutrition (deficiency of
proteins).
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 49
Signs and Symptoms
◘ Signs and symptoms of early pregnancy are
present.
◘ Excessive frequent vomiting.
◘ Over distension of the uterus and larger than
expected for weeks of gestation.
◘ vaginal bleeding with passage of vesicles.
◘ No fetal movements are reported by the mother.
◘ No fetal parts can be palpated and no fetal
heartbeats can be detected.
◘ On palpation the uterus may have an elastic
consistency or it may be doughy.
◘ There is an increased incidence of pre-eclampsia.
◘ Positive pregnancy test result in highly diluted
urine 1:500.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 50
Investigations:-
◦ Pregnancy test is +ve in high dilution.
◦ Ultrasound.
◦ X-ray (no fetal skeleton.
◦ If 1/200 is +ve it is highly suggestive.
◦ If 1/500 is +ve  it is surely diagnostic
Complications:-
◘ Hemorrhage.
◘ Uterine sepsis.
◘ Choriocarcinoma
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 51
Management:-
 ◘ Admit the woman into hospital.
 ◘ Fluid replacement and packed RBCs.
 ◘Prepare the woman for evacuation of the uterus
under general anesthesia.
 ◘ HCG levels should be checked periodically.
 ◘ Health education on the following:
 Need for monitoring HCG levels for two years
(monthly for the first 3 months, then every three
months for one year).
 Birth spacing methods to prevent pregnancy for
two years.
 If HCG levels remain more than five international
units per liter eight weeks postpartum,
prophylactic chemotherapy is indicated.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 52
3- Ectopic Pregnancy
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 53
Ectopic Pregnancy:-
 Ectopic pregnancy is defined as
pregnancy occurring outside the
normal uterine cavity.
 ◘ It is an abnormal implantation
of the fertilized ovum that occurs
outside the uterine cavity.
 Approximately 2% of
pregnancies are ectopic.
 Second most frequent cause of
bleeding.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 54
Sites of ectopic pregnancy
implantation:
1. The surface of the ovary
2. Cervix
3. Fallopian tube (95% ): 80% occur in the
ampullar
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 55
Ectopic Pregnancy Incidence
increase with:
 Smoking.
 Intrauterine devices (IUDs).
 In vitro fertilization.
 History of ectopic pregnancy (10%-20%).
 Pelvic inflammatory disease.
 History of previous pelvic operations such as
D and C, tuboplasty, tubal sterilization,
ovarian surgery.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 56
Causes:-
 Obstruction, such as an adhesion of the fallopian
tube.
Causes of adhesions:
1. Previous infection.
2. Congenital malformations.
3. Scars from tubal surgery.
4. Uterine tumor.
 Impaired tubal ciliary action.
 Impaired tubal contractility.
 Decreased sperm mobility.
 The use of intrauterine contraceptive device.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 57
Signs and Symptoms :-
 Short periods of amenorrhea.
 History of infertility, tubal surgery, induced
abortion.
 Sudden/recurrent severe, colicky abdominal
pain in one iliac fossa or entire lower
abdomen.
 Dizziness and fainting attacks.
 Blood stained vaginal discharge.
 Diffuse tenderness on lower abdomen.
 Signs of shock.
 Dyspareunia.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 58
 Management
 Once the diagnosis of ectopic pregnancy has
been made, the pregnancy should be evacuated
immediately.
 Salpingectomy is preformed.
 Provide emotional support to the patient.
 Prepare for emergency surgery.
 Monitor the patient for shock. Follow-up is
needed.
 Family planning should be discussed.
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 59
THANKYOU
Thank you
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 60

Más contenido relacionado

La actualidad más candente

Pharmacotherapeutics in obstetrics
Pharmacotherapeutics in obstetricsPharmacotherapeutics in obstetrics
Pharmacotherapeutics in obstetricsSnehlata Parashar
 
Gynecological disorders
Gynecological disordersGynecological disorders
Gynecological disordersAnila Eapen
 
