Discrepancy in Uterine Size
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Important points when addressing a pregnancy which doesn't correspond to the expected gestational size
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Abnormal labor or dystocia can be caused by problems with uterine contractions (uterine dysfunction), issues with the baby's size or position (fetopelvic disproportion), or a narrow pelvis (contracted pelvis). Common types include protracted or arrested dilation, shoulder dystocia, and breech presentation. Obstructed labor occurs when progress stalls despite adequate contractions, typically due to a mechanical obstruction, and can lead to serious maternal complications if not addressed. Management may involve resuscitation, expedited delivery depending on fetal/maternal status, and transfer to a higher level facility for those in advanced labor.
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Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It accounts for 1-2% of pregnancies and risk factors include previous pelvic inflammatory disease, IUD use, infertility, and smoking. Clinical features range from asymptomatic to acute abdominal pain and vaginal bleeding. Transvaginal ultrasound and quantitative beta-hCG levels are used to confirm the diagnosis. Treatment options include surgical removal by laparoscopy or laparotomy, or medical management with methotrexate depending on the stability of the patient. Expectant management may be considered for some stable cases. Ruptured ectopic pregnancies require emergency surgery and blood transfusions to stabilize the patient.
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1. Ulipristal acetate is a selective progesterone receptor modulator approved for treatment of uterine fibroids. It binds to progesterone receptors and blocks their action, reducing fibroid size and symptoms without affecting estrogen levels.
2. Studies showed ulipristal acetate effectively controlled bleeding and reduced fibroid volumes more rapidly than leuprolide acetate. It maintained fertility without significant safety issues.
3. Long term treatment with ulipristal acetate provided sustained control of bleeding and pain, with shrinkage of fibroid volumes maintained during off treatment periods. Quality of life was improved.
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Systematic pelvic devascularisation is an effective and uterus conserving surgical method to control PPH.
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Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It accounts for 1-2% of pregnancies and risk factors include previous pelvic inflammatory disease, IUD use, infertility, and smoking. Clinical features range from asymptomatic to acute abdominal pain and vaginal bleeding. Transvaginal ultrasound and quantitative beta-hCG levels are used to confirm the diagnosis. Treatment options include surgical removal by laparoscopy or laparotomy, or medical management with methotrexate depending on the stability of the patient. Expectant management may be considered for some stable cases. Ruptured ectopic pregnancies require emergency surgery and blood transfusions to stabilize the patient.
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This document discusses post-term pregnancy, which is defined as a pregnancy extending beyond 42 weeks of gestation. Risks of post-term pregnancy include fetal complications like meconium aspiration and fetal distress as well as maternal risks such as increased need for instrumental or cesarean delivery. Diagnosis involves assessing factors like menstrual history, fundal height, and ultrasound evaluations. Management may involve expectant monitoring for low-risk cases or induction of labor for cases with complications or signs of fetal distress.
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Delivery of twins
This document provides guidelines for the delivery of twins, including:
- Spontaneous twins occur in 1 in 90 pregnancies and reproductive technology has increased twin rates.
- Vaginal delivery is recommended when possible, with an obstetrician in attendance and extra staff on hand. Delivery in the hospital is advised.
- Different guidelines are provided for vertex-vertex, vertex-breech, breech-breech, and other twin positions. C-section may be recommended depending on positions and other risk factors.
- Close monitoring of both fetal heart rates is important during labor and delivery to ensure fetal well-being.
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Uterine rupture is a life-threatening condition where the wall of the uterus tears, potentially exposing the fetus and placenta to the mother's abdominal cavity. It most commonly occurs in women with a previous cesarean section scar. Signs include acute abdominal pain, fetal distress, and hemorrhage. Diagnosis is often made using ultrasound or MRI to detect tears in the uterine wall. Immediate exploratory laparotomy and cesarean delivery is usually required for treatment. Conservative uterine repair may be attempted for some cases but hysterectomy is often necessary due to severe hemorrhage. Prevention focuses on careful management of trial of labor for women with previous scars.
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Post-term pregnancy is defined as exceeding 40 weeks of gestation. It occurs in 5-10% of pregnancies, often due to inaccurate gestational age calculation. Both mother and baby are at increased risk of complications like dystocia, meconium aspiration, stillbirth. Management includes assessing gestational age accurately, monitoring the fetus, and inducing labor between 41-42 weeks to prevent risks of post-term pregnancy. Intrauterine fetal death is the death of a fetus before delivery. It can result from maternal, fetal or obstetric complications. Evaluation includes detailed history, examinations, and tests to determine the cause to help counsel patients and prevent future recurrence.
