Complication During Pregnancy

COMPLICATION DURING
PREGNANCY
PREPERED BY:
JEAN ROSE H. BALITAON
RIZZA D. BALANGITAN
DAINDY KRIS B. GAJO
AGNES C. HADAP
1.HEMORRHAGIC COMPLICATION
HEMORRHAGIC
PERTAINING TO BLEEDING OR THE ABNORMAL FLOW OF
BLOOD.
MOST COMMON COMPLICATIONS ARE:
• ABORTION
• GESTATIONAL TROPHOBLASTIC DISEASE

ABORTION
• ABORTION IS THE EXPULSION OF FETUS BEFORE IT REACHES

VIABILITY {UNTIL 22 WEEKS OF GESTATION. WHO}
CAUSES OF ABORTION
• OVO-FETAL FACTORS
• MATERNAL FACTORS
OVO-FETAL FACTORS
• CHROMOSOMAL ABNORMALITY AND GROSS CONGENITAL ABNORMALITY

• INTERFERENCE OF BLOOD SUPPLY TO THE FETUS DUE TO KNOTS OR TWISTS IN UMBILICAL
CORD
• LOW ATTACHMENT OR FAULTY PLACENTAL FORMATION.
• TWINS OR HYDRAMNIOS BY RAPIDLY STRETCHING THE UTERUS MAY CAUSE ABORTION.
MATERNAL FACTORS
• VIRAL ILLNESS SUCH AS RUBELLA.

• MATERNAL HYPOXIA AND SHOCK DUE TO ACUTE RESPIRATORY DISEASE, HEART FAILURE, SEVERE ANEMIA.
• HYPERTENSION
• HYPOTHYROIDISM AND DIABETES MELLITUS
• TRAUMA TO THE ABDOMEN BY BLOW OR FALL.
• PSYCHIC: EMOTIONAL UPSET OR CHANGE MAY LEAD TO ABORTION
• PREMATURE RUPTURE OF MEMBRANES
• DEFICIENCY OF FOLIC ACID AND VITAMIN E
TYPES OF ABORTION
• INDUCED (THERAPEUTIC) ABORTION
• SPONTANEOUS ABORTION
SPONTANEOUS ABORTION
• WHICH IS THE LOSS OF A PREGNANCY WITHOUT

OUTSIDE INTERVENTION BEFORE 20 WEEK’S GESTATION,
AFFECTS UP TO 20 PERCENT OF RECOGNIZED
PREGNANCIES.
TYPES OF SPONTANEOUS ABORTION:
• THREATENED
• INEVITABLE
• COMPLETE
• INCOMPLETE
• MISSED
• RECURRENT ABORTION
THREATENED ABORTION
• THREATENED ABORTION IS BLEEDING OF INTRAUTERINE

ORIGIN OCCURRING BEFORE THE 20TH COMPLETED
WEEK, WITH OR WITHOUT UTERINE CONTRACTIONS,
WITHOUT DILATATION OF THE CERVIX, AND WITHOUT
EXPULSION OF THE PRODUCTS OF CONCEPTION.
TREATMENT OF THREATENED ABORTION
• THERE ARE NO EFFECTIVE THERAPIES FOR THREATENED

ABORTION, BED REST, ALTHOUGH OFTEN PRESCRIBED,
DOES NOT ALTER THE COURSE OF THREATENED ABORTION.
INEVITABLE ABORTION
ABORTION BECOMES INEVITABLE IF UTERINE BLEEDING IS

ASSOCIATED WITH STRONG UTERINE CONTRACTIONS WHICH CAUSE
DILATATION OF THE CERVIX.
COMPLETE ABORTION
• EXPULSION OF THE ENTIRE PREGNANCY MAY BE

COMPLETED BEFORE A WOMEN PRESENTS TO THE
HOSPITAL.
INCOMPLETE ABORTION
• INCOMPLETE ABORTION IS THE SAME, BUT NOT ALL OF THE

PRODUCTS OF CONCEPTION.
MISSED ABORTION
• IN A FEW CASES OF ABORTION THE DEAD EMBROYO OR FETUS

AND PLACENTA ARE NOT EXPELLED SPONTANEOUSLY AND ARE
RETAINED IN UTERO.
CLINICAL ASPECTS OF MISSED ABORTION
• THE PATIENT COMPLAIN OF A DIRTY BROWN DISCHARGE WHICH PERSISTS.
• THE UTERUS FAILS IN GROW AND SYMPTOMS INDICATING EARLY PREGNANCY DISAPPEAR
TREATMENT OF MISSED ABORTION
• THERE IS NO NEED TO TREAT MISSED ABORTION URGENTLY

