Pregnancy

complication
Department of
gynaecology and
obstetrics
 Early pregnancy complication
 Late pregnancy complication
Late pregnacy
complication
 preterm labor
 pre mature rupture of membranes
（ prom ）
 prolonged pregnancy
 RH isoimmunization other blood group
incompatiblities
 Management of the pregnancy with
isoimmunization
 Defination
 pathogenesis
 Clinical fingdings
 Laboratory studies
 Treatment
 conduct of labor and delivery
 Prognosis
preterm labor
 Preterm labor is defined as labor
occurring after 20weeks’ but
before 37 weeks’gestation.
Defination
 Labor is the process of coordinated
uterine contractions leading to
progress cervical effacement and
dilatation by which the fetus and
placenta are expelled 。
 1. contractions need to be regular and at
frequent intervals
 2.cervical effacement or dilation.
 3.the uterine contractions need not be
painful to cause cervical change and may
manifest themselves as abdominal
tightening ,lower back pain,or pelvic
pressure.
 1.cervical incompentence
 cerclage placement

 2.preterm uterine contracions

 a self-limited phenomenon that
resolve spontaneously and
requires no intervention
 Defination
 pathogenesis
 Clinical fingdings
 Laboratory studies
 Treatment
 conduct of labor and delivery
 Prognosis
pathogenesis

 Medical complications
 Surgical complications
 Genital tract anomalies
pathogenesis
 A Obstetric complications
 1) In previous or current pregnancy
 1.Severe hypertensive state of pregnancy
 2.Anatomic disorders of the placenta
 3.Placental insufficiency
 4.Premature rupture of membrance
 5.Polyhydramnios or oligohydramnios

pathogenesis
 2)Previous premature or low birth weight
infant
 3)Low socioeconomic status
 4)Maternal age <18or >40 years
 5)Low prepregnancy weight
 6)Non caucasian race
 7)Multiple pregnancy
 8)Short intermal between pregnancies
 9)Previou abortion
 10)Previous laceration of cervix or ulterus
 B Medical complications
 1.Pulmonary or systemic hypertension
 2.Renal disease
 3.Heart disease
 4.infection:pyelonephritis,
 acute systemic infection, urinary tract
infection,genital tract infection,fetotoxic
infection,maternal systemic infectin,maternal
intra-abdominal sepsis
 5.Heavy cigarette smoking
 6.Alcoholism or drug addiction
 7Severe anemia
 8alnutritin or obesity
 9.Leaking benign cystic teratoma
 10.Perforated gastric of duodenal ulcer
 11.Adnexal torsion
 12.Maternal trauma or burns
 C Surgical complications
 1. any intra-abdominal procedure
 2. conization of cervix
 3.previous incision in uterus or cervix
 D Genital tract anomalies
 1.Bicornuate,subseptate,or unicornuate uterus
 2.Congenital cervical incompetency
 Defination
 pathogenesis
 Clinical fingdings
 Laboratory studies
 Treatment
 conduct of labor and delivery
 Prognosis
Clinical fingdings
 1.symptoms and sings
 A uterine contractions
 B dilatation and effacement of
cervix
 C vaginal bleeding
 A uterine contractions
 regular uterine contractions at
frequent intervals as documented
by tocomenter or uterine
palpation,generally more than two
in onehalf hour
 B dilatation and effacement of
cervix
 documented cervical change in
dilation or effacement of at least
1cm or a cervix that is well-effaced
and dilated (at least 2cm) on
admission is considered diagnositic
 the length of cervix is2.5-3cm
 C vaginal bleeding
 1.many patients present with
bloody mucous vaginal discharge
or bloody show.
 2.more significant vaginal bleeding
should be evaluated for abruption
placentae or placenta previa
Normal position of
the placenta
abruption placentae

