This document discusses hemorrhage in early pregnancy, miscarriage, ectopic pregnancy, and hydatidiform mole. It provides definitions, risk factors, clinical features, management, and pathogenesis for each condition. Key points include:
- Miscarriage (spontaneous abortion) occurs in 10-20% of pregnancies and is often due to fetal chromosomal abnormalities or maternal factors like age. Management depends on severity from expectant to surgical evacuation.
- Recurrent miscarriage is defined as 2 or more losses and can be caused by genetic, endocrine, immune, or inherited factors.
- Ectopic pregnancies implant outside the uterus, most commonly in the fallopian tubes. Risk factors
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
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
Definitions
Stages and Phases of Normal Labour
Abnormal Patterns of Labour
Classification of Abnormal Labour/Dystocia
Diagnosis and Management of Abnormal Labour
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
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
Definitions
Stages and Phases of Normal Labour
Abnormal Patterns of Labour
Classification of Abnormal Labour/Dystocia
Diagnosis and Management of Abnormal Labour
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
this slide helps a physician in understanding the basics of miscarriages(definition, types/classification, causes, clinical presentation, investigations and complications. In understanding the basics, this helps a physician to able to treat or manage abortions.
A miscarriage, or spontaneous abortion, is an event that results in the loss of a fetus before 20 weeks of pregnancy. It typically happens during the first trimester, or first three months, of the pregnancy. Miscarriages can happen for a variety of medical reasons, many of which aren't within a person's control.
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
this slide helps a physician in understanding the basics of miscarriages(definition, types/classification, causes, clinical presentation, investigations and complications. In understanding the basics, this helps a physician to able to treat or manage abortions.
A miscarriage, or spontaneous abortion, is an event that results in the loss of a fetus before 20 weeks of pregnancy. It typically happens during the first trimester, or first three months, of the pregnancy. Miscarriages can happen for a variety of medical reasons, many of which aren't within a person's control.
Causes and management of first and second trimester abortions
anatomical, chromosomal, immunological, hormonal causes and infections. Investigation for detection of cause and possible treatment. Surgical correction of cervical incompetence and medical treatment, progestational drugs
PELVIC ORGAN PROLAPSE, uterine prolapse , cystocele, rectocele, urethrocele, supports of uterus, sling surgeries, pessaries, grades of prolapse, uterine preserving surgery for pop, pelvic floor repair, vaginal hysterectomy, ward mayos surgery, pop q grading, grading of prolapse, laproscopic surgeries for prolapse, peregee, apogee , mesh repair, tot, tvt, colpo suspension, colpoclysis, SUI management, epidemiology of prolapse, decubitus ulcer, best ppt for pelvic organ prolapse, better understanding of pelvic organ prolapse and pelvic floor. dr . m. gokul reshmi, dr. gokulreshmi m
PELVIC ORGAN PROLAPSE, uterine prolapse , cystocele, rectocele, urethrocele, supports of uterus, sling surgeries, pessaries, grades of prolapse, uterine preserving surgery for pop, pelvic floor repair, vaginal hysterectomy, ward mayos surgery, pop q grading, grading of prolapse, laproscopic surgeries for prolapse, peregee, apogee , mesh repair, tot, tvt, colpo suspension, colpoclysis, SUI management, epidemiology of prolapse, decubitus ulcer, best ppt for pelvic organ prolapse, better understanding of pelvic organ prolapse and pelvic floor.
dysmenorrhea ,dysmenorrhea definition, types of dysmenorrhea, menstrual pain , pathophysiology of dysmenorrhea, management of primary dysmenorrhea, management of secondary dysmenorrhea, treatment of dysmenorrhea.