• IF SPONTANEOUS ABORTION HAS NOT OCCURRED WITHIN 28 DAYS, THE PREGNANCY
SHOULD BE TERMINATED, AS COAGULATION DEFECTS MAY RESULT
• IF THE UTERUS IS > 12 WEEKS GESTATIONAL SIZE, THE UTERUS CAN BE EVACUATED BY
SPONGE FORCEPS AND CURETTED AFTER CERVICAL DILATATION.
RECURRENT (HABITUAL) ABORTION
• RECURRENT ABORTION IN ITS BROADEST DEFINITION IS DEFINED AS 2 OR

MORE CONSECUTIVE PREGNANCY LOSSES BEFORE 20 WEEKS OF GESTATION,
EACH WITH A FETUS WEIGHING LESS THAN 500GRAM. APPROXIMATELY 1%
OF WOMEN ARE HABITUAL ABORTERS.
ECTOPIC PREGNANCY
• A COMPLICATION OF PREGNANCY IN WHICH THE EMBRYO ATTACHES OUTSIDE THE UTERUS,

MOSTLY OCCURS IN FALLOPIAN TUBE.
• AN ECTOPIC PREGNANCY CANNOT SURVIVE ALONE BECAUSE ONLY THE UTERUS CAN
SUPPORT THE GROWTH OF A FETUS AND ITS PLACENTA.
SIGNS AND SYMPTOMS
• VAGINAL BLEEDING
• ACUTE OR DULL PAIN IN THE LOWER ABDOMEN
• INCREASED HCG
• PELVIC PAIN
• LACK OF APPETITE
• PAIN DURING INTERCOURSE
CAUSES OF ECTOPIC PREGNANCY
• PELVIC INFLAMMATORY DISEASE / PID

• INFERTILITY
• USE OF IUD
• SMOKING
• PREVIOUS ECTOPIC PREGNANCY
• MATERNAL AGE OF 35-44 YEARS
• SEVERAL INDUCED ABORTION
• ENDMETRIOSIS
• PREVIOUS EXPOSURE TO DIETHYL AND STILL BESTROL (DES)
 RUPTURE OF AN ECTOPIC PREGNANCY CAN LEAD TO SYMTOMS SUCH AS:
• ABDOMINAL DISTENSION
• TENDERNESS
• PERITONISM
• HYPOVOLEMIC SHOCK
 A WOMAN WITH ECTOPIC PREGNANCY MAY BE EXCESSIVELY MOBILE WITH UPRIGHT
POSTURING, IN ORDER TO DECREASE INTRAPELVIC BLOOD LOW WHICH CAN LEAD TO
SWELLING OF THE ABDOMINAL CAVITY AND CAUSE ADDITIONAL PAIN.
TYPES OF ECTOPIC PREGNANCY
• TUBAL
• CERVICAL
• CORNUAL OR INTERSTITIAL
• FALLOPIAN TUBE
 ECTOPIC PREGNANCY MOSTLY OCCURS IN THE FALLOPIAN TUBE. –AMPULLA
• THE AMPULLAR PORTION OF THE FALLOPIAN TUBE IS MORE DISTENSABLE THAN OTHER AREAS.
DIAGNOSTIC METHOD:
• ULTRASOUND
• BLOOD TEST FOR HCG
MANAGEMENT
 METHOTREXATE (MTX) –FORMERLY KNOWN AS AMETHOPTERIN

