Hemorrhage Ppt

7/29/2019 Hemorrhage Ppt

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Obstetric

Hemorrhage

Nelly Astika 09700260


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Classification of obstetric hemorrhage:

O Bleeding in first trimester pregnancy

O Antepartum hemorrhage

O Post partum hemorrhage


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Bleeding in first trimesterpregnancy


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ABORTION

abortion is usually defined as pregnancy

termination prior 20 weeks gestation or less

than 500-g birthweight.


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Etiology:

O Endocrine abnormalities

O Genetic factors

O Reproductive tract abnormalitiesO Infection

O Systemic disease

O Environmental factors

O Other factors: advanced maternal age,

delayed fertilization (old egg), trauma


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Type ofAbortion

Definition

Threatened Considered when any vaginal bleeding

occurs during the first half of pregnancy

Complete Spontaneous expulsion of the entire ofconception, fetus, placenta, and membranes

Incomplete Spontaneous expulsion of only part of the

products of conception, with retained

products remainin in the uterus

Missed Death of the fetus without sign or symptoms

of pregnancy loss

Septic An abortion resulting in uterine infection with

pathogens from the bowel and/ or vagina


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Sign and symptoms:

General: vaginal bleeding, abdominal

cramping, passage of tissue, cervicaldilatation


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Management & Therapy

Nonpharmacologic: general measures,

specific measures (curettage), diet,activity, patient education

Drug of choice: Oxytocin or

methylergonovine maleate. Septic

abortion: antibiotic therapy (ampicilin orclindamycin and gentamicin)


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Ectopic Pregnancy

Implantation and growth of fetus and

placenta outside the uterine cavity is called

an ectopic pregnancy.


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Risk factors for ectopic pregnancy:

O Pelvic inflammatory disease

O History of ectopic pregnancyO History of prior tubal surgery

O Assisted reproductive technology

O IUD for contraception

O Advanced maternal age

O Sterilization


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Sign and symptoms:

O Pelvic and abdominal pain

O Abnormal menstruationO Abdomen and pelvic tenderness

O Uterine changes

O Blood pressure and pulse: early responses to

moderate hemorrhage range from no changein vital sign to a slight in blood pressure.

O Pelvic mass


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Assesment of ectopic pregnancy:

History : menstrual history is useful in

assesing ectopic pregnancyPelvic exam : uterus is usually enlarged

appropriate to gestational age

Laboratory analysis : increase in beta

hCG levels less than 66%Ultrasound


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Treatment of ectopic pregnancy:

1. Surgical treatment : laparotomy and

salpingectomy2. Non surgical: Methotrexate


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Hydatiform Mole

Gestational trophoblastic disease (GTD) or

hydatiform molar pregnancy, occurs as a

developmental anomaly in the placenta.


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Risk Factor:O Delayed hemorrhage after a pregnancy

immediately preceding the current one

O Excessive uterine enlargment

O Theca lutein cysts

O HCG levels greater than 100.000 mlU/mL

O Prior molar pregnancy

O Prior miscarriage

O

Use of birth control pillsO Maternal age older than 40 years and

younger than 20 years


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Signs and symptoms:

Vaginal bleeding

Uterus size greater than expected

Absence of fetal indications

Hyperemesis

Hyperthyroidism

Pre-eclampsia

Anemia Enlarged ovaries


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Diagnosis:

Ultrasound

Laboratory test


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Treatment:

treatment of GTD depends on many factors,including:

O The location and extent of the disease

O The type of GTD present

O The level of hCG

O The duration of the disease

O Sites of metastasis if any

O The extent of prior treatment

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Hemorrhage Ppt