Gynecological

disorders in pregnancy
Abnormal Vaginal
Discharge:
 There is an increased vaginal transudate
during pregnancy due to increased
vascularity & hyperestrogenic state.
 Discharge: Mucoid in nature non
irritating.
 Diagnostic: Microscope: Cornified
squamous cells with few pus cells.
 Treatment: Personal hygiene is helpful.
No other treatment is
required.
Trichomonas Vaginalis:
 Treatment: Metronidazole (Flagyl)- 200
mg thrice daily for 7 days.
Avoid metronidazole in 1st
trimester.
The husband should be
treated simultaneously.
Monilia Vaginalis:
 Due to: Candida albicans.
 S/S : High acid pH of vaginal secretions.
Presence of sugar in urine during
pregnancy.
 Treatment: Miconazole vaginal exam.
CONGENITAL MALFORMATIONS OF
THE UTERUS & VAGINA
 Common types of malformations:
 ARCUATE.

 SUBSEPTATE.

 BICORNUATE with equal horns or

unequal horns (rudimentary).

* Severe degrees of congenital
malformations of the uterus leads to
infertility.
Cont.,.,
The adverse obstetric effects:
 Recurrent mid trimester abortion.

 Rupture pregnant rudimentary horn (Cornual

pregnancy).
 Malpresentation (Transverse, Breech).

 Abnormal uterine action (Asymmetrical

uterine contractions).
 Prematurity.

 Dysmaturity.

 PPH.
Cont.,.,
 Retained placenta.
 Increased incidence of operative
interference.
 Obstruction labor with bicornuate
uterus.
CARCINOMA CERVIX WITH
PREGNANCY
Incidence: 1 in 1000 pregnancies.
Effects on pregnancy:
 Abortion.
 Premature labor.
 Secondary cervical dystocia.
 Missed labor.
 Injury to cervix and lower segment.
 PPH.
 Uterine sepsis.
 Cont.,.,
Treatment:
 First trimester:

1. Radical hystrectomy ( With fetus in uterus).

2. Radiotherapy – External pelvic radiation.
 Second trimester:

1. Uterus is to be evacuated.
2. Prophylactic antibiotic.
 Third trimester:

1. Radical hystrectomy.
2. Pelvic lymphadenopathy after classical C.S
delivery.
Cont.,.,
 Labor:
1. No vaginal delivery because chance of
cervical dystocia & injuries.
2. Classical cesarean section should be
done.
FIBROID WITH
PREGNANCY
Incidence: 1 in 1000 pregnancies.
Effects on pregnancy:
 Retention of urine.

 Constipation.

 Abortion.

 Malpresentation.

 Non- engagement of presenting part.

 Preterm Labor & prematurity.

Cont.,..
Effects on labor:
 Obstructed labor.

 PPH.

 Difficult C.S.

Effects on puerperium:
 Sub involution.

 Sepsis.

 Secondary PPH.

 Inversion of the uterus.

Cont.,.,
Clinical features:
 Acute onset of pain over the tumor.

 Malaise or even increased temperature.

 Dry or furred tongue.

 Rapid pulse.

 Constipation.

 Tenderness & rigidity over the tumor.

 Blood count: Leukocytosis.

Cont.,.
Diagnosis:
 Laprotomy.

Treatment:
 Patient is put to bed.

 Ampicillin 500 mg capsule thrice daily

for 7 days.
 Analgesic & sedative is frequently

needed.
Cont.,.,
During pregnancy:
 Usual ANC is followed.
During labor:
 LSCS: If cervical or broad ligament fibroid is
present.
Other associated complicating factors.
 Alert for PPH & retained placenta.
OVARIAN TUMOR IN PREGNANCY
Incidence: 1 in 2000 pregnancies.
Effects on pregnancy:
 Retention of urine.

 Mechanical distress.

 Malpresentation.

 Non-engaged head at term.

 Obstructed labor.
Cont.,.,
Treatment:
 Remove the tumor b/w 14-18 week

( because chance of abortion is less).

 Beyond 36 weeks: Wait for delivery.

Then remove tumor

early in puerperium as possible.
Adequate pain relief
for 48 hrs following surgery.
Cont.,.,
During labor:
 Tumor is well above the presenting part-

Vaginal delivery can be done.

 Tumor is impacted in the pelvis- C.S

followed by removal of tumor in the

same time.
RETROVERTED GRAVID
UTERUS
Definition:
 Retroverted gravid uterus either

congenital or acquired is considered as a

normal variant of uterine position.
Incidence: 10% during 1st trimester of
pregnancy.
Effects on pregnancy:
 Abortion, Malpresentation, Non-engaged

head, Preterm delivery & Prematurity,

Rupture of uterus during labor.
Cont.,.,
Treatment:
Before Incarcenation
 Periodic check up upto 12 weeks until

the uterus becomes an abdominal organ.

 Advise to empty the bladder frequently.

 Lie in prone position as far as possible.

Cont.,.,
After Incarcenation
 Foley’s catheter (To empty bladder
slowly).
 Lie on Sims position.
 Urine sent for culture.
 Ampicillin-500 mg, 8 hrly daily.

* It is expected to be corrected
spontaneously within 48 hours.
Cont.,.,
If spontaneous correction fails:
Manual correction: By pushing uterus
through posterior fornix while drawing
the cervix posteriorly at the same by
“ALLIS or RING FORCEPS” is effective.
Position: SIMS or KNEE-CHEST position.
After correction: HODGE-SMITH
PESSARY may be inserted to be kept
upto 18th-20th week.
GENITAL PROLAPSE IN PREGNANCY
 Pregnancy in 3rd degree prolapse is an
extremely rare event.
Incidence: 1 in 250 pregnancies.
Effects on pregnancy:
 Abortion. Discomfort due to increased

ailments, Chorioamnionitis, PROM.

Effects on labor:
 Early ROM, Prolonged labor, Operative

interference.
Cont.,.,
Effects on puerperium:
 Sub involution, Uterine sepsis.

Treatment:
During Pregnancy:
 The cervix is to be replaced inside the

vagina & kept in position by a ring

pessary ( till 18th-20th week).
 If reposition is not possible: MTP is

indicated.
Cont.,.,
During labor:
 The pt should be in bed.

 Intavaginal plugging soaked with

“glycerine & acriflavine” ( Reduces

cervical edema & also facilitates
dilatation).
 If head deeply engaged but the cervix

not dilated, then DUHRSSEN’S INCISION

at 2 & 10’O clock position and followed
by ventouse or forceps application.
Cont.,.,
 If head is not-engaged, cervix not dilated
C.S is preferable.
During puerperium:
 Pt should lie flat on the bed.

 Mass remains outside, it should be covered

with gauze soaked in glycerine & acriflavine.

 If sub involution: Ring pessary is used until

involution is completed.
 Prophylactic antibiotic is administered.