1. Major Obstetrical Complications of Pregnancy
Spontaneous Abortion (MISCARRIAGE)
Spontaneous Abortion (MISCARRIAGE) is the ending of a
pregnancy before week 20. (Pregnancy loss after 20 weeks is
considered a stillbirth.)
Chromosomal abnormalities cause most spontaneous
abortions in the first trimester. Other causes in the first
trimester include maternal hormonal imbalances, chronic
disease, infection, implantation abnormalities, and exposure
to teratogenic chemicals in the environment.
Spontaneous abortion between 14 and 20 weeks of
gestation is often associated with cervical insufficiency,
infection, uterine defects such us bicornate uterus, or fibrous
tumors of the uterus.

2. How common is miscarriage?
Miscarriage is very common. Because
many or even most miscarriages occur so
early in pregnancy that a woman might not
have known that she was pregnant, it is
difficult to estimate how many miscarriages
occur. Some experts believe that about half of
all fertilized eggs die before implantation or
are miscarried. Of known pregnancies (in
which a woman misses a period or has a
positive pregnancy test), about 10% to 20%
end in miscarriage.

3. Risk factors for miscarriage include the following:
• Older maternal age
• Cigarette Smoking (>10 cigarettes/day)
• Moderate to high alcohol consumption
• Trauma to the uterus
• Radiation exposure
• Previous miscarriage
• Maternal weight extremes (BMI either below 18.5 or above
25 kg/m2)
• Anatomical abnormalities of the uterus
• Illicit drug use
• Use of non-steroidal anti-inflammatory drugs (NSAIDs)
around the time of conception may increase the risk of
miscarriage

4. What are the types of miscarriage?
Threatened abortion: a woman may experience vaginal bleeding or
others signs of miscarriage, but miscarriage has not occurred
Incomplete abortion: some of the products of conception (fetal and
placental tissues) have been expelled from the uterus, but some
remain within the uterus
Complete abortion: all of the tissue from the pregnancy has been
expelled
Missed abortion: the fetus has not developed, so there is no viable
pregnancy, but there is placental tissue contained within the
uterus
Septic abortion: a miscarriage in which there is infection in the
fetal and pregnancy material before or after a miscarriage
Inevitable or Imminent
Recurrent/ Habitual

5. What are signs and symptoms of a miscarriage?
Vaginal bleeding .All vaginal bleeding during
pregnancy should be investigated, although not all
instances of bleeding result from a miscarriage.
Bleeding in the first trimester of pregnancy is very
common and does not typically signify a
miscarriage.
The pain tends to be dull and cramping, and it
may come and go or be present constantly
pelvic pain are the hallmark symptoms of
miscarriage.

6. Precipitating Factor
-8 weeks AOG (occurs
during first trimester of
pregnancy)
No Precipitating Factor
-Age common among women over 35
years old
-Rare no significant racial differences
During egg implantation egg
slightly separates
Blood collects between the
chrorionic membrane ( a
membrane that develops
around a fertilized egg) and
the wall of the uterus
Blood leaks in the cervix
Minimal vaginal
spotting/bleeding
Risk for miscarriage and still
birth (threatened Abortion)

7. What happens after a miscarriage?
There are no specific treatments that can stop a
miscarriage, although women who are at risk and have
not yet miscarried may be advised to rest in bed, abstain
from sexual activity, and restrict all activity until any
warning signs are no longer present. Once a miscarriage
occurs, there is no treatment available. In many cases,
the miscarriage will take its course, and unless there is
severe pain and cramping or severe blood loss, no
treatment is required. If a miscarriage does not
completely clear the pregnancy tissue from the uterus, a
procedure known as a dilation and curettage (D&C) can
be performed to remove the remaining pregnancy
material.

8. Is treatment is used in the case of a missed abortion, for
example, when the pregnancy material is not expelled from
the uterus.
As mentioned above, women who are Rh-negative will
receive a dose of rho-D immune globulin to prevent
complications in future pregnancies.
If a miscarriage is due to infection, antibiotic treatment
will be given.
Miscarriage is such a common occurrence that typically,
unless known risk factors are present, no special testing is
performed. For couples who have experienced more than two
miscarriages, diagnostic studies to detect genetic, hormonal,
or anatomical problems may be recommended. Some doctors
recommend evaluation of the couple after the second
miscarriage, particularly if the woman is over 35 years of
age.