Contracted pelvis, CEPHALOPELVIC DISPROPORTION, PELVIC ABNORMALITY, CPD, TYPES OF PELVIS , TYPES OF PELVIS AND ITS OUT COME, MECHANISM OF LABOUR IN CONTRACTED PELVIS, DIAGNOSIS OF CPD, DIAGNOSIS and MANAGEMENT OF CONTRACTED PELVIS, PELVIMETRY, PELVIC ASSESSMENT, TRIAL OF LABOUR
fibroid, endometriosis, medical management of fibroid, medical management of endometriosis, drug theraphy, hormonal, non hormonal. gnrh. aromatase inhibitor,COC, PAIN FULL MENSES,
REPRODUCTIVE AND CHILD HEALTH, national scheme, RCH, Maternal health, neonate, maternal and child health, Family planning program, Child survival & safe motherhood program, Components of RCH , Adolescent health care and family life education,
post term pregnancy, post dated pregnancy, prolonged pregnancy,
m.g. reshmi, management of post dated pregnancy,management of post term pregnancy, fetal maturity assesment, post maturity syndrome, mortality and morbidity ,placental dysfunction, aminotic fluid volume in prolonged pregnancy.
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. Etiology…
• Those related to the pregnant state:
• Abortion (95%),
• Ectopic pregnancy,
• Hydatidiform mole
• Implantation bleeding.
3. Etiology…
• Those associated with the pregnant state:
• The lesions are unrelated to pregnancy—either pre-existing or
aggravated during pregnancy.
• Cervical lesions such as vascular erosion, polyp, ruptured varicose
veins and malignancy are important causes.
5. SPONTANEOUS ABORTION (MISCARRIAGE)
• DEFINITION:
Abortion is the expulsion or extraction from its mother, of an
embryo or fetus weighing 500 g or less when it is not capable of
independent survival, ie., approximately at 22 weeks (154 days) of
gestation.
• INCIDENCE:
10–20% of all clinical pregnancies end in miscarriage,
10% are induced illegally.
75% abortions occur before the 16th week and of these, about
75% occur before the 8th week of pregnancy.
8. MISCARRIAGE - Etiology…
• Fetal factor :
• Trisomy 50 to 60 percent;
• Trisomy's of chromosomes 13, 16, 18, 21, and 22 are most common.
• Monosomy X 09 to 13 percent;
• Monosomy X (45,X) is the single most frequent specific chromosomal abnormality.
Autosomal monosomy is rare and incompatible with life.
• Triploidy 11 to 12 percent .
• Triploidy is often associated with hydropic or molar placental degeneration.
• Tetraploid fetuses most often abort early in gestation, and rarely liveborn.
9. SPONTANEOUS ABORTION (MISCARRIAGE)
Etiology…
• Fetal factor :
• Trisomies typically result from isolated nondisjunction, rates of
which rise with maternal age.
• Balanced structural chromosomal rearrangements may originate
from either parent and are found in 2 to 4 percent of couples with
recurrent pregnancy loss.
10. SPONTANEOUS ABORTION (MISCARRIAGE)
Etiology…
• Fetal factor :
• The fetus within a partial hydatidiform mole frequently aborts
early, and the few carried longer are all grossly deformed.
• Advanced maternal and paternal ages do not increase the
incidence of triploidy.
11. SPONTANEOUS ABORTION (MISCARRIAGE)
Etiology…
• Maternal Factors:
• In chromosomally normal pregnancy losses, maternal influences
play a role.
• The rate of euploid abortion peaks at approximately 13 weeks .
• In addition, the incidence of euploid abortion rises after maternal
age exceeds 35 years.
15. SPONTANEOUS ABORTION (MISCARRIAGE)
• Paternal Factors:
• Increasing paternal age is significantly associated with an greater
risk for abortion.
• Risk lowest before age 25 years, after which it progressively
increased at 5-year intervals.
• chromosomal abnormalities in spermatozoa likely play a role.
18. SPONTANEOUS ABORTION (MISCARRIAGE)…
THREATENED MISCARRIAGE: It is a clinical entity where the process of
miscarriage has started but has not progressed to a state from which
recovery is impossible .