Abnormal uterine action
Abnormal uterine actionAbnormal uterine action
Abnormal uterine actionDrpawan Jhalta
 
Post Partum Hemorrhage in ED
Post Partum Hemorrhage in EDPost Partum Hemorrhage in ED
Post Partum Hemorrhage in EDRunal Shah
 
Bleeding in Early Pregnancy
Bleeding in Early PregnancyBleeding in Early Pregnancy
Bleeding in Early Pregnancylimgengyan
 
Inversion of the uterus
Inversion of the uterusInversion of the uterus
Inversion of the uterusPriyanka Gohil
 
Bleeding in early pregnancy
Bleeding in early pregnancy Bleeding in early pregnancy
Bleeding in early pregnancy Aboubakr Elnashar
 
Multiple pregnancy
Multiple pregnancyMultiple pregnancy
Multiple pregnancyAbino David
 
Bleeding in early pregnancy
Bleeding in early pregnancyBleeding in early pregnancy
Bleeding in early pregnancySushma Sharma
 
Adolecent pregnancy,unwed mothers, elderly primi,substance abuse
Adolecent pregnancy,unwed mothers, elderly primi,substance abuseAdolecent pregnancy,unwed mothers, elderly primi,substance abuse
Adolecent pregnancy,unwed mothers, elderly primi,substance abusepkbpkbpkb
 

La actualidad más candente (20)

Pharmacotherapeutics in obstetrics
Pharmacotherapeutics in obstetricsPharmacotherapeutics in obstetrics
Pharmacotherapeutics in obstetrics
 
Aph
AphAph
Aph
 
ECLAMPSIA
ECLAMPSIAECLAMPSIA
ECLAMPSIA
 
Malpositions
MalpositionsMalpositions
Malpositions
 
Amniotic fluid
Amniotic fluidAmniotic fluid
Amniotic fluid
 
Obstetrics Quiz
Obstetrics QuizObstetrics Quiz
Obstetrics Quiz
 
Gynecological disorders
Gynecological disordersGynecological disorders
Gynecological disorders
 
Abnormal uterine action
Abnormal uterine actionAbnormal uterine action
Abnormal uterine action
 
Post Partum Hemorrhage in ED
Post Partum Hemorrhage in EDPost Partum Hemorrhage in ED
Post Partum Hemorrhage in ED
 
Bleeding in Early Pregnancy
Bleeding in Early PregnancyBleeding in Early Pregnancy
Bleeding in Early Pregnancy
 
PREMATURE LABOR
PREMATURE LABORPREMATURE LABOR
PREMATURE LABOR
 
Inversion of the uterus
Inversion of the uterusInversion of the uterus
Inversion of the uterus
 
Bleeding in early pregnancy
Bleeding in early pregnancy Bleeding in early pregnancy
Bleeding in early pregnancy
 
Obstructed labour
Obstructed labourObstructed labour
Obstructed labour
 
Multiple pregnancy
Multiple pregnancyMultiple pregnancy
Multiple pregnancy
 
Prolonged pregnancy
Prolonged pregnancyProlonged pregnancy
Prolonged pregnancy
 
Abnormal uterine action
Abnormal uterine actionAbnormal uterine action
Abnormal uterine action
 
ECTOPIC PREGNANCY
 ECTOPIC PREGNANCY ECTOPIC PREGNANCY
ECTOPIC PREGNANCY
 
Bleeding in early pregnancy
Bleeding in early pregnancyBleeding in early pregnancy
Bleeding in early pregnancy
 
Adolecent pregnancy,unwed mothers, elderly primi,substance abuse
Adolecent pregnancy,unwed mothers, elderly primi,substance abuseAdolecent pregnancy,unwed mothers, elderly primi,substance abuse
Adolecent pregnancy,unwed mothers, elderly primi,substance abuse
 

Similar a Bleeding in early pregnancy

Abruptio placenta
Abruptio placenta Abruptio placenta
Abruptio placenta Soad Ramadan
 
Bleeding in late pregnancy
Bleeding in late pregnancyBleeding in late pregnancy
Bleeding in late pregnancySoad Ramadan
 
