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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

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abnormal pregnancy

Abnormal Pregnancy

CAPT Mike Hughey, MC, USNR

incidence of miscarriage
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
Causes of Miscarriage
  • 60% chromosome abnormalities
  • 30% placental malformation
  • 10% miscellaneous, but not: -trauma -climbing mountains -intercourse -medication -too much activity, etc.
threatened abortion
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
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
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
Incomplete Abortion: Treatment
  • Convert it to a Complete Abortion
  • If tissue visible in the os, remove it
  • Ergotrate, Oxytocin
  • Antibiotics
  • Rhogam
  • D&C

Tissue removed from os

Tissue still inside uterus

inevitable abortion
Inevitable Abortion
  • No tissue has been passed
  • Cervix dilated or hemorrhage
  • Ergotrate, Oxytocin
  • Antibiotics
  • Rhogam
  • D&C
septic abortion
Septic Abortion
  • Any abortion complicated by infection
  • Fever, Tenderness
  • Ergotrate, Oxytocin
  • Antibiotics
  • MEDEVAC
  • D&C
septic abortion antibiotics
Septic Abortion: Antibiotics
  • Clindamycin & Gentamicin IV
  • Flagyl & Gentamicin IV
  • Cefoxitin IV
unruptured ectopic pregnancy
Unruptured Ectopic Pregnancy
  • + HCG
  • Unilateral pelvic pain and tenderness
  • ±Pelvic mass?
  • DD: CL cyst, Appy, PID
  • Lie still
  • MEDEVAC
ruptured ectopic diagnosis
Ruptured Ectopic: Diagnosis
  • Pelvic & right shoulder pain
  • Sudden onset
  • Shock
  • Positive pregnancy test
  • Rebound & Rigidity late
  • Ultrasound
  • Culdocentesis
ruptured ectopic treatment
Ruptured Ectopic: Treatment
  • Surgery
  • MEDEVAC
  • IVs, oxygen, lie still
  • Maintain urine output(Foley)
  • MAST suit?
blood transfusion
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
Placental Abruption
  • >20 weeks
  • Uterine pain, tenderness, and contractions
  • ±Bleeding
  • Coagulopathy
  • Lie still, IV Fluids
  • MEDEVAC, Cesarean Section
placenta previa
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
Toxemia of Pregnancy
  • Elevated BP (>140/90)
  • Proteinuria (>300 mg in 24 hours)
  • Weight Gain (>2 pounds/week)
  • Swelling (?)
  • Increased reflexes (Clonus)
pre eclampsia
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
Eclampsia
  • Siezures
  • Risk of maternal death
  • Risk of HELLP syndrome
    • Hemolysis
    • Elevated Liver Enzymes
    • Low Platelets

Naval Hospital Guam

treatment of toxemia of pregnancy
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