Bleeding causes in the first trimester pregnancy
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Bleeding causes in the first trimester pregnancy. Threatened abortion Ectopic pregnancy Cervical polyps Hydatidiform mole Cervicitis. Abortion. Threatened abortion Inevitable abortion Complete abortion Incomplete abortion Missed abortion. Threatened abortion.

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Bleeding causes in the first trimester pregnancy

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Bleeding causes in the first trimester pregnancy

Bleeding causes in the first trimester pregnancy

  • Threatened abortion

  • Ectopic pregnancy

  • Cervical polyps

  • Hydatidiform mole

  • Cervicitis


Abortion

Abortion

  • Threatened abortion

  • Inevitable abortion

  • Complete abortion

  • Incomplete abortion

  • Missed abortion


Threatened abortion

Threatened abortion

Bleeding and uterine cramping without cervical dilation


Inevitable abortion

Inevitable abortion

  • Profuse haemorrhaging, rupture of the membranes, cramping with a dilated cervical os


Incomplete abortion

Incomplete abortion

  • When some products of conception are expelled but some tissue remains in the uterine cavity.


Recurrent pregnancy loss rpl

RECURRENT PREGNANCY LOSS (RPL)

  • The loss of tree or more spontaneous and consecutive pregnancies, occuring before the period of viabity

    PRIMARY RPL

    SECONDARY RPL


Causes of rpl

Causes of RPL

  • Chromosomal 1,8- 4,6%

  • Anatomic 1-28%

  • Immunologic 6-65%

  • Hormonal 5- 29%

  • Infectious

  • Unexpained 15-50%


Genetic causes

Genetic causes

  • Trisomy 40-50%

  • Monosomy 15-25%

  • Triploidy 15%

  • tetraploidy 5%


Anatomic abnormalities

Anatomic abnormalities

  • Uterine congenital abnormalieties ( septate uterus, bicornuate or unicornuate uterus)

  • Intrauterine adhaesiones

  • Leiomyomata

  • Cervical incompetence


Endokrinologic causes

Endokrinologic causes

  • The luteal phase deficiency

  • Thyroid disease

  • diabetes


Infections

Infections

  • Listeria monocytogenes

  • Mycoplasma hominis

  • Ureaplasma urealiticum

  • Toxoplasmosis

  • Cytomegalia

  • Rubella


Enviromental factors

Enviromental factors

  • Smoking

  • Alkohol

  • Ansthetic gases

  • Toxins

  • Radiations


Missed abortion

Missed abortion

Death of the fetus or embryo without the onset of labour or the passage of tissue


Diagnosis of abortion

Diagnosis of abortion

  • Clinical examination ( bleeding, abdominal pain, cramping)

  • Ultrasonography


Medical conditions associated with pregnancy loss

Medical conditions associated with pregnancy loss

  • Collagen vascular diseases

  • Thyroid disease

  • Diabetes mellitus

  • Chronic active hepatitis

  • Infections

  • Endometriosis

  • Thrombo-embolic disease

  • Chronic renal disease

  • Chronic cardiovascular disease


Immune theories of rpl

Immune theories of RPL

  • In the alloimmune theory state, the maintenance of normal pregnancy requires the immune system to recognize the implanting embryo as foreign

  • the autoimmune theory state, in whichwomen’s immune system may produce antiphospholipid antibodies


Criteria for the antiphospholipid antiboby syndrome

Criteria for the antiphospholipid antiboby syndrome


Criteria for anti phospholipid antibody syndrome

Laboratory findings

Persistently elevated anti-phospholipid antibodies (ACA)

Lupus anticoagulant (LA)

Clinical findnings

Thrombosis (venous or arterial)

Recurrent pregnancy loss

Thrombocytopenia

Criteria for anti-phospholipid antibody syndrome


The target cells for antiphospholipid antibodies

The target cells for antiphospholipid antibodies

  • Endothelial cells

  • Throphoblastic cells

  • Blood platelets

  • Embyonic tissue cells

  • Coagulation factors

  • Proteins involved in the coagulation cascade or in antibodies bindings


Molar pregnancy microscopic features

Molar pregnancy (microscopic features)


Molar pregnancy microscopic features1

Complete mole

Marked oedema and enlargement of the villi

Dissappearance of the villous blood vassels

Proliferation of lining trophoblast of the villi

Absence of the fetus, cord ar amniotic membrane

A normal kariotype

Partial mole

Marked swelling of the villi with atrophic throphoblastic cells

Presence of normal villi

Presence of fetus, cord and amniotic membrane

An abnormal karyotype

Molar pregnancy (microscopic features)


Symptoms

Symptoms:

  • Bleeding

  • The uterus is often larger than expected

  • Nausea and vomiting

  • Preeclampsia

  • Clinical hyperthyroidism

  • Abdominal pain secondary to theca lutean cysts


Diagnosis

Diagnosis

  • Passage of vesicular tissue

  • A quantitative HCG > 100 000 uIU/ml

  • Ultrasonography ( snow storm)


Clinical classification of gestational thropfoblastic disease

Clinical classification of gestational thropfoblastic disease

Molar pregnancy (hydatidiform mole)

  • Compete mole

  • Partial mole

    Gestational throphoblastic neoplasia


Persistent gestational throphoblastic neoplasia

Persistent gestational throphoblastic neoplasia

  • Histologically benign

  • Persistent histologically benign

  • Persistent histologically malignant


Benign gtd

Benign GTD

  • Low socioeconomic status

  • Older women

  • Spontaneous remission in 80-85% after dilatation and evacuation

  • Choriocarcinoma develops in 3- 5% of moles


Malignant gtd

Malignant GTD

  • 1 : 20 000 pregnancies

    A/ molar pregnancy (50%)

    B/ normal pregnancy (25%)

    C/ abortion and ectopic pregnancy (25%)


Management

Management

  • Suction curetage

  • Primary hysterectomy

  • Prophylactic chemiotherapy


Follow up examination include

Follow–up examination include

  • HCG determinations every 1-2 weeks until they are negative twice, then montly for 1 year

  • Contraception for 1year

  • Physical examination every 2 weeks until remission, then every 3 months for 1 year

  • Chest film initially and repeated if the HCG plateau or rises

  • Chemiotherapy should be started if the HCG titer rises or is stable if metastases are detected at any time


Abortion1

Abortion

  • Spontaneous

  • Induced

  • Early ( before 12 weeks)

  • Late (after 12 weeks)


Abortion2

Abortion

The termination of pregnancy before viability,

(22 weeks from the first day of the last normal menstrual bleeding).


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