9. Can miscarriage be prevented?
There is no evidence that bed rest can help prevent
miscarriage, but women who have vaginal bleeding
during pregnancy are often advised to rest and limit
sexual activity until there are no more potential signs of
miscarriage. It is possible that some risk factors for
miscarriage can be minimized by maintaining a healthy
weight and avoiding the use of alcohol, illicit drugs, or
tobacco. Screening for and treatment of any sexually
transmitted disease (STDs) can also reduce the risk of a
miscarriage. Avoidance of sports such as horseback
riding or skiing can reduce your risk of trauma to the
uterus. In most instances, however, the cause of a
miscarriage is outside of the woman's control.

10. What Is Ectopic Pregnancy?
Ectopic pregnancies occur when a fertilized egg
fails to attach to the uterus. In most ectopic
pregnancies, the egg will attach to the fallopian
tubes. Less common, it may also attach to the
abdominal cavity or cervix. Ectopic pregnancies
occur in one out of every 50 pregnancies.
Outside the uterus, a fertilized egg has virtually
no chance of survival. This condition may cause
serious health complications if not treated. As such,
immediate treatment is highly recommended. Early
treatment may prevent fertility problems as well as
future health complications.

13. What Causes Ectopic Pregnancy?
• The cause of an ectopic pregnancy is not clear in all
cases. In some cases, the following conditions have
been linked with the abnormal pregnancy:
• inflammation and scarring of the fallopian tubes
from a previous medical condition or surgery
• hormonal factors
• medical conditions that affect the shape and
condition of the fallopian tubes and reproductive
organs

14. Who Is at Risk for Ectopic Pregnancy?
• advanced maternal age of 35 years or older
• history of pelvic surgery, abdominal surgery, or
multiple abortions
• history of endometriosis
• conception occurred despite tubal ligation or IUD
• conception aided by fertility drugs or procedures
• smoking
• previous ectopic pregnancies
• Hormonal imbalance

15. What Are the Symptoms of Ectopic Pregnancy?
• Nausea and sore breasts, which are also common
in a normal pregnancy, are common in ectopic
pregnancies. Other symptoms more clearly point
to an abnormal pregnancy. The following
symptoms should be discussed with your doctor:
• sharp waves of pain in the abdomen, pelvis,
shoulder, or neck
• light to heavy vaginal spotting or bleeding
• dizziness or fainting
• rectal pressure

16. Diagnosing Ectopic Pregnancy
If you suspect an ectopic pregnancy, see your healthcare
provider as soon as possible. Ectopic pregnancies cannot be
diagnosed from the outside. Your doctor may perform a physical
exam to rule out other factors.
If an ectopic pregnancy is suspected, a blood test can assess
hCG and progesterone levels. If hormone levels are not typical,
additional tests will be required.
If blood tests point to a problem, your doctor will perform a
transvaginal ultrasound. This will locate the fertilized egg and
confirm an ectopic pregnancy diagnosis.
In extreme cases, the fallopian tube may rupture and bleed. A
surgeon may then perform an emergency laparotomy by making
an incision in the abdomen. This procedure is used not only to
diagnose an ectopic pregnancy, but to provide immediate
treatment.

17. Treating Ectopic Pregnancy
• Medications
If your physician concludes that immediate
complications are unlikely, he or she may inject a
drug called methotrexate. Methotrexate stops the
growth of rapidly dividing cells, such as the cells of
the embryo. Regular blood tests will ensure that the
drug is effective. Methotrexate does not carry the
same risks of fallopian tube damage that come with
surgery.

18. • Surgeries
Many surgeons choose laparoscopic surgery to remove
the embryo and repair any internal damage. Under
anesthesia, a small camera is inserted through an incision in
the abdomen. Additional incisions may be made that allow
other tools to remove the embryo and repair damage to the
fallopian tube. If the surgery is unsuccessful, a laparotomy
will be performed through a larger incision.
• If the fallopian tube has ruptured or is severely damaged, it
may need to be removed during surgery.
• Home Care
Patients will be advised to rest. Follow-up appointments
can confirm that the embryo has been completely removed or
reabsorbed.