• A CHEMOTHERAPY AGENT AND IMMUNE SYSTEM SUPPRESSANT.
 SURGERY
• LAPAROSCOPY
• SALPINGECTOMY
GESTATIONAL TROPHOBLASTIC DIASEASE
• A TERM USED FOR A GROUP OF PREGNANCY RELATED TUMOURS. THESE TUMOURS ARE RARE,
AND THEY APPEAR WHEN CELLS IN THE WOMB START TO PROLIFERATE UNCONTROLLABLY, THE
CELLS THAT FROM GESTATIONAL TROPHOBLASTIC TUMOURS ARE CALLED TROPHOBLASTS AND
COME FROM TISSUE THAT GROWS TO FORM THE PLACENTA DURING PREGNANCY.
SIGNS AND SYMPTOMS:
• ABNORMAL VAGINAL BLEEDING DURING OR AFTER PREGNANCY.
• A UTERUS THAT IS LARGER THAN EXPECTED AT A GIVEN POINT IN THE PREGNANCY.
• SEVERE NAUSEA OR VOMITING DURING PREGNANCY
• PRE-ECLAMPSIA AT ABOUT 12 WEEKS
• ABDOMINAL SWELLING
• PAIN OR PRESSURE IN THE PELVIC AREA
• ANEMIA
• UNEXPLAINED WEIGHT LOSS
• ANXIETY AND IRRITABILITY
 OCCASIONALLY, SYMPTOMS MAY APPEAR WEEKS, MONTHS OR EVEN YEARS AFTER A NORMAL PREGNANCY AND BIRTH.
TYPES:
GTD IS COMMON NAME FOR FIVE CLOSELY RELATED TUMOURS, ONE BENIGN TUMOURS, FOUR
MALIGNANT TUMOUR.
ONE BENIGN TUMOUR
• HYDATIDIFORM MOLE/ H-MOLE

 A BUNCH OF GRAPE LIKE THAT IS FORMED FROM THE SWELLING OF CHORIONIC VILLI.
 THE MOST COMMON TYPE OF GTD.
FOUR MALIGNANT TUMOUR
• INVASIVE MOLE
 A TYPE OF NEOPLASIA THAT GROWS INTO THE MUSCULAR WALL OF THE UTERUS. IT IS
FORMED AFTER CONCEPTION, IT MAY SPREAD TO THE OTHER PARTS OF THE BODY SUCH AS:
VAGINA, VULVA AND LUNGS.
• CHORIOCARCINOMA
 A MALIGNANT TUMOUR THAT FORMS FROM TROPHOBLAST CELLS AND SPREAD TO THE
MUSCLE LAYER OF THE UTERUS AND NEARBY BLOOD VESSELS. IT MAY ALSO SPREAD TO THE
OTHER PARTS OF THE BODY SUCH AS: THE BRAIN, LUNGS, LIVER, SPLEEN, KIDNEY, INTESTINES,
PELVIC OR VAGINA.
• PLACENTAL- SITE TROPHOBLASTIC TUMOURS (PSTT)
 A RARE TYPE OF GTN THAT FORMS WHERE THE PLACENTA ATTACHES TO THE UTERUS. THE
TUMOURS FORMS FROM TROPHOBLAST CELLS AND SPREAD INTO THE MUSCLE OF UTERUS
AND INTO BLOOD VESSELS. A PSTT MAY SPREAD INTO THE LUNGS, PELVIS OR LYMPH NODES.
• EPITHELIOID TROPHOBLASTIC TUMOUR

 A VERY RARE TYPE OF GTN THAT MAY BE BENIGN OR MALIGNANT, WHEN THE TUMOUR IS
MALIGNANT, IT MAY SPREAD INTO THE LUNGS.
DIAGNOSTIC METHOD
• PELVIC EXAMINATION
• ULTRASOUND
• BLOOD CHEMISTRY STUDIES
• SERUM TUMOUR MARKER TEST
• URINALYSIS
MANAGEMENT
• CURETTAGE
HYPERTENSIVE DISORDER
• IS A GROUP OF DISEASE THAT INCLUDES PRE-ECLAMPSIA, ECLAMPSIA,

GESTATIONAL HYPERTENSION, AND CHRONIC HYPERTENSION.
• HYPERTENSIVE DISORDER IT IS ALSO KNOW AS MATERNAL
HYPERTENSIVE DIS-ORDER
• DURING PREGNANCY, SEVERE OR UNCONTROLLED HYPERTENSION CAN CAUSE
COMPLICATIONS.
• CHRONIC HYPERTENSION IS HIGH BLOOD PRESSURE THAT WAS PRESENT

BEFORE YOU BECOME PREGNANT OR THAT OCCURS IN THE FIRST HALF
(BEFORE 20 WEEKS) OF PREGNANCY.
TREATMENT OF UNDERLYING DISORDER
• THE UNDERLYING DISORDER MUST BE IDENTIFIED AND CORRECTED, WHETHER IT IS AN

OBSTETRIC PROBLEM, AN INFECTION, OR A CANCER. THE CLOTTING PROBLEMS SUBSIDE WHEN
THE CAUSE IS CORRECTED.
DISSEMINATE INTRAVASCULAR COAGULATION (DIC)
• THAT DEVELOPS SUDDENLY IS LIFE THREATENING AND IS TREATED AS AN EMERGENCY.