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The document describes the Manchester Repair procedure, which is designed to correct uterine prolapse while preserving the uterus. The key steps are: 1) preliminary dilation and curettage of the uterus, 2) amputation of the cervix, 3) plication of the Mackenrodt's ligaments in front of the cervix, 4) anterior colporrhaphy, and 5) colpoperineorrhaphy. Additional details provided include techniques for covering the amputated cervix with vaginal flaps and suturing the Mackenrodt's ligaments to the cervix to elevate it. Potential complications of the surgery are also outlined.
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2) Malaria in pregnancy can cause maternal complications like anemia, hypoglycemia, acute pulmonary edema, and immunosuppression as well as fetal complications like low birth weight, intrauterine growth retardation, and congenital malaria.
3) Proper diagnosis and treatment are needed to prevent adverse outcomes for both mother and baby.
Diabetes Mellitus in Pregnancy
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy. Risk factors include obesity, family history of diabetes, and ethnicity. During pregnancy, hormones cause insulin resistance and the pancreas must produce more insulin to maintain blood glucose levels. Untreated GDM can lead to complications for both mother and baby like preeclampsia, macrosomia, and neonatal hypoglycemia. Screening and tight glucose control are important. Pre-gestational diabetes also requires careful management to reduce risks of birth defects, complications, and future diabetes in the child.
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This document discusses premature rupture of membranes (PROM), which is the spontaneous rupture of membranes before the onset of labor. It defines term and preterm PROM and discusses the diagnosis, causes, complications, and management of PROM. The key points are:
- PROM is diagnosed based on a history of leakage and physical exam findings like pooling of fluid. Tests like nitrazine and fern tests can also help diagnose.
- Causes of PROM can include infections, smoking, collagen deficiencies, mechanical stress from twins or polyhydramnios.
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- Management depends on gestational age,
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Discrepancy in uterine size
This document discusses discrepancies in uterine size where the size does not correspond to the expected gestation. It may indicate an underlying problem related to the mother, fetus, or placenta. It is important to first confirm the pregnancy dates are correct and consider implications such as whether the fetus is at risk. Key points to consider include investigating potential causes of the discrepancy and determining appropriate management and delivery timing based on the underlying issue.
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This document discusses abnormal labor and provides definitions and classifications of abnormal labor. It covers the four major etiologic categories that can cause abnormal labor: the passage (pelvis), the passenger (fetus), the powers (uterine action and cervical resistance), and the patient/provider. For each category it provides examples of specific conditions that can cause dystocia or difficult labor. It also discusses the importance of communication between providers and patients to prevent trauma and post-traumatic stress disorder from difficult labor experiences.
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MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANI
This document discusses the management of vault prolapse, which is the descent of the vaginal cuff after a hysterectomy. It defines vault prolapse and lists risk factors. Conservative management includes pessaries but surgery is often needed. Surgical options include vaginal approaches like sacrospinous ligament fixation or abdominal approaches like sacral colpopexy. The document compares techniques and factors to consider in surgical planning like prolapse severity and patient factors. Prevention techniques like culdoplasty at time of hysterectomy are also discussed.
Ecv- External Cephalic Version- Define, Risk, procedure, step, benefits PPT
External cephalic version (ECV) is a procedure used to manually turn a fetus from a breech position to a head-down position in utero. ECV is generally performed after 36 weeks of gestation with tocolysis to reduce risks. It can successfully turn 44-57% of breech fetuses, reducing the need for cesarean section. Risks of ECV include brief fetal bradycardia in 8% of cases and 5% risk of fetomaternal hemorrhage. However, meta-analyses show ECV significantly reduces breech birth, cesarean rates, and risks to the fetus and mother when compared to breech vaginal delivery or planned cesarean. ECV
Pprom & prom
PPROM refers to rupture of membranes before 37 weeks of pregnancy, while PROM occurs at or after 37 weeks but before the onset of labor. PPROM and PROM are associated with risks like cord prolapse, maternal and neonatal infection, and 40% of preterm deliveries. Diagnosis involves history of fluid leakage and examination finding a smaller uterus and pooling of fluid in the vagina. Management of PPROM includes antibiotics and steroids to reduce infection rates while PROM may allow labor or require induction depending on presence of meconium. Chorioamnionitis is a maternal infection following rupture that requires delivery and IV antibiotics.