placenta previa
 2 evaluation
 a gestational age
 b fetal weight
 c presenting part
 d fetal monitoring
 A gestational age
 gestational age must be between
20 and 37weeks estimated
gestation age (EGA)which should
be calculatedc by the patient’s
last menstrual period （ LMP ）
or date of conception ,if known
,or by previous sonographic
estimation if these dates are
 B fetal weight
 care must be taken to determine
fetal size by ultrasonography
 C presenting part
 the presenting part must be noted
becauses abnormal presentation is
more common in earlier stages of
gestation
 prolapse of
breech
the cord
presentation
 D fetal monitoring
 continuous fetal monitoring should
be performed to ascertain fetal
well-being.
 3Laboratory studies
 1completely blood cout with differential
 2.urine obtained
 5 speculum examination
 4.amniocentesis
 3.ultrasound examination
 6.fetal fibronectin enzyme immunoassay
 Defination
 pathogenesis
 Clinical fingdings
 Laboratory studies
 Treatment
 conduct of labor and delivery
 Prognosis
Laboratory studies
 1completely blood cout with
differential
 2.urine obtained by catheter for
urinalysis,culture,and sensitivity
testing
 3.ultrasound examination for fetal
size ,position,and placental
location.
 4.amniocentesis may be useful to
ascertain fetal lung maturity in
instances where EGA is
uncertain,the size of the fetus is in
conflict with the estimated data of
conception(EDC),or the fetus is
more than 34week ‘EGA
 the amniotic fluid should be tested
for L/S tatio ， phosphatidyl
glycerol （ PG ） level ， lamellar
body count
 5 speculum examination should be
performed.
 A wet mount should be performed
to look for signs of bacterial
vaginosis.
 6.fetal fibronectin enzyme
immunoassay kits ， as a means
to predict preterm birth in patients
with preterm labor.
 Defination
 pathogenesis
 Clinical fingdings
 Laboratory studies
 Treatment
 conduct of labor and delivery
 Prognosis
Treatment
 1 observation
 to determine appropriate
management.

 a longer period of observation is

not desirable ,because the
effectiveness of therapy diminishes
as labor advances .
 3.decisions regarding management
are made based on estimated
gestarional age ,estimated weight
of the fetus ,and whether
contraindications exist to
suppresing preterm labor.
 factors indicating that preterm labor should be
allowed to continue .
 Maternal factors
 1.severe hypertersive (eg.acute exacerbation
of chronic
 hypertension,eclampsia,severe
preeclampsia )
 2.pulmonary or cardiac diseaes(eg.pulminary
edema,adult respiratory
 distress syndrome,valvular
disease,tachyarhythmias)

factors indicating that preterm labor
should be allowed to continue
 Fetal factors
 1.fetal death or lethal anomaly
 2.fetal distress
 3.intrauterine infection(chorioamnionitis)
 4.therapy adversely affecting the fetus(eg.fetal distress
due to attempted
 suppression of labor )
 5.estimated fetal weight >2500g
 6.erythroblastosis fetalis
 7. severe intrauterine growth fetardation
 4. expectant management or
intervention .
 a. 24-34weeks EGA and
fetalweight between 600-2500g
 b. beyond 34-37weeks’EGA and
grater than 2500g

 1. bed rest
 2.corticosteroids
 3. tocolysis
 4.antibiotics
 5.conduct of labor and delivery
 corticosteroids
 the administration of corticosteroids to
accelerate fetal lung maturity has
become the standard of care for all
women at risk of preterm delivery
between 24-34weeks’ EGA.
 it has been shown to decrease the
incidence of neonatal respiratory
distress,
 Intraventricular hemorrhage ,and
neonatal mortalit
 tocolysis
 goals
 1. The shortterm goal is to continue the
pregnancy for 48 h after steroid
administration,afer which the maximum
effect of the steroids can be achieved.
 2.The long-term goal is to contiue the
pregnancy beyond 34-37weeks ,at
which point fetal morbidity and
mortality is dramaticallyreduced and
tocolysis van be disvontinued.
 1.Tocolytic therapy should be considered
in the patient with cervical dilation less
than 5cm.
 2.successful tocolysis is generally
considered fewer than 4-6uterine
contractions per h without further cervical
change.
 A beta-mimetic adrenergic agent
 ritodrine
 terbutaline
 B magnesium sulfate
 C Calcium channel blockers
 Prostaglandin synthetase inhibitors
 Tocolytic effects
 maternal fetal
 Beta-mimetics pulmonary edema tachycardia

