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Abnormal Pregnancy

CAPT Mike Hughey, MC, USNR

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 1

Incidence of Miscarriage

1 in every 6 pregnancies
Risk of subsequent miscarriage 1/6 Bedrest will not prevent miscarriage but may postpone it

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 2

Causes of Miscarriage
60% chromosome abnormalities

30% placental malformation


10% miscellaneous, but not: -trauma -climbing mountains -intercourse -medication -too much activity, etc.

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 3

Threatened Abortion

1 in every 4 pregnancies
1st TM bleeding/cramping Half will abort, Half will be OK

Bedrest will not prevent abortion but may postpone it.

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 4

Complete Abortion

Passage of all tissue


9-week spontaneous complete abortion

Rest for a day or two


Ergotrate, Oxytocin Antibiotics Rhogam D&C?

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 5

Incomplete Abortion: Diagnosis

Some tissue remains behind


Continuing bleeding/cramping Tissue in cervical os

Uterus tender
Fever if infection present Ultrasound helpful if available

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 6

Incomplete Abortion: Treatment

Convert it to a Complete Abortion

If tissue visible in the os, remove it


Ergotrate, Oxytocin

Tissue removed from os

Antibiotics
Rhogam D&C

Tissue still inside uterus


Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000 Slide 7

Inevitable Abortion

No tissue has been passed

Cervix dilated or hemorrhage


Ergotrate, Oxytocin Antibiotics Rhogam D&C

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 8

Septic Abortion

Any abortion complicated by infection Fever, Tenderness Ergotrate, Oxytocin

Antibiotics
MEDEVAC D&C

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 9

Septic Abortion: Antibiotics


Clindamycin & Gentamicin IV Flagyl & Gentamicin IV Cefoxitin IV

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 10

Unruptured Ectopic Pregnancy

+ HCG
Unilateral pelvic pain and tenderness Pelvic mass? DD: CL cyst, Appy, PID Lie still MEDEVAC

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 11

Ruptured Ectopic: Diagnosis


Pelvic & right shoulder pain Sudden onset Shock Positive pregnancy test Rebound & Rigidity late Ultrasound Culdocentesis

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 12

Ruptured Ectopic: Treatment

Surgery
MEDEVAC IVs, oxygen, lie still

Maintain urine output (Foley)


MAST suit?

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 13

Blood Transfusion
O Negative blood

Blood collection bags


Direct Donor to Patient #16 needle 3-4 feet gravity feed 10 minutes Have a plan before you need it

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 14

Placental Abruption

>20 weeks

Uterine pain, tenderness, and contractions


Bleeding Coagulopathy Lie still, IV Fluids

MEDEVAC, Cesarean Section

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 15

Placenta Previa
>20 weeks Painless vaginal bleeding No pelvic exam unless instructed by an OBGYN Pelvic exam may cause torrential hemorrhage, exsanguination and death within minutes Rest, IVs, MEDEVAC

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 16

Toxemia of Pregnancy

Elevated BP (>140/90) Proteinuria (>300 mg in 24 hours) Weight Gain (>2 pounds/week) Swelling (?) Increased reflexes (Clonus)

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 17

Pre-Eclampsia

Naval Hospital Jacksonville

BP, Protein Stable and unstable Risk of IUGR Risk of Abruption Risk of maternal seizures Risk of HELLP syndrome
Hemolysis Elevated Liver Enzymes Low Platelets

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 18

Eclampsia

Siezures Risk of maternal death Risk of HELLP syndrome


Hemolysis Elevated Liver Enzymes Low Platelets

Naval Hospital Guam

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 19

Treatment of Toxemia of Pregnancy

Delivery is definitive treatment


If delivery is to be postponed (prematurity), then consider hospitalization for unstable patients Magnesium sulfate Watch for HELLP syndrome

Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

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Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000

Slide 21