Pregnancy induced hyper tension
Pregnancy induced hyper tension Pregnancy induced hyper tension
Pregnancy induced hyper tension Soad Ramadan
 
(Normal labor) .ppt
(Normal labor) .ppt(Normal labor) .ppt
(Normal labor) .pptSoad Ramadan
 
Anatomy of the female reproductive system
Anatomy of the female reproductive systemAnatomy of the female reproductive system
Anatomy of the female reproductive systemSoad Ramadan
 
Diabetus mellitus
Diabetus mellitus Diabetus mellitus
Diabetus mellitus Soad Ramadan
 
01 history and examination dr isameldin
01 history and examination dr isameldin01 history and examination dr isameldin
01 history and examination dr isameldinIsamaldin Elamin
 
Misscarage and recurrent miscarriage .pptx
Misscarage and recurrent miscarriage .pptxMisscarage and recurrent miscarriage .pptx
Misscarage and recurrent miscarriage .pptxlezan sorkan
 
Fertilization conception fetal development
Fertilization conception fetal developmentFertilization conception fetal development
Fertilization conception fetal developmentSoad Ramadan
 
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)College of Medicine, Sulaymaniyah
 
plcenta previa.pptx
plcenta previa.pptxplcenta previa.pptx
plcenta previa.pptxMohdSabaileh
 
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptx
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptxDELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptx
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptxBAISHWANARBANERJEE1
 
Early pregnancy hemorrhage
Early pregnancy hemorrhageEarly pregnancy hemorrhage
Early pregnancy hemorrhagehemnathsubedii
 

Similar a Bleeding in early pregnancy (20)

Abruptio placenta
Abruptio placenta Abruptio placenta
Abruptio placenta
 
Vesicular mole
Vesicular moleVesicular mole
Vesicular mole
 
Bleeding in late pregnancy
Bleeding in late pregnancyBleeding in late pregnancy
Bleeding in late pregnancy
 
Placenta previa
Placenta previa Placenta previa
Placenta previa
 
Pregnancy induced hyper tension
Pregnancy induced hyper tension Pregnancy induced hyper tension
Pregnancy induced hyper tension
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
 
(Normal labor) .ppt
(Normal labor) .ppt(Normal labor) .ppt
(Normal labor) .ppt
 
Antenatal care
Antenatal careAntenatal care
Antenatal care
 
Anatomy of the female reproductive system
Anatomy of the female reproductive systemAnatomy of the female reproductive system
Anatomy of the female reproductive system
 
Diabetus mellitus
Diabetus mellitus Diabetus mellitus
Diabetus mellitus
 
01 history and examination dr isameldin
01 history and examination dr isameldin01 history and examination dr isameldin
01 history and examination dr isameldin
 
Misscarage and recurrent miscarriage .pptx
Misscarage and recurrent miscarriage .pptxMisscarage and recurrent miscarriage .pptx
Misscarage and recurrent miscarriage .pptx
 
CBL INFERTILITY.pptx
CBL INFERTILITY.pptxCBL INFERTILITY.pptx
CBL INFERTILITY.pptx
 
Fertilization conception fetal development
Fertilization conception fetal developmentFertilization conception fetal development
Fertilization conception fetal development
 
Garbha vyapad
Garbha vyapadGarbha vyapad
Garbha vyapad
 
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
 
plcenta previa.pptx
plcenta previa.pptxplcenta previa.pptx
plcenta previa.pptx
 
Nursing care of patients
Nursing care of patientsNursing care of patients
Nursing care of patients
 
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptx
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptxDELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptx
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptx
 
Early pregnancy hemorrhage
Early pregnancy hemorrhageEarly pregnancy hemorrhage
Early pregnancy hemorrhage
 

Último

DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 

Último (20)

DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 

Bleeding in early pregnancy

  • 1. Bleeding during pregnancy Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 1
  • 2. ‫الرحيم‬ ‫الرمحن‬ ‫هللا‬ ‫بسم‬ َ‫ل‬ َ‫ك‬َ‫ن‬‫ا‬َ‫ح‬ْ‫ب‬ُ‫س‬ ْ‫ا‬‫و‬ُ‫ل‬‫ا‬َ‫ق‬‫آ‬َ‫ن‬َ‫ل‬ َ‫م‬ْ‫ل‬ِ‫ع‬ّ‫ل‬ِ‫إ‬ ُ‫م‬‫ي‬ِ‫ل‬َ‫ع‬ْ‫ال‬ َ‫ت‬ْ‫ن‬َ‫أ‬ َ‫ك‬ّ‫ن‬ِ‫إ‬ ‫آ‬َ‫ن‬َ‫ت‬ْ‫م‬ّ‫َل‬‫ع‬ ‫ا‬َ‫م‬ ُ‫م‬‫ي‬ِ‫ك‬َ‫ح‬ْ‫ال‬ ‫العظيم‬ ‫اهلل‬ ‫صدق‬ ‫سورة‬‫البقرة‬‫أية‬32 Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 2
  • 3. 3 • Chairman of obstetrics &woman health nursing department • Pre. Vice of dean for students &Education Affair Faculty of nursing Benha University Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan
  • 5. Learning objectives:-  Describe causes of bleeding in early pregnancy.  Apply nursing care plan for woman with bleeding in late pregnancy.  Enumerate types of associated medical problems during pregnancy.  Describe the nurses responsibilities in relation to various types of associated medical problems during pregnancy. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 5
  • 7. 1- Bleeding in early pregnancy Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 7
  • 8. 1-Bleeding In Early Pregnancy (Before 20 weeks Gestation) Causes:-  Abortion.  Vesicular mole.  Ectopic pregnancy. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 8
  • 9. Related to pregnant state  Abortion  Ectopic pregnancy  Molar pregnancy Bleeding in early pregnancy abortion ectopic Vesicular mole Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 9
  • 10. 1- Abortion Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 10
  • 11. 1- Abortion :- Definition It is the termination of pregnancy before 24 weeks, or products of conception weighing below 500 grams. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 11
  • 12. Causes Fetal  Chromoso mal anomalies.  Diseases of the fertilized ovum.  Hypoxia. Maternal General conditions: ►Infections acute febrile conditions e.g. influenza, malaria. ►Disease such as chronic nephritis. ►Drug intake during pregnancy. ►Rh and ABO incompatibility. Local conditions: ►Conditions that interfere with embedding, development and nutrition of the ovum. ►Implantation of the ovum in the lower uterine segment. ►Incompetent cervix. ►Uterine malformation. ►Trauma - criminal interference, accidents, violent exercises, uterine stimulation. ►Endocrine dysfunction Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 12
  • 13. Types of Abortion Spontaneous induced Therapeutic Criminal Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 13
  • 15. Types of Abortion:- A- Spontaneous abortion: It means termination of pregnancy through natural causes.  ◘ Threatened abortion: It is one of the subdivisions of spontaneous abortion. It may go to term, or it may become inevitable.  ◘ Missed abortion: Occurs when the fetus dies and is not expelled but it is retained in utero for two months or longer. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 15
  • 16. Cont. ◘ Inevitable abortion: Persistent bleeding and cramps with dilatation of the cervix. Complete abortion:All the products of conception are expelled. ◘ Incomplete abortion: Some parts of the products of conception have been expelled, while others (placenta and membranes) remain within the uterus. ◘ Septic abortion: Incomplete abortion complicated by infection of the uterine cavity. ◘ Habitual abortion: The patient has had three or more successive, spontaneous abortions. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 16
  • 17. B- Induced abortion  Therapeutic abortion: It means artificial legal termination of pregnancy by a physician due to medical indication.  ◘ Criminal abortion: The illegal termination of pregnancy.There are no medical or obstetrical indications. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 17
  • 18. pes Types of abortion Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 18
  • 19. Signs and Symptoms of Abortion 1-Threatened abortion: Cervical os is closed. Membranes are intact. Pain and backache may or may not be present. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 19
  • 20. 2- Incomplete abortion:  Parts of the products of conception are expelled (fetus is expelled from uterus, placenta and membranes are still inside).  Severe bleeding.  Cervical os partly closed.  No uterine involution.  Pain may or may not be present.  Uterus is soft and smaller than the expected period of pregnancy Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 20