INEVITABLE MISCARRIAGE: It is the clinical type of abortion where the
changes have progressedto a state from where continuation of
pregnancy is impossible.
19. SPONTANEOUS ABORTION (MISCARRIAGE)
• COMPLETE MISCARRIAGE: When the products of conception are
expelled en masse, it is called complete miscarriage.
• INCOMPLETE MISCARRIAGE: When the entire products of conception
are not expelled, instead a part of it is left inside the uterine cavity, it
is called incomplete miscarriage.
• MISSED MISCARRIAGE: When the fetus is dead and retained inside
the uterus for a variable period, it is called missed miscarriage or early
fetal demise.
20. SPONTANEOUS ABORTION (MISCARRIAGE)
• SEPTIC ABORTION: Any abortion associated with clinical evidences of
infection of the uterus and its contents, is called septic abortion.
• Consider septic abortion :
(1) rise of temperature of at least 100.4°F (38°C) for 24 hours or
more .
(2) Offensive or purulent vaginal discharge and
(3) Other evidences of pelvic infection such as lower abdominal pain
and tenderness.
21. SEPTIC ABORTION…
CLINICAL FEATURES:
• Sick look and anxious
• Temperature > 38degree c
• Chills and rigor (suggest-bacteremia)
• Persistent tachycardia > 90bpm
• Hypothermia <36 degree(entotoxic shock)
• Abdominal and chest pain
• Tachypnoea > 20 /min
23. SEPTIC ABORTION…
• A rising pulse rate of 100–120/min or more is a significant finding
than even pyrexia. It indicates spread of infection beyond the uterus.
• P/V: Offensive purulent vaginal discharge or a tender uterus usually
with patulous os or a boggy feel of the uterus associated with variable
pelvic findings depending upon the spread of infection.
24. SEPTIC ABORTION…
• CLINICAL GRADING:
• Grade–I: The infection is localized in the uterus.
• Grade–II: The infection spreads beyond the uterus to the
parametrium, tubes and ovaries or pelvic peritoneum.
• Grade–III: Generalized peritonitis and/or endotoxic shock or
jaundice or acute renal failure.
25. SEPTIC ABORTION…
• Grade-I The commonest and is usually associated with
spontaneous abortion.
• Grade-III Almost always associated with illegal induced
abortion.
26. TYPES SYMPTOMS UTERINE SIZE CERVIX
THREATENED VAGINAL BLEEDIGNG
PELVIC PAIN
CORRESPONDS TO GA OS CLOSED
INEVITABLE VAGINAL BLEEDIGNG
PELVIC PAIN
SAME / SMALLER OPEN WITH PALPABLE
CONCEPTUS
INCOMPLETE VAGINAL BLEEDIGNG
(HEAVY)
SMALLER OPEN
COMPLETE VAGINAL BLEEDING
(TRACE/ABSENT)
SMALLER CLOSE
MISSED VAGINAL BLEEDING
(TRACE/BROWINSH)
SMALLER CLOSE
SEPTIC VAGINAL DISCHARGE-
PURULENT AND FOUL
SMELLING WITH
FEATURES OF SEPSIS
VARIABLE/MAY BE
LARGER
OPEN
27. TYPES USG MANAGEMENT
THREATENED FOETUS ALIVE
RETROPLACENTAL HAEMORRHAGE
CONSERVATIVE MANAGAMENT
INEVITABLE FOETUS OFTEN DEAD
RETROPLACENTAL HAEMORRHAGE
RESUSCITATION OF THE PATIENT
FOLLOWED BY EVACUATION
INCOMPLETE PARTLY RETAINED POC EVACUATION
COMPLETE UTERINE CAVITY EMPTY NO ACTIVE INTERVATION
MISSED BELIGHTED OVUM/ FOETUS
WITHOUT CARDIAC ACTIVITY
EVACUATION
SEPTIC POC RETAINED, PRESENCE OF
FOREIGN BODY+ , FREE FLUID IN
THE PERITONEAL CAVITY/ POD
EVACUATION
TO REMOVE SEPTIC FOCUS
28. RECURRENT PREGNANCY LOSS…
• DEFINITION:
Two or more spontaneous abortions as documented by either
sonography or on histopathology before 20 weeks.