 (ritodrine, hypotension hyperglycemia

 terbutaline) tachycardia hypoglycemia

 hyperglycemia ileus
 hypokalemia
 cardiac arrhythmias
 Tocolytic effects
maternal fetal
 magnesium
 sulfate flushing lethargy
 mausea/vomiting hypotonia
 headache respiratory
deprssion
 generalized muscle weakness
 shortness of breath
 diplopia
 pulmonary edema
 chest pain
 hypotension
 tetany
 respiratory depression
 limited by dose –related major
cardiovascular side effects,
including pulminary edma,adult
resporatory distress
syndrome,,and both maternal and
fetal tachcardia.other dose-related
effects are decreased serum
potassium and increased blood
glucose,
 maternal medical
contraindications to the use of
beta include cardiac
disease,hyperthyroidism
,uncontrolled hypertension or
pulmonary hypertension,asthma
requieing sympathomimetic drugs,
 B magnesium sulfate
 it appeara to inhibit calcium uptake into
smooth muscle cells ,reducing uterine
contractility
 less effective than rito-drine or
terbutaline,magnesium sulfate is better
tolerated than beta-mimetics and ,as a
result ,has become the first-line agent
for tocolysis in many institutions
 monitored closely for signs of toxicity with
frequent chesks of
 deep tendon reflexes ,pulmonary
exams.and strict calculations of the
patienti’s fluid balance
 this antidote should be kept at the bedside
when this drug is used
 Prostaglandin synthetase
inhibitors
 1.It has been show to be as
effective as ritodrine for tocolysis
 2.Their use has been limited by
potentially serous fetal effect.
Results of tocolysis
therapy
 due to the progess of labor .
 1.if cervical dilatation reaches 5 cm,the
treatment should be considerde a
failure and abandoned .

 if labor resumes after a period of

quiescence,treatment may be
reinstituted using the same or a
different drug
 Antibiotic
 no benefits in delaying preterm
birth in this population of patients .
 patients with preterm labor should
be stated on antibiotics for
prevention of neonatal group B
streptococcal infection

 if the patient is well tocolysised

and there is no sign of imminent
delivery,the group B Streptococcus
prophylaxis can be discontinued
 Defination
 pathogenesis
 Clinical fingdings
 Laboratory studies
 Treatment
 conduct of labor and delivery
 Prognosis
conduct of labor and
delivery
 1. samll premature infants should
be delivered in a hospotal
equipped for neonatal intensive
care
 every effort should be made to
avoid fetal hypoxis and
intraventricular
hemorrhage.adequate hydratin
should assist in preventing
 a generoud episiotomy should be
made to further reduce the risk of
injury.
delivery can be aided by forceps
with a short cephalic curve
 if a cesarean is indicated,the
decision to operate is based on
maturity of the fetus and prognosis
for survival.
 in managing the premature
newborn infant ,the avoidance of
heat loss is of critical importance.
 keep in mind the potential residual
adverse effects of these drugs .
 .1.Bta-addreger agents may cause
neonatal
hypotension,hypoglycemia,hypocalcemi
a,and ileus
 2.magnesium sulfate may be
responsible for respiratory and cardiac
depression.in addition,oral maintenace
doses of a beta-can produce
hypoglycemia in the newborn
 Defination
 pathogenesis
 Clinical fingdings
 Laboratory studies
 Treatment
 conduct of labor and delivery
 Prognosis
Prognosis
 1.Excellent neonatal care in the
delivery room and nursery will do
much to ensure a good prognosis
for the preterm infant.
 2.Lower-bithweight babies have a
lesser chance of survial and a
greater chance of permancent
sequelae in direct relationship to
size.
 Asherman’s syndrome is the presence
of intrauterine adhesions that typically
occur as a result of scar formation after
uterine surgery, especially after a
dilatation and curettage (D&C). The
adhesions may cause amenorrhea (lack
of menstrual periods) and/or infertility.
 DES exposure DES (diethylstilbestrol)
exposure during fetal development
 Hypothalamus
 Anterior pituitary inhibit


 hold-back ovulation ， when this

function is stop ， the Lh
peak ， ovulation （ discharge of an
ovum from the ruptuing graafian
follicle ） ， the Endometriais not
suitable for implantation ， so the
fertilized ovum move 。