Obstetrics Complications: Spontaneous Abortion

Spontaneous Abortion

• Vaginal bleeding in the first trimester may suggest spontaneous abortion, ectopic pregnancy, or infection.
• Classifications of abortion include:
  • Threatened: Bleeding without cervical dilation.
  • Inevitable: Bleeding with cervical dilation.
  • Incomplete: Partial loss of pregnancy products, typically between 6-14 weeks.
  • Complete: Full loss before 20 weeks.
  • Missed: Fetal death without loss of conception products for 4 weeks.
  • Septic: Infection accompanying the abortion.
• Diagnostic tests involve pelvic exams, CBC, ultrasound, and quantitative serum B-hCG levels.
• Treatment includes suctioning with pathological examination, evacuation for incomplete abortions, and RhoGAM administration for unsensitized Rh-negative women.

Ectopic Pregnancy

• Occurs when a fertilized ovum implants outside the uterus, most commonly in the fallopian tube.
• Diagnosis uses vaginal exams, hCG titers, and transvaginal sonography.
• Early symptoms include amenorrhea, breast tenderness, and signs of pregnancy.
• Symptoms of rupture involve unilateral abdominal pain, decreased hemoglobin, and hypotension.
• Treatment can involve Methotrexate for unruptured cases or laparoscopic procedures if necessary.

Fetomaternal Hemorrhage (FMH)

• FMH can be asymptomatic or present with fetal blood entering the maternal circulation.
• Massive FMH (over 30 ml) can cause significant stillbirth risk.
• Risk factors include maternal trauma, placental abruption, and twin pregnancies.
• Diagnosis often utilizes the Kleihauer-Betke test to check for fetal hemoglobin in maternal blood.

Abruptio Placentae

• Premature detachment of the placenta can result in severe bleeding.
• Risk factors encompass maternal hypertension, cocaine use, and coagulopathy.
• Symptoms include vaginal bleeding, a tender uterus, abdominal pain, and potential fetal distress.
• Diagnosis involves ultrasound and blood studies.
• Treatment varies from monitoring and bedrest to immediate delivery based on severity.

Placenta Previa

• Condition where the placenta implants over or near the cervical opening.
• Symptoms frequently present as painless bleeding after 20 weeks gestation.
• Diagnosis is performed via ultrasound; vaginal exams should be avoided to prevent hemorrhage.

Hypertensive Disorders of Pregnancy

• Includes essential hypertension, preeclampsia, eclampsia, and HELLP syndrome.
• Preeclampsia is characterized by hypertension with proteinuria and may progress to seizures (eclampsia).

Disseminated Intravascular Coagulation (DIC)

• A serious condition often triggered by abruptio placentae, uterine rupture, or severe infection.
• Symptoms manifest as bleeding, shock, and laboratory signs of coagulopathy.
• Treatment focuses on addressing the underlying cause, blood products, and potentially anticoagulants.

Pregnancy Terminology

• Gravida: Total number of pregnancies.
• Nulligravida: Woman who has never been pregnant.
• Primigravida: First-time pregnant woman.
• Multipara: Woman who has given birth multiple times.
• Term: Full term pregnancy lasts 38-48 weeks.

Fetal and Neonatal Complications

• Conditions leading to fetal anomalies include chromosomal abnormalities and central nervous system issues.
• Increased risk of complications with multiple gestations and certain prenatal conditions.

Precipitous Labor

• Characterized by labor lasting ≤3 hours, potentially resulting in trauma or low Apgar scores.
• Increased risks include meconium aspiration and intracranial injury for the neonate.

Prolapsed Umbilical Cord

• Occurs when the cord precedes the fetus in labor, requiring prompt management to prevent fetal hypoxia.
• Management includes changing the maternal position and preparing for immediate delivery if necessary.

Induction of Labor

• Induction may be conducted for various medical conditions but contraindicated in certain fetal and maternal situations.
• Common methods include membrane stripping and oxytocin administration.

Cesarean Section

• Indicated for risks such as fetal distress, dystocia, and placenta previa.
• Regional anesthesia preferred due to fewer complications compared to general anesthesia.

Cephalopelvic Disproportion

• Diagnosed when labor does not progress, often related to pelvic size or fetal position.
• Cesarean delivery may be necessary in cases of disproportion or severe fetal malpresentation.

Delivery Management

• Effective pushing techniques are crucial during the expulsive period of labor.
• Perineal considerations may lead to the need for episiotomy to assist delivery.