Problems due to abnormalities of the pelvic organ
ANTI PARTUM HEAMORRHAGE
Post term pregnancy
Urinary tract infection
AMNIOTIC FLUID proplems
Problems due to abnormalities of the
Retroversion of the uterus
Congenital uterine anomalies
Ovarian cyst in pregnancy
non-cancerous (benign) growths that develop in the muscular wall of the
Uterine fibroids are the most common tumors of the female genital tract.
Fibroids may grow as a single tumour (growth) or in a cluster.
They can range in size from very tiny (a quarter of an inch) to larger than a
Fibroids can dramatically increase in size during pregnancy.
fibroids are the product of many factors, which could be genetic,
hormonal, environmental, or a combination of all three.
Prolonged and heavy bleeding or painful periods
Bleeding between periods.
Frequent passing of urine.
Lower back pain
child bearing age (between 25 to 45 years of age)
Afro-Caribbean origin women
weighed or obese women
Retroversion of the uterus
A retroverted uterus means the uterus
is tipped backwards so that it aims
towards the rectum instead of
forward towards the belly.
Some women may experience
symptoms including painful sex.
In most cases, a retroverted uterus
won’t cause any problems during
Treatment options include exercises, a
pessary or surgery.
Lower abdominal or pelvic pain
Pain or pressure with urination or bowel movements
Irregular menstrual periods
Nausea and vomiting
Increased facial hair similar to a male pattern
Risk Factors of Ovarian Cysts
(11 years or
•IS A PLACENTA THAT IS
IMPLANTED ENTIRELY OR
IN PART IN THE LOWER
• HEAMORRHAGE OCCURE WHEN
CONTRACTIONS DILATE THE CX THERBY
APPLYING SHEARING FORCES TO THE
PLACENTAL ATTACHMENT IN THE LOWER
• WHEN SEPARATION IS PROVOKED BY
UNWISE DIGITAL VAGINAL EXAMINATION
•THE PLACENTA ENCROACHES ON THE LOWER SEGMEN T
BUT DOES NOT REACH THE INTRNAL CERVICAL OS
•THE PLACENTA DOES REACH THE EDGE OF THE CX. BUT
DOES NOT COVER IT
•THE PLACENTA DOES COVER THE CX BUT WOULD NOT DO
SO AT FULL CX.DILATATION
•THE PLACENTA IS SYMETRICALLY IMPLANTED IN THE LOWER
SO THAT IT COVERS THE CX TOTALLY
VAGINAL BLEEDING FROM
NORMALLY IMPLANTED PLACENTA
IN UPPER UTERINE SEGMENT
FETAL VESSELS CROSSING OR RUNNING
IN CLOSE PROXIMITY TO THE INNER
ACCESSORY PLACENTAL LOBES
Initial management of APH
NO PV before excluding
Nurse on side
IV access/ resuscitate
U/S Placental localization
Speculum examination when placenta praevia excluded, bleeding settled
Anti-D if Rh-negative
• 1- GENERAL CONDITIONS OF THE MOTHER
• 2- VITAL SIGNS – BP / PULSE
• 3-SEVERITY OF BLEEDING
• 4- CBC / HB
• 5-RH-GP FOR ANTI-D
• 1- US EXAMINATION FOR FETAL WELLBEING
WHICH INCLUDES FH / MOVEMENT / LIQOUR
• 2-FETAL WT
• 3- NST
• 4- CONFERM GESTATIONAL AGE
• AFTER EVALUATING MATERNAL AND FEATL
CONDITIONS SO DELIVERY OR CONSERVATIVE
DEPENDS ON FETAL GESTATIONAL AGE – ASK ABOUT LMP –SURE DATES /
DEPENDS ON MATERNAL CONDITIONS AND SEVERITY OF BLEEDING
IN SEVER BLEEDING – BLOOD TRANSFUSION
SOMETIMES AFTER CS BLEEDING DON’T STOP FROM LOWER UTERINE
SEGMENT SO MUST DO TAH
Post term pregnancy
Refers to a pregnancy that has extended to or beyond a gestational age of
42.0 weeks or 294 days from the first day of the LMP
Affect 10% of al pregnancies and the aetiology is unknown .
Post term pregnancy is associated with increased perinatal mortality and
Indications of induction of labor in post
There is reduced Amniotic fluid on scan
Fetal growth is reduced
There are reduced fetal movement
The CTG is not perfect
The mother is hypertensive or suffers a significant medical condition.
of forceps , vacuum
or cesarean birth
of shoulder dystocia
Induction of labour.