  • 21. 3- Septic abortion:  Tender and painful uterus.  Offensive vaginal bleeding.  High temperature.  Rapid pulse.  Chills.  Unstable blood pressure.  Shock. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 21
  • 22. 4- Inevitable abortion:  Bleeding is excessive (more than 10 days).  Blood is red in color with clots.  Severe colicky lower abdominal pain.  Cervical os is dilated and rupture of membranes has occurred.  Uterus will be firm.  There is severe blood loss and the woman becomes shocked. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 22
  • 23. 5- Missed abortion:  Fetus dies and is retained in the uterus.  Some signs of pregnancy disappear.  Pregnancy test will be negative.  Fundal height does not increase in size.  The breasts may secrete milk due to hormonal changes/(Prolactin). FHR are absent.  No fetal movement.  A sonar test confirms fetal death.  Some brownish vaginal discharge.  Cervix os is closed. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 23
  • 24. Treatment ◘Threatened abortion:  Complete bed rest.  All vaginal pads and stained linen should be kept to estimate the amount of blood loss.  Good personal hygienic care.  Sedatives such as phenobarbital 60 mg. is usually ordered, for pain, pethidine 30-60 mg is ordered.  Checking ofTPR and BP twice daily, or every 4 hours according to the condition of the mother. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 24
  • 25. Cont. :-  Avoid enema and purgatives.  Avoid constipation and diarrhea.  Rich protein diet with supplementary iron and vitamin should be provided.  Advise no sexual intercourse.  Administration of prescribed drugs.  Accurate observation of blood loss, color, odor, amount and content.  Intake and output chart should be kept. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 25
  • 26. Treatment of incomplete abortion:  Go to hospital for assessment and proper intervention.  If no heart beats are detected a dilute solution of oxcytocin may be given as the doctor orders to help in the expulsion of the contents of the uterus.  Dilatation and curettage should be done. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 26
  • 27. Treatment of Septic abortion:  Isolation.  Clinical bacteriological and hematological investigation to identify the infectious organisms.  Administration of antibiotics as doctor orders. Electrolyte control.  Accurate observation of renal functions.  Intake and output chart should be kept.  General hygienic care.  The soiled pads should be properly collected and burned.  Accurate observation of TPR and BP.  Understanding and supporting. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 27
  • 28. 6- Recurrent (Habitual) Abortion  Definition: Three (two by some authors) or more consecutive abortions. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 28
  • 29. Recurrent (Habitual) Abortion>Aetiology:  1. Chromosomal abnormalities: Can be detected in o Foetus: e.g. autosomal trisomy, sex chromosome monosomy (X), and polyploidy. o Parents: e.g. balanced translocation. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 29
  • 30. Recurrent (Habitual) Abortion>Aetiology:  2.Uterine abnormalities: o Congenital anomalies: e.g. hypoplasia, bicornuate, septate and subseptate uterus. o Intrauterine synechiae (Asherman’s syndrome). o Cervical incompetence: whether congenital or acquired. o Uterine myomas. o Deficiency of endometrial oestradiol and progesterone receptors: leads to failure of implantation or early abortion o Divided uterine artery: uterus with two ascending uterine arteries may fail to provide adequate blood flow to the developing placenta and the growing foetus. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 30
  • 31. Recurrent (Habitual) Abortion>Aetiology:  3.Infections: oToxoplasma. o Mycoplasma hominis. o Ureaplasma urealyticum. o Listeria monocytogenes. o Brucella. o Chlamydia. o Syphilis. Dr. Soad Abd El salam Ramdan Thursday, April 5, 2018 31
  • 32. Recurrent (Habitual) Abortion>Aetiology:  4. Hormonal: o Hypothyrodism, o Diabetes. o Luteal phase deficiency. Dr. Soad Abd El salam Ramdan Thursday, April 5, 2018 32
