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8/8/2019 Pregnancy Disorders
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PREGNANCY DISORDERS
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INTRODUCTION
Pregnancy is the carrying of one or more offspring, i.e. a fetus
or embryo, inside the womb of a female.
Human pregnancy lasts for 40 weeks.Childbirth usually occurs
about 38 weeks after conception.
Although most pregnancies progresses without problems some
complications can arise in the mother , placenta , or fetus.
The routine problems are normal complications, and pose no
significant danger to either the woman or the fetus. Serious
problems can cause both maternal death and fetal death if
untreated
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CONTINUE««..
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PLACENTA Placenta(with umbilical cord ) is the primary link
between the fetus and mother . It grows throughout
pregnancy.
Functions :-
It keeps the maternal and fetal circulation separate.
Nourishes the fetus
Eliminates fetal waste Produces hormones vital for pregnancy
Transfer of many substances which depends upon,
Concentration gradient
Presence and absence of binding proteins
Lipid solubility
Ion pumps or receptor mediated endocytosis
Effective barrier for movement of large proteins
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A MNIOTIC FLUID
Throughout the intrauterine life fetus lives within
fluid filled compartment which provides medium inwhich fetus can move.
It cushions a fetus against possible injury and helpsin temperature maintenance .its vol. increases from
first to last week.
Increase and decrease in amniotic fluid is
responsible for several abnormalities .
Oligohydramnios
Polyhydramnios
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M ATERNAL ADAPTATION
During pregnancy physiological and hormonal
changes occurs.
Large amount of hormones produces during
pregnancy affects metabolic, physiological and
endocrine system.
Several changes in lipid metabolism , thyroid
production , fibrin production and various other
proteins.
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BIOCHEMICAL CHANGES
Changes in electrolytes.
40% increase in serum triglycerides , cholesterol ,
phospholipids and fatty acids.
Late period : plasma albumin decreases and
globulin conc. Increases.
Activity of some enzymes also changes.
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RENAL FUNCTION
GFR increases so urea , creatinine and uric acidclearance is high.
In urea protein loss is higher
ENDOCRINE CHANGESo Progesterone action prevents menses and allows
pregnancy to continue.
o Earlier hormone is produced by corpus luteum and
later produced by placenta for maintenance.o Plasma para thyroid and estrogen hormone
concentration increases
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M ATERNAL AND FETAL HEATH ASSESSMENT
For optimum healthcare :
Evaluation of medical , reproductive and family
history.
Physical examination
Laboratory tests.
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COMPLICATIONS OF PREGNANCY
Complications may arise in mother , fetus or
placenta.
In mother primary conditions are :
1. Ectopic pregnancy.
2. Hyperemesis gravidarum.
3. Preeclampsia.
4. HELLP syndrome ( hemolysis , elevated liver
enzymes and low platelet counts in association
with preeclampsia).
5. Liver diseases.
6. Graves disease.
7. Hemolytic disease of newborn.
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ECTOPIC PREGNANCY AND THREATENED
A BORTION
When fertilized egg implants in location other than thebody of uterus, condition is called as ectopic pregnancy.
Most abnormal implantation occurs in fellopian tube and
also in abdomen (rare).
Common complications are tubal rupture and
hemorrhage Symptoms:
Lower abdominal pain
Vaginal bleeding
Pelvic and bladder infections Appendicitis
Kidney Stones
Intestinal viruses
Miscarriage
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CONTINUE«««
o Incomplete or complete abortion
o 1 in 200 chance of dying of patient from ectopic
pregnancy.
Prevention:
Management is either surgical (laparoscopy) or
medical.
Un preventable;Early detection and proper
management of ectopic pregnancy is the most
effective means of prevention.
Ultrasound examination and measurement of
serum CG level
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A N OUTLOOK A FTER ECTOPIC PREGNANCY
If an ectopic pregnancy is caught and treated at
an early stage, the results are encouraging.
If the fallopian tube has not ruptured and is
saved, the chance for a future normal pregnancyis 50 percent, with a 15-percent chance of a
repeat tubal pregnancy.
After a second ectopic pregnancy, the risk for a
third ectopic pregnancy goes up to 40 percent.
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Surgically removed, formalin-fixed
fallopian tube has been opened to reveal
human embryo and placenta.
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PREECLAMPSIA
Pre-eclampsia is a medical condition in which
hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant
amounts of protein in the urine.
Characterized by :
Hypertension Protein in urea
Edema
Pre-eclampsia may develop from 20 weeks gestation.