Hypertension in pregnancy
Hypertension is a common complication of pregnancy that can lead to increased maternal and neonatal morbidity and mortality if not properly managed. It includes conditions like chronic hypertension, pre-eclampsia, and gestational hypertension. Pre-eclampsia affects 5-15% of pregnancies and is characterized by new onset hypertension and proteinuria developing after 20 weeks of gestation. Risk factors include primigravidas, family history, chronic hypertension, and obesity. Treatment involves monitoring, medication to control blood pressure, delivery after 36 weeks gestation, and magnesium sulfate in severe pre-eclampsia to prevent eclampsia. Close antenatal surveillance and multidisciplinary care are important to optimize outcomes.
Delivery of twins
This document provides guidelines for the delivery of twins, including:
- Spontaneous twins occur in 1 in 90 pregnancies and reproductive technology has increased twin rates.
- Vaginal delivery is recommended when possible, with an obstetrician in attendance and extra staff on hand. Delivery in the hospital is advised.
- Different guidelines are provided for vertex-vertex, vertex-breech, breech-breech, and other twin positions. C-section may be recommended depending on positions and other risk factors.
- Close monitoring of both fetal heart rates is important during labor and delivery to ensure fetal well-being.
Rupture uterus
Uterine rupture is a life-threatening condition where the wall of the uterus tears, potentially exposing the fetus and placenta to the mother's abdominal cavity. It most commonly occurs in women with a previous cesarean section scar. Signs include acute abdominal pain, fetal distress, and hemorrhage. Diagnosis is often made using ultrasound or MRI to detect tears in the uterine wall. Immediate exploratory laparotomy and cesarean delivery is usually required for treatment. Conservative uterine repair may be attempted for some cases but hysterectomy is often necessary due to severe hemorrhage. Prevention focuses on careful management of trial of labor for women with previous scars.
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Post-term pregnancy is defined as exceeding 40 weeks of gestation. It occurs in 5-10% of pregnancies, often due to inaccurate gestational age calculation. Both mother and baby are at increased risk of complications like dystocia, meconium aspiration, stillbirth. Management includes assessing gestational age accurately, monitoring the fetus, and inducing labor between 41-42 weeks to prevent risks of post-term pregnancy. Intrauterine fetal death is the death of a fetus before delivery. It can result from maternal, fetal or obstetric complications. Evaluation includes detailed history, examinations, and tests to determine the cause to help counsel patients and prevent future recurrence.
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Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
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This document discusses various methods of antenatal fetal surveillance to monitor fetal well-being and detect any issues. It describes clinical tests like fundal height measurements, biochemical tests like estriol levels, and biophysical tests like fetal movement counts and non-stress tests. The aim is to determine gestational age, check for fetal anomalies, detect growth abnormalities, and identify acute or chronic fetal hypoxia through regular surveillance. This monitoring is especially important for high-risk pregnancies.
Eclampsia
The document discusses hypertensive disorders in pregnancy, specifically pre-eclampsia and eclampsia. It notes that pre-eclampsia is characterized by new hypertension and proteinuria after 20 weeks of gestation, and can progress to eclampsia involving seizures. Risk factors include primigravidas, family history, and obesity. Magnesium sulfate is the primary treatment for preventing seizures, while antihypertensives are used if blood pressure remains high. Timely treatment is important but outcomes depend on severity of symptoms and can include maternal and fetal complications like premature birth.
Manchester repair (Fothergill’s Operation)
The document describes the Manchester Repair procedure, which is designed to correct uterine prolapse while preserving the uterus. The key steps are: 1) preliminary dilation and curettage of the uterus, 2) amputation of the cervix, 3) plication of the Mackenrodt's ligaments in front of the cervix, 4) anterior colporrhaphy, and 5) colpoperineorrhaphy. Additional details provided include techniques for covering the amputated cervix with vaginal flaps and suturing the Mackenrodt's ligaments to the cervix to elevate it. Potential complications of the surgery are also outlined.
Malaria in pregnancy
1) Malaria is a major health problem in many parts of the world, infecting over 3 billion people. It poses significant risks during pregnancy, especially for primigravida women.
2) Malaria in pregnancy can cause maternal complications like anemia, hypoglycemia, acute pulmonary edema, and immunosuppression as well as fetal complications like low birth weight, intrauterine growth retardation, and congenital malaria.
3) Proper diagnosis and treatment are needed to prevent adverse outcomes for both mother and baby.
Diabetes Mellitus in Pregnancy
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy. Risk factors include obesity, family history of diabetes, and ethnicity. During pregnancy, hormones cause insulin resistance and the pancreas must produce more insulin to maintain blood glucose levels. Untreated GDM can lead to complications for both mother and baby like preeclampsia, macrosomia, and neonatal hypoglycemia. Screening and tight glucose control are important. Pre-gestational diabetes also requires careful management to reduce risks of birth defects, complications, and future diabetes in the child.
