Beruflich Dokumente
Kultur Dokumente
COMPLICATIONS
By Dr Amy, Dr Zul
Supervisor: Dr Sumayyah
Learning Outcome
Hyperemesis Gravidarum
Miscarriage
Molar Pregnancy
Gestational Trophoblastic Neoplasia
MISCARRIAGE
Definition
Etiology
Chromosomal
Abnormalities
Endocrine
Disorders
Chemical
agents
Ten Teachers
50 % of all miscarriages
Eg Downs syndrome
Diabetes
Hypothroidism
Polycystic ovarian
syndrome
Drugs (Isotretinoin for
acne)
Chemicals (benzene,
arsenic, ethylene oxide,
pesticides, lead, mercury,
cadmium)
Etiology
Trauma
Abnormalitie
s of Uterus
Infections
UTI
Parvovirus, Rubella, HSV, CMV,
Chlamydia
Terminolog
y
Threatene
d
miscarriag
e
Inevitable
miscarriag
e
Incomplete
miscarriag
e
Clinical
Presentation
Slight PV bleed
+ Pain
Examination
Cervical os
CLOSED
Variable PV bleed
Pain
H/o passing out
POC
Complete No PV bleed
miscarriag No pain
e
H/o passing out
POC
Missed
With or without
miscarriag
pain or bleeding.
e
US
Findings
IUP (viable)
FH+
IUP
OPEN
Cervical os
open
POC seen
Cervical os
closed
Cervical os
closed
Retained
product of
conception
(RPOC)
No RPOC
Gest. Sac
+
FH -
Management
Counselling
Management
Expectant
Management
Medical
If Rhesus Isoimunisation:
Occur in Rh ve Mother carrying a Rh +ve
Fetus
IM RhoGAM 300mcg/2ml (1 ampoule)
For Miscarriage > 12 gest wk
Surgical
ERPOC + HPE of POC
TCA Gynae clinic 2/12 to review HPE
Counsel
20% Risk of recurrent in future pregnancy
Hyperemesis
Gravidarum
Referrence:
1.
https://www.rcog.org.uk/globalassets/documents/guidelines/
green-top-guidelines/gtg69-hyperemesis.pdf
2.https://www.rcog.org.uk/globalassets/documents/guideline
s/gtg_38.pdf
3.Kevin haye,Simon Jackson Lawrence Impey page Oxford
Handbook of Obstetric and Gynaecology 3 rd edition 2013
Definition
classification
History
Examination
Investigation
FBC
RP (Watch out hyponatremia & hypokalemia)
TFT (abnormal in 60% if hyperemesis
gravidarum patient) aka: Transient
Hyperthyroidism of Hyperemesis Gravidarum
UFEME (UTI and Urine Ketone)
Daily Urine Ketone
USG (exclude multiple and molar pregnancy)
Management
Molar pregnancy
Mechanism
Clinical features
USG finding
Snowstorm
No fetal part
Theca lutein cyst
Management
Follow up
Gestational
Trophoblastic
Neoplasia
Post-Evacuation Follow
up
Counselling
Braga A, Maest I, Michelin OC, et al. Maternal and perinatal outcomes of first pregnancy after chemotherapy for gestational trophoblastic
neoplasia in Brazilian women. Gynecol Oncol 2009; 112:568
1. Kohorn EI. Negotiating a staging and risk factor scoring system for gestational trophoblastic neoplasia. A progress report. J Reprod Med
II
GTN extends outside of the uterus, but is limited to the genital structures
(adnexa, vagina, broad ligament).
III
GTN extends to the lungs, with or without known genital tract involvement.
IV
Age
<40
40
Antecedent
pregnancy
mole
abortion
term
Interval months
from index
pregnancy
<4
46
712
>12
Pretreatment
<103
serum hCG (iu/1)
103104
104105
>105
Largest tumor
size (including
uterus)
<3
34 cm
5 cm
Site of
metastases
lung
spleen, kidney
gastrointestinal
liver, brain
Number of
metastases
14
58
>8
Previous failed
single drug
2 drugs
Thank You!