PLATELETS AND CLOTTING FACTORS ARE TRANSFUSED TO REPLACE THOSE DEPLETED AND TO
STOP BLEEDING. HEPARIN MAYBE USED TO SLOW THE CLOTTING IN PEOPLE WHO HAVE MORE
CHRONIC, MILDER DIC IN WHICH CLOTTING IS MORE OF A PROBLEM THAN BLEEDING.
DISSEMINATED INTRAVASCULAR COAGULATION(DIC)
• A SYNDROME CHARACTERIZED BY A MASSIVE, WIDE SPREAD, AND ONGOING

ACTIVATION OF THE COAGULATION SYSTEM, SECONDARY TO A VARIETY OF
CLINICAL CONDITIONS.
 MANY OBSTETRIC COMPLICATIONS SUCH AS:
• ABRUPTIO PLACENTA
• AMNIOTIC FLUID EMBOLISM
• ENDOTOXIN SEPSIS
• RETAINED DEAD FETUS
• POST-HEMORRHAGIC SHOCK
• HYDATIDIFORM MOLE
• GYNECOLOGICAL MALIGNANCIES
 THIS MIGHT ALL CAN TRIGGER DIC
• DIC IS USUALLY ASSOCIATED WITH HIGH MORTALITY AND MORBIDITY RATES.
• DIS IS A SERIOUS DISORDER IN WHICH PROTEINS THAT CONTROL BLOOD

CLOTTING BECOME OVER ACTVE.

Complication During Pregnancy

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Complication During Pregnancy

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COMPLICATION DURING

• GESTATIONAL TROPHOBLASTIC DISEASE

• ABORTION IS THE EXPULSION OF FETUS BEFORE IT REACHES

• CHROMOSOMAL ABNORMALITY AND GROSS CONGENITAL ABNORMALITY

• VIRAL ILLNESS SUCH AS RUBELLA.

• INDUCED (THERAPEUTIC) ABORTION

• WHICH IS THE LOSS OF A PREGNANCY WITHOUT

• THREATENED ABORTION IS BLEEDING OF INTRAUTERINE

• THERE ARE NO EFFECTIVE THERAPIES FOR THREATENED

ABORTION BECOMES INEVITABLE IF UTERINE BLEEDING IS

• EXPULSION OF THE ENTIRE PREGNANCY MAY BE

• INCOMPLETE ABORTION IS THE SAME, BUT NOT ALL OF THE

• IN A FEW CASES OF ABORTION THE DEAD EMBROYO OR FETUS

• THE PATIENT COMPLAIN OF A DIRTY BROWN DISCHARGE WHICH PERSISTS.

• THERE IS NO NEED TO TREAT MISSED ABORTION URGENTLY

• RECURRENT ABORTION IN ITS BROADEST DEFINITION IS DEFINED AS 2 OR

• A COMPLICATION OF PREGNANCY IN WHICH THE EMBRYO ATTACHES OUTSIDE THE UTERUS,

• PELVIC INFLAMMATORY DISEASE / PID

 METHOTREXATE (MTX) –FORMERLY KNOWN AS AMETHOPTERIN

• HYDATIDIFORM MOLE/ H-MOLE

• EPITHELIOID TROPHOBLASTIC TUMOUR

• IS A GROUP OF DISEASE THAT INCLUDES PRE-ECLAMPSIA, ECLAMPSIA,

• CHRONIC HYPERTENSION IS HIGH BLOOD PRESSURE THAT WAS PRESENT

• THE UNDERLYING DISORDER MUST BE IDENTIFIED AND CORRECTED, WHETHER IT IS AN

• THAT DEVELOPS SUDDENLY IS LIFE THREATENING AND IS TREATED AS AN EMERGENCY.

• A SYNDROME CHARACTERIZED BY A MASSIVE, WIDE SPREAD, AND ONGOING

• DIS IS A SERIOUS DISORDER IN WHICH PROTEINS THAT CONTROL BLOOD

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