20. Hydatidiform Mole
A hydatidiform mole is a growing mass of tissue
inside your womb (uterus) that will not develop into
a baby. It is the result of abnormal conception. It
may cause bleeding in early pregnancy and is
usually suspected on an early pregnancy ultrasound
scan. It needs to be removed and most women can
expect a full recovery. However, close follow-up is
needed after a hydatidiform mole because there is a
small chance of developing a type of cancer. If a
cancer does develop, effective treatment is available
and most women can be cured.

21. • patho

22. What are the symptoms of a hydatidiform mole?
Women with a hydatidiform mole usually have
higher-than-average levels of the pregnancy
hormone human chorionic gonadotrophin (hCG)
compared with women with a normal pregnancy.
This hormone is produced by the trophoblastic
tissue. It is the hormone that is detected in a
standard pregnancy test. The high levels of hCG
occur because there is an excessive amount of
trophoblastic tissue with a hydatidiform mole. The
high hCG levels are responsible for some of the
symptoms.

23. What is the treatment for a hydatidiform mole?
If you have a hydatidiform mole, you will
need to have it removed. This means having a
small operation. This is done in hospital by a
doctor who is a gynaecology specialist. You
will be given an anaesthetic. In most cases, a
small tube is passed into your womb (uterus)
through the opening of your uterus (your
cervix) and the abnormal tissue is removed by
suction. The tissue is then sent off to the
laboratory for examination under the
microscope.

24. Placental Abruption
After a woman gives birth and the umbilical
cord has been cut, her body sends a signal to her
uterus that the placenta is no longer needed. The
placenta then begins to peel away from the uterine
wall so that it can leave the body following the path
the baby just took. Sometimes, the placenta begins to
peel away from the uterus too soon, while the baby
still needs the placenta to supply oxygen and
nutrients. This is called placental abruption or just
abruption.

25. Doctors aren't sure exactly how placental
abruption occurs. Many believe, however,
that tiny blood vessels on the surface of the
placenta begin to leak and form a bruise or
blood blister, which then spreads between the
placenta and the uterine wall. The blood
loosens the connection between the uterine
wall and the placenta, allowing it to separate.

26. Non Modifiable
-Traumatic Injury
-Inc. Maternal Age
30 years and above
-Hx of abruptio
placenta
Socio economic
Modiafiable
-Smoking
-Use of cocaine
-Multiple Gestation
-Malnutrition
Decrease resiliency of blood vessels
at placental bed
Torn of ruptured vessels
Partial
Separation
Total
Separation
Peripheral portion
is detached mild
to moderate
vaginal bleeding
Central portion is
detached mild to
moderate concealed
bleeding
Blood is trapped to
intact peripheral
Massive
vaginal or
Conceived
hemorrhage
Fetal Death

27. When a woman has placental abruption, the most common
signs are:
• vaginal bleeding;
• abdominal tenderness or back pain;
• contractions; and
• abnormalities in the baby's heartbeat.
Factors that increase a woman's risk for abruption include:
• high blood pressure
• past pregnancies
• past placental abruptions
• smoking
• street drugs,
• preterm premature rupture of membranes

28. How Common is Placental Abruption?
Abruption is a common complication of
pregnancy. About one in 20 women probably
have small abruptions, but these are small
enough they do not affect the mother or her
baby. In fact, doctors rarely know that these
abruptions exist. About one in 120 women
who deliver has a larger abruption, and about
one in 830 has an abruption so severe that the
baby cannot survive.

29. The main risks associated with placental
abruption include:
• heavy bleeding -the amount of bleeding depends on
how much of the placenta has separated from the
uterine wall. The more separation that occurs, the
greater the amount of bleeding; and
• disruption in the blood's ability to clot (disseminated
intravascular coagulation, or DIC)-DIC occurs as a
complication of serious illness or heavy blood loss.
DIC is a serious condition because once the clotting
mechanisms of the blood have been disrupted, it is
difficult to get them working again. This results in
additional blood loss.