  • 33. Recurrent (Habitual) Abortion>Aetiology:  5. Immunological: o Human leukocyte antigens (HLA): the difference in HLA between both parents stimulates the maternal production of the "blocking factors" which prevent rejection of the conception. More sharing in HLA between the parents causes recurrent abortions. So the incidence of recurrent abortions is higher if there is positive consanguinity between the two partners. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 33
  • 34. Recurrent (Habitual) Abortion>Aetiology:  5. Immunological: o Antiphospholipid antibodies:These antibodies cause placental vessels thrombosis resulting in infarction and placental insufficiency. o Systemic lupus erythematosus. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 34
  • 35. Recurrent (Habitual) Abortion>Aetiology:  6. Miscellaneous: o Chronic malnutrition. o Chronic anaemia. o Chronic cardiac and renal diseases. o Cigarette smoking and alcohol abuse. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 35
  • 36. Recurrent (Habitual) Abortion>:Treatment  Medical treatment:  Treatment of the cause as: o anaemia and malnutrition, o diabetes, o renal diseases, Dr. Soad Abd El salam RamdanThursday, April 5, 2018 36
  • 37. Recurrent (Habitual) Abortion>:Treatment  o infections as chlamydia and mycoplasma (tetracycline or doxycycline) and toxoplasma (spiramycin) which may need another coarse(s) of treatment during pregnancy. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 37
  • 38. Recurrent (Habitual) Abortion>:Treatment  Luteal phase defect treated by progesterone or progestogens in the secretory phase and up to 16th week of pregnancy. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 38
  • 39. Recurrent (Habitual) Abortion>:Treatment * Surgical treatment: Cervical cerclage: Ultrasonography is done before operation to: # confirm foetal viability, # exclude congenital anomalies, # measure the internal os. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 39
  • 40. Recurrent (Habitual) Abortion>:Treatment  o Cervical cerclage: + It means encircling the cervix at or as near as possible to the internal os by a non-absorbable suture. + The best time for the operation is about 12-14 weeks, so that the placenta is formed and there is no possibility of abortion due to congenital anomalies of the early embryo. + The suture is removed at 38 weeks or if labour started at any time. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 40
  • 41. Recurrent (Habitual) Abortion>:Treatment Vaginal cerclage: # Shirodkar operation: * Two incisions at the reflection of the vaginal wall on the cervix are done anteriorly and posteriorly and bladder is dissected upwards.A nylon or silk suture or a dacron (mersilene) tape is applied around the internal os under the cervical mucosa. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 41
  • 42. Recurrent (Habitual) Abortion>:Treatment  Vaginal cerclage:  # Mc Donald operation: * It is the commonest operation. * The cervix is surrounded from outside by a nylon or silk purse- string suture.The suture takes bites of cervical tissue at 3,6,9 and 12 o'clock then tied anteriorly or posteriorly. * This operation is easier and gives nearly the same results as Shirodkar. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 42
  • 43. Recurrent (Habitual) Abortion>:Treatment  + Abdominal cerclage: # In case of previous high amputation of the cervix extensive cervical laceration or repeated failure of vaginal cerclage. # The isthmus uteri is encircled by a non-absorbable suture and the patient should be delivered by caesarean section. Dr. Soad Abd El salam RamdanThursday, April 5, 2018 43
  • 44. 2-Vesicular mole Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 44
  • 45. Hydatidiform Mole (Vesicular Mole) Hydatidiform mole is a gross malformation of the trophoblast in which the chorionic villi proliferate and become avascular. The villi are filled with fluid forming vesicles, which look like a bunch of grapes. It is an abnormal development of the chorionic villi of conceptus. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 45
  • 46. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 46
  • 47. Causes:-  The exact cause is unknown ◘ Risk factors are:-  age ; old than 45 years or younger than 20 years  Parity ;more with high parity  Socioeconomic ;more in poor  Previous obstetric performance ;common with one or more abortion . Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 47