Recurrent pregnancy loss Presentation by Dr.Laxmi Shrikhande
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
PROM
This document discusses premature rupture of membranes (PROM), which is the spontaneous rupture of membranes before the onset of labor. It defines term and preterm PROM and discusses the diagnosis, causes, complications, and management of PROM. The key points are:
- PROM is diagnosed based on a history of leakage and physical exam findings like pooling of fluid. Tests like nitrazine and fern tests can also help diagnose.
- Causes of PROM can include infections, smoking, collagen deficiencies, mechanical stress from twins or polyhydramnios.
- Complications include infections, preterm labor and delivery, and respiratory distress in preterm infants.
- Management depends on gestational age,
Prolonged pregnancy
This document discusses prolonged pregnancy, defined as continuing past 42 weeks of gestation. Risks to the fetus include stillbirth, distress, injuries from large size, and meconium-related issues. Maternal risks include anxiety, operative delivery, and infection. Management involves expectant monitoring with tests like CTG and ultrasound or inducing labor. Induction methods include membrane sweeping, amniotomy, prostaglandins like misoprostol, and oxytocin. Caesarean section is indicated if monitoring finds issues or induction fails. Guidelines recommend offering induction from 41 weeks onward.
Preterm Labor 2021 Update
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
Cervical stitches
Cervical insufficiency, also known as cervical incompetence, is a condition where the cervix is unable to retain a pregnancy at term due to a functional or structural defect. It is characterized by painless dilatation of the cervix resulting in premature rupture of membranes and delivery, usually occurring in the second or third trimester. Cervical cerclage procedures aim to surgically suture the cervix closed to prevent premature opening. There are several techniques for cervical cerclage placement depending on the location and indication, including McDonald, Shirodkar, emergency/rescue cerclages, and pessary or balloon alternatives. Cerclage procedures can be done through the vagina or abdomen depending
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Discrepancy in Uterine Size
- 1. DISCREPANCY IN UTERINE SIZE An understanding of the issues involved when a uterus doesn’t correspond to its gestational age
- 2. By Associate Professor Dr Hanifullah Khan
- 3. Objectives To understand the To understand the The important points to definitions involved implications of this situation consider
- 4. Discrepancy – what is it? When the uterine size does not correspond to the expected gestation May be larger or smaller Objective measurement - > 2 cm variation with symphysiofundal height (SFH)
- 5. Is there an Is there a underlying problem with problem causing the mother? this discrepancy? Is the fetus at Has there been a risk? mistake in calculating • If so, when do we deliver it? gestation? Implications of this situation
- 6. Points to consider The patient has been found to have a gestation which does not correspond to calculations. This may be a feature of an underlying problem The problem may be related to the mother, fetus or placenta It is our job to determine the underlying cause of this problem
- 7. In all cases, always begin by Dates confirming the dates Be absolutely positive The mother remembers the exact LMP (1st day) The periods have been regular The onset of pregnancy symptoms & quickening correspond to the dates That an early pregnancy ultrasound (if done), confirmed the dates Subsequent antenatal check ups have noted previous corresponding growth of
- 8. Remember, an early pregnancy ultrasound scan is the definitive decider of dates
- 9. IUGR Intrauterine growth restriction or Fetal growth restriction Leads to uterus < dates A manifestation of underlying problem Maternal, fetal or placental Most commonly caused by placental insufficiency (unknown cause), hypertensive disease, maternal disease, fetal anomaly Most non-fetal causes lead to asymmetrical FGR (the so- called head-sparing effect)
- 10. Fetal Growth Restriction Leads to long term problems
- 11. The left ear
- 12. Big baby • If fetal macrosomia is the cause in an uterus > dates, it is most often a consequence of gestational diabetes • GDM can also lead to polyhydramnios on its own • It is mandatory to look hard for GDM in such cases
- 13. Macrosomia
- 14. Fetal anomalies Any discrepancy in uterine size must lead to an extensive search for fetal anomalies
- 15. Multiples Any large uterus may be caused by more than one passenger in it See for yourself
- 16. The diagnosis of SGA A constitutionally small fetus is a diagnosis of exclusion This is the last diagnosis in your list of differentials Always rule out disease before you can say its normal These fetuses display linear growth despite being small Usually, the mother is also small (this is logical)
- 17. Summary
- 18. Discrepancy in uterine size This denotes a uterine size not corresponding to gestational age It may be a sign of an underlying problem This problem could be of maternal, fetal or placental origin One common cause is wrong dates Rule out disease before diagnosing a constitutionally small fetus
- 19. THE END Thank You Very Much