30. What Is Placenta Previa?
• Placenta previa is a condition in which the
placenta attaches to the wall of the lower
portion of the uterus and covers all or part of
the cervix. Doctors classify placenta previa
according to the placenta's location on the
uterine wall and how completely the placenta
covers a woman's cervix:

31. • complete -the placenta covers the entire
opening of the cervix. If the placenta is
centered exactly over the cervical opening, it
may be called a central previa;
• partial -the placenta covers a significant part
of the cervix, but not the entire area; and
• marginal -the placenta reaches the edge of
the cervical opening, but doesn't actually
cover any part of it.

33. Predisposing
Factor
-Age
-Gender
-Genetic
Precipitating Factors
-Hx of Placenta Previa
-Multi Para
-Smoking
Progesterone and
Estrogen level
Pre embryonic stage
Production of fertile ovum
Implantation in the ovum
Embryonic stage
Placenta arise from the
thropoblast tissue
Insufficient blood
Placenta migrates to where
there is sufficient blood
supply

34. Placenta resides in the lower
Total placenta Previa
The placenta
completely covers the
top of the cervix
Partial Placenta
The placenta partially
covers the top of the
cervix
Marginal Placenta
Touches but does not
cover the top of the
cervix
Low lying pla
The Placenta
encroaches th
lower segment
of the uterus
but does not
infringe on
the cervical os
Profuse bright red
bleeding Painless vaginal
bleeding
If treated and managed
-Avoidance several intercourse and
vaginal examinations
-frequent check ups
Good prognosis
If not treated and
managed
Profuse bleeding
Hypotension
Poor prognosis
Hypovolemic
Shock
Coma
Death of Mother
and Fetus

35. How Common Is Placenta Previa?
About 30% of pregnant women have placenta
previa early in their pregnancies; however, most of
the time this spontaneously resolves as the
pregnancy progresses. By the time a woman is
within a couple of weeks of her due date, the chance
of placenta previa drops to less than 1%. The reason
placenta previa is less common in late pregnancy
has to do with the way the uterus stretches over the
nine months. The top half of the uterus tends to
stretch more easily than the bottom half so that, as
the baby grows, the uterus pulls the placenta up and
away from the cervix. This is called placental
migration.

36. What Causes Placenta Previa?
Although the exact cause of placenta
previa is unknown, the following risk factors
suggest that some cases may be caused by
previous scarring of the wall of the uterus:
• history of cesarean section;
• previous pregnancy;
• previous dilation and curettage (scraping) for
miscarriage or abortion; and
• maternal age 35 or older.

37. What Are the Signs of Placenta Previa?
Placenta previa is usually characterized by
vaginal bleeding in the late second or third
trimester. However, placenta previa often
causes no symptoms throughout the
pregnancy and is often diagnosed only during
a routine ultrasound. When an abdominal
ultrasound does not allow the doctor to see
the relationship between the placenta and the
cervix, ultrasound may be conducted
carefully through the vagina.

38. Potential Complications from Placenta Previa
For the baby, preterm delivery (and the
complications resulting from it) is the most
common potential complication of placenta
previa. Preterm delivery occurs in nearly two-
thirds of placenta previa cases. Babies are
usually delivered early because of dangerous
amounts of bleeding. Complications stemming
from the position of the baby during delivery
occur in up to 30% of cases. Placental
separation and bleeding due to placenta
previa may cause anemia in the newborn

39. For the mother, bleeding and complications during
cesarean delivery are the most common potential
complications of placenta previa. Blood transfusions are
necessary in one-third to one-half of the cases. In addition,
9 to 10% of placenta previa cases are associated
with placenta accreta, an abnormally firm attachment of
the placenta to the wall of the uterus. Placenta accreta
prevents the placenta from separating from the uterine
wall at the time of delivery. This can cause severe bleeding,
often necessitating hysterectomy. Placenta accreta is
particularly common in women who have placenta previa
and a history of one or more previous cesarean sections.
More than 50% of patients with placenta accreta require
blood transfusions