abnormal pregnancy

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1

Abnormal Pregnancy

CAPT Mike Hughey, MC, USNR


Incidence of Miscarriage

• 1 in every 6 pregnancies

• Risk of subsequent miscarriage 1/6

• Bedrest will not prevent miscarriage but may postpone it


Causes of Miscarriage• 60% chromosome abnormalities

• 30% placental malformation

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


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.


Complete Abortion

• Passage of all tissue

• Rest for a day or two

• Ergotrate, Oxytocin

• Antibiotics

• Rhogam

• D&C?9-week spontaneous complete abortion


Incomplete Abortion: Diagnosis

• Some tissue remains behind

• Continuing bleeding/cramping

• Tissue in cervical os

• Uterus tender

• Fever if infection present

• Ultrasound helpful if available


Incomplete Abortion: Treatment• Convert it to a Complete

Abortion

• If tissue visible in the os, remove it


• Antibiotics

• Rhogam

• D&C

Tissue removed from os

Tissue still inside uterus


Inevitable Abortion

• No tissue has been passed

• Cervix dilated or hemorrhage


• Antibiotics

• Rhogam

• D&C


Septic Abortion

• Any abortion complicated by infection

• Fever, Tenderness


• Antibiotics

• MEDEVAC

• D&C


Septic Abortion: Antibiotics

• Clindamycin & Gentamicin IV

• Flagyl & Gentamicin IV

• Cefoxitin IV


Unruptured Ectopic Pregnancy

• + HCG

• Unilateral pelvic pain and tenderness

• ±Pelvic mass?

• DD: CL cyst, Appy, PID

• Lie still

• MEDEVAC


Ruptured Ectopic: Diagnosis• Pelvic & right shoulder pain• Sudden onset• Shock• Positive pregnancy test• Rebound & Rigidity late• Ultrasound• Culdocentesis


Ruptured Ectopic: Treatment

• Surgery

• MEDEVAC

• IVs, oxygen, lie still

• Maintain urine output(Foley)

• MAST suit?


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


Placental Abruption

• >20 weeks

• Uterine pain, tenderness, and contractions

• ±Bleeding

• Coagulopathy

• Lie still, IV Fluids

• MEDEVAC, Cesarean Section


Placenta Previa• >20 weeks

• Painless vaginal bleeding

• No pelvic exam unless instructed by an OB-GYN

• Pelvic exam may cause torrential hemorrhage, exsanguination and death within minutes

• Rest, IVs, MEDEVAC


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


Pre-Eclampsia

• 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

Naval Hospital Jacksonville


Eclampsia

• Siezures• Risk of maternal death• Risk of HELLP syndrome

• Hemolysis• Elevated Liver Enzymes• Low Platelets

Naval Hospital Guam


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

abnormal pregnancy

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