Obstetric Hemorrhage

Nelly Astika 09700260

Classification of obstetric hemorrhage:

O Bleeding in first trimester pregnancy O Antepartum hemorrhage O Post partum hemorrhage

Bleeding in first trimester pregnancy

ABORTION
abortion is usually defined as pregnancy termination prior 20 weeks gestation or less than 500-g birthweight.

Etiology: O Endocrine abnormalities O Genetic factors O Reproductive tract abnormalities O Infection O Systemic disease O Environmental factors O Other factors: advanced maternal age, delayed fertilization (old egg), trauma

Type of Abortion Threatened

Definition

Considered when any vaginal bleeding occurs during the first half of pregnancy

Complete
Incomplete

Spontaneous expulsion of the entire of conception, fetus, placenta, and membranes

Spontaneous expulsion of only part of the products of conception, with retained products remainin in the uterus Death of the fetus without sign or symptoms of pregnancy loss An abortion resulting in uterine infection with pathogens from the bowel and/ or vagina

Missed Septic

Sign and symptoms: General: vaginal bleeding, abdominal cramping, passage of tissue, cervical dilatation

Management & Therapy Nonpharmacologic: general measures, specific measures (curettage), diet, activity, patient education Drug of choice: Oxytocin or methylergonovine maleate. Septic abortion: antibiotic therapy (ampicilin or clindamycin and gentamicin)

Ectopic Pregnancy
Implantation and growth of fetus and placenta outside the uterine cavity is called an ectopic pregnancy.

Risk factors for ectopic pregnancy: O Pelvic inflammatory disease O History of ectopic pregnancy O History of prior tubal surgery O Assisted reproductive technology O IUD for contraception O Advanced maternal age O Sterilization

Sign and symptoms: O Pelvic and abdominal pain O Abnormal menstruation O Abdomen and pelvic tenderness O Uterine changes O Blood pressure and pulse: early responses to moderate hemorrhage range from no change in vital sign to a slight in blood pressure. O Pelvic mass

Assesment of ectopic pregnancy: History : menstrual history is useful in assesing ectopic pregnancy Pelvic exam : uterus is usually enlarged appropriate to gestational age Laboratory analysis : increase in beta hCG levels less than 66% Ultrasound

Treatment of ectopic pregnancy: 1. Surgical treatment : laparotomy and salpingectomy 2. Non surgical: Methotrexate

Hydatiform Mole
Gestational trophoblastic disease (GTD) or hydatiform molar pregnancy, occurs as a developmental anomaly in the placenta.

Risk Factor: O Delayed hemorrhage after a pregnancy immediately preceding the current one O Excessive uterine enlargment O Theca lutein cysts O HCG levels greater than 100.000 mlU/mL O Prior molar pregnancy O Prior miscarriage O Use of birth control pills O Maternal age older than 40 years and younger than 20 years

Signs and symptoms: Vaginal bleeding Uterus size greater than expected Absence of fetal indications Hyperemesis Hyperthyroidism Pre-eclampsia Anemia Enlarged ovaries

Diagnosis: Ultrasound Laboratory test

Treatment: treatment of GTD depends on many factors, including: O The location and extent of the disease O The type of GTD present O The level of hCG O The duration of the disease O Sites of metastasis if any O The extent of prior treatment