30. RECURRENT PREGNANCY LOSS…
ETIOLOGY:
• Inherited thrombophilia:
• protein c resistance (factor V Leiden mutation) is the most common cause.
• Deficiency of protein c, s, antithrombin III.
• Hyperhomocystinemia and prothrombin gene mutation are also the known
cause of recurrent miscarriage.
31. RECURRENT PREGNANCY LOSS…
• Immune factors:
• Antibodies – Anti Nuclear Antibody, Anti Phospholipid Antibody, Anti DNA
Antibody.
• Anti Phospholipid Antibody- lupus anticoagulant, anti cardiolipin antibody,
anti beta glycoprotein I .
• Unexplained: in majority of the cases.
40. ECTOPIC PREGNANCY
• A. Transvaginal sonography of an
anechoic fluid collection (arrow)
in the retrouterine cul-de-sac.
• B. Culdocentesis: with a 16- to
18-gauge spinal needle attached
to a syringe, the cul-de-sac is
entered through the posterior
vaginal fornix as upward traction
is applied to the cervix with a
tenaculum.
41. Interstitial ectopic pregnancy
• A. This parasagittal view using
transvaginal sonography shows an
empty uterine cavity and a mass that
is cephalad and lateral to the uterine
fundus (calipers).
• B. Intraoperative photograph during
laparotomy and before cornual
resection of the same ectopic
pregnancy. In this frontal view, the
bulging right-sided interstitial ectopic
pregnancy is lateral to the round
ligament insertion and medial to the
isthmic portion of the fallopian tube.
43. Cervical pregnancy
• (1) an hourglass uterine shape and
ballooned cervical canal;
• (2) gestational tissue at the level of
the cervix;
• (3) absent intrauterine gestational
tissue .
• (4) a portion of the endocervical canal
seen interposed between the
gestation and the endometrial canal.
47. Typical pathogenesis of complete and partial
moles.
• A 46,XX complete mole may be
formed if a 23,X-bearing haploid
sperm penetrates a
23,Xcontaining haploid egg
whose genes have been
“inactivated.”
• Paternal chromosomes then
duplicate to create a 46,XX
diploid complement solely of
paternal origin.
• A partial mole may be formed if
two sperm—either 23,X- or 23,Y-
bearing—both fertilize
(dispermy) a 23,X-containing
haploid egg whose genes have
not been inactivated.
• The resulting fertilized egg is
triploid with two chromosome
sets being donated by the father.
This paternal contribution is
termed diandry..
49. Sonograms of hydatidiform moles
• A complete hydatidiform mole.
The characteristic “snowstorm”
appearance is due to an
echogenic uterine mass, marked
by calipers, that has numerous
anechoic cystic spaces.
• partial hydatidiform mole, the
fetus is seen above a multicystic
placenta.
52. MANAGEMENT OF HYDATIDIFORM MOLE
• INTRAOPERATIVE:
• large bore IV catheter
• regional/GA
• oxytocin 20 U in 1000ml RL for cont.inf
• karmans cannula – 10/14mm
• consider sonography machine
53. MANAGEMENT OF HYDATIDIFORM MOLE
one or more other uterotonic agents:
methergine 0.2 mg im every 2 hrs
carboprost 250 mcg im every 15 to 90 min
misoprostol 200 mcg PR 800 to 1000mcg
54. MANAGEMENT OF HYDATIDIFORM MOLE
• Post evacuation:
• anti D immunoglobulin if Rh negative
• initiate effective contraception
• review HPE report
• Sr. HCG levels: within 48 hrs of evacuation, weekly until
undectectable, mnthly for 6 mnths.