Urinary tract infection
It’s common in pregnancy
8% of women have asymptomatic bacteruria
If not treated , it may progress to UTI or even pyelonephritis associted with
low birth weight and preterm delivery.
low back pain
flu like symptoms
• MSU -> send for urine microscopy
, culture ,sensitivities .
• E.Coli most common
• less common Klebseilla , proteus
More than 10^5 organisms are present at culture , this
confirm the diagnosis .
MSU repeated after a week .
1st line ATB -> amoxycillin , oral cephalosporin
> 38.5 c
Occurs 11000-2000 pregnancies
Leading cause of maternal death in developed countries
Pregnancy associated with 6-10 fold increase in the risk of VTE compared to
non pregnant situation
Clinical Dx of acure VTE is unreliable , therefore women who are suspected to
have DVT , PE should be investigated promptly
Risk factors for thromboembolic disease
•maternal age > 35
•Obesity > 80 kg
•Sever varicose vein
•Damage to pelvic vein
•Prolonged bed rest
Deep vein thrombosis
most common symptom pain in calf with varying degree of
redness or swelling
Women’s legs are often swollen during pregnancy
therefore unilateral symptoms should ring alarm bells
Investigation : compression US ,Venography
It’s crucail to recognize PE as missing the Dx could have fatal implications
The most common Presentationis of : mild breathlessness or inspiratory chest
pain , in a woman who is not cyanosed but may be slightly tachycardia (>90bpm)
with mild pyrexia(>37.5)
Investigation : ECG , Chest x-ray , ABGs to exclude other Respiratory
diagnosis , we should investigate the lower limbs for DVT by US
VQ scan , CTPA
Treatment of VTE
LMWHs : are now the Tx of choice
Warfarin : Rarely recommended for use in pregnancy ( exception include
women with mechanical heart valves )
Following delivery women can choose to convert to warfarin , warfarin and
LMWHs safe in breastfeeding
Graduated elastic stockings shoulde be used for intital Tx of DVT and should
be worn for 2 years following DVT
The liquid that surrounds the developing fetus during pregnancy. It is
contained within the amniotic sac.
Amniotic fluid is mainly derived from the blood plasma. After the fetal
kidneys form and become functional at about 10-11 weeks, fetal urine
becomes the main source of amniotic fluid. In addition to lung fluid ,fetal oral
and nasal secretions and fetal surface of placenta .
It is removed due to fetal swallowing and absorption into the fetal blood.
Uptake also occurs across the placental surface.
Protect fetus from pressure or trauma.
Permitting fetal lungs to expands and develop.
Protects cord from compression.
Permits fetal movements – development of musculoskeletal system,
Swallowing of AF enhances growth & development of GIT.
Maintenance of fetal body temperature.
Too little amniotic fluids , AFI less than 5th centile for gestation
Fetal prognosis depends on the cause of
oligohydramnios but both pulmonary
hypoplasia and limbs deformeties are
common in severe early onset (<24
weeks ) oligohydraminos
Renal agenisis and bliateral multicystic
kidneys carry a lethal prognosis
Oligohydraminos due to
FGRuteroplacental unsuffeciency less
severe degree and less commonly causes
limb and lung problems .
& WELL BEING
Women who have a healthy pregnancy, developing mild oligohydramnios often
do not need any treatment
Delivery is the most appropriate management option if oligohydramnios occurs
during the last stage of pregnancy.
More severe cases of pre-term oligohydramnios may require the following
It involves infusing sodium chloride solution into the amniotic cavity using an
Maternal Rehydration & Bed Rest
Using oral fluids and IV fluids to rehydrate the mother’s body helps to raise
the amniotic fluid level
Termination of pregnancy may be the only option in severe cases occurring
during the first trimester
Excess of amniotic fluid ,AFI more than 95th centile for gestation on US
Signs and symptoms
Abdominal swelling and
On examination: The abdomen
may be tense and tender and
fetal poles will be hard to
In addition to:
According to the cause and severity .
Mild cases of polyhydramnios rarely require treatment.
Treatment for an underlying condition ,such as diabetes ,may help resolve
carries a small risk of complications, including preterm labor, placental abruption and
premature rupture of the membranes
Decreases lung liquid production
Decreases fetal urine production
Increases fluid movement across fetal membranes