  • 48. Types: Partial molar pregnancy: This is where a baby starts to develop, but is unable to survive, often being absorbed into the vesicles that continue to multiply. Complete molar pregnancy: This is where a baby never develops, but the placenta implants and grows many small cysts, like sacs filled with fluid. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 48
  • 49. Causes ◘ The exact cause is unknown. ◘ Risk factors are: Maternal age above 40 years or below 19 years. Malnutrition (deficiency of proteins). Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 49
  • 50. Signs and Symptoms ◘ Signs and symptoms of early pregnancy are present. ◘ Excessive frequent vomiting. ◘ Over distension of the uterus and larger than expected for weeks of gestation. ◘ vaginal bleeding with passage of vesicles. ◘ No fetal movements are reported by the mother. ◘ No fetal parts can be palpated and no fetal heartbeats can be detected. ◘ On palpation the uterus may have an elastic consistency or it may be doughy. ◘ There is an increased incidence of pre-eclampsia. ◘ Positive pregnancy test result in highly diluted urine 1:500. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 50
  • 51. Investigations:- ◦ Pregnancy test is +ve in high dilution. ◦ Ultrasound. ◦ X-ray (no fetal skeleton. ◦ If 1/200 is +ve it is highly suggestive. ◦ If 1/500 is +ve  it is surely diagnostic Complications:- ◘ Hemorrhage. ◘ Uterine sepsis. ◘ Choriocarcinoma Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 51
  • 52. Management:-  ◘ Admit the woman into hospital.  ◘ Fluid replacement and packed RBCs.  ◘Prepare the woman for evacuation of the uterus under general anesthesia.  ◘ HCG levels should be checked periodically.  ◘ Health education on the following:  Need for monitoring HCG levels for two years (monthly for the first 3 months, then every three months for one year).  Birth spacing methods to prevent pregnancy for two years.  If HCG levels remain more than five international units per liter eight weeks postpartum, prophylactic chemotherapy is indicated. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 52
  • 53. 3- Ectopic Pregnancy Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 53
  • 54. Ectopic Pregnancy:-  Ectopic pregnancy is defined as pregnancy occurring outside the normal uterine cavity.  ◘ It is an abnormal implantation of the fertilized ovum that occurs outside the uterine cavity.  Approximately 2% of pregnancies are ectopic.  Second most frequent cause of bleeding. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 54
  • 55. Sites of ectopic pregnancy implantation: 1. The surface of the ovary 2. Cervix 3. Fallopian tube (95% ): 80% occur in the ampullar Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 55
  • 56. Ectopic Pregnancy Incidence increase with:  Smoking.  Intrauterine devices (IUDs).  In vitro fertilization.  History of ectopic pregnancy (10%-20%).  Pelvic inflammatory disease.  History of previous pelvic operations such as D and C, tuboplasty, tubal sterilization, ovarian surgery. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 56
  • 57. Causes:-  Obstruction, such as an adhesion of the fallopian tube. Causes of adhesions: 1. Previous infection. 2. Congenital malformations. 3. Scars from tubal surgery. 4. Uterine tumor.  Impaired tubal ciliary action.  Impaired tubal contractility.  Decreased sperm mobility.  The use of intrauterine contraceptive device. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 57
  • 58. Signs and Symptoms :-  Short periods of amenorrhea.  History of infertility, tubal surgery, induced abortion.  Sudden/recurrent severe, colicky abdominal pain in one iliac fossa or entire lower abdomen.  Dizziness and fainting attacks.  Blood stained vaginal discharge.  Diffuse tenderness on lower abdomen.  Signs of shock.  Dyspareunia. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 58
  • 59.  Management  Once the diagnosis of ectopic pregnancy has been made, the pregnancy should be evacuated immediately.  Salpingectomy is preformed.  Provide emotional support to the patient.  Prepare for emergency surgery.  Monitor the patient for shock. Follow-up is needed.  Family planning should be discussed. Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 59
  • 60. THANKYOU Thank you Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan 60