Pre-eclampsia occurs in as many as 10% of pregnancies
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C AUSES:
endothelial cell injury
immune rejection of the placenta
compromised placental perfusion
altered vascular reactivity
imbalance between prostacyclin and thromboxane
decreased glomerular filtration rate with retention of
salt and water decreased intravascular volume
increased central nervous system irritability
disseminated intravascular coagulation
uterine muscle stretch (ischemia)
dietary factors, including vitamin deficiency
genetic factors
air pollution
obesity
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TREATMENTS
Anti-Hypertensive Therapy
Magnesium sulphate
Dietary and nutritional factors
Aspirin supplementation
Exercise
Induction of paternal tolerance
Administration of immune factors
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ECLAMPSIA
Eclampsia isan acute and life-threateningcomplication of pregnancy, is characterized by theappearance of tonic-clonic seizures usually in apatient who had developed preeclampsia.(Preeclampsia and eclampsia are collectively calledHypertensive disorder of pregnancy and toxemia of pregnancy.)
Eclampsia includes seizures and coma that happenduring pregnancy but are due to preexisting ororganic brain disorders.
Symptoms:
nausea, vomiting, headaches, and corticalblindness
abdominal pain, liver failure, signs of the HELLP syndrome, pulmonary edema, and oliguria.
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HELLP SYNDROME
Occurs in 0.1% pregnancies.
HELLP syndrome is a life-threatening obstetriccomplication usually considered to be a variant of pre-
eclampsia.
HELLP is an abbreviation of the main findings:[1]
Hemolytic anemia
Elevated Liver enzymes and
Low Platelet count
Symptoms:
Headaches , blurred vision, malaise , nausea/vomiting
(30%), "band pain" around the upper abdomen andparesthesia (tingling in the extremities). Edema may
occur. Arterial hypertension. Rupture of the liver capsule
and a resultant hematoma may occur. If the patient has
a seizure or coma, the condition has progressed into full-
blown eclampsia.
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LIVER DISEASE
Unique liver disorders of pregnancy are:
HYPEREMESIS GRAVIDARUM :
CHOLESTASIS OF PRAGNANCY:
F ATTY LIVER OF PRAGNANCY :
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HYPEREMESIS GRAVIDARUM :
Hyperemesis gravidarum (HG) is a severe form of morningsickness, with "unrelenting, excessive pregnancy-related nausea
and/or vomiting that prevents adequate intake of food and fluids
When HG is severe and/or inadequately treated, it may result in:
Loss of 5% or more of pre-pregnancy body weight
Dehydration, causing ketosis and constipation
Nutritional deficiencies
Metabolic imbalances
Altered sense of taste
Sensitivity of the brain to motion
Food leaving the stomach more slowly
Rapidly changing hormone levels during pregnancy
Stomach contents moving back up from the stomach Physical and emotional stress of pregnancy on the body
Subconjunctival hemorrhage (broken blood vessels in the eyes)
Difficulty with daily activities
Hallucinations
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CHOLESTASIS OF PRAGNANCY:
cholestasis is a condition where bile cannot flow
from the liver to the duodenum.
It is a medical condition in which cholestasis occurs
during pregnancy. It typically presents with to
troublesome itchingand can lead to complications
for both mother and fetus. Ursodeoxycholic Acid &Cholestyramine appears to
only relieve itching but no way to guarantee a
successful outcome.
If additional blood tests to check clotting functionidentify a problem, giving Vitamin K may help
avoid the risk of hemorrhage at delivery.
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F ATTY LIVER OF PRAGNANCY :
Acute fatty liver of pregnancy is a rare life-threatening complication of pregnancy that occurs in
the third trimester or the immediate period after
delivery . Occurs in 1 in 7000 pregnancies
It is thought to be caused by a disordered metabolism of
fatty acids by mitochondria in the mother, caused bydeficiency in the LCHAD (long-chain 3-hydroxyacyl-
coenzyme A dehydrogenase) enzyme.
Initial treatment involves supportive management with
intravenous fluids, intravenous glucose and blood
products, including fresh frozen plasma. The fetusshould be monitored with cardiotocography. After the
mother is stabilized, arrangements are usually made
for delivery. This may occur vaginally, but, in cases of
severe bleeding or compromise of the mother's status, a
caesarian section may be needed.
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NEONATAL GRAVES DISEASE
The fetal thyroid-pitutary axis functions
independently from the mother·s axis.
If mother has preexisting graves disease , it may
possible that her auto antibodies may cross
placenta and stimulate the fetal thyroid gland.
It may develop hyperthyrodism.
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HEMOLYTIC DISEASE OF NEW BORN
Caused by maternal antibodies directed againstantigen on fetal erythrocytes.
when the IgG molecules produced by the motherpass through the placenta. Among these antibodiesare some which attack the red blood cells in the
fetal circulation; the red cells are broken down andthe fetus can develop reticulocytosis and anaemia.
This fetal disease ranges from mild to very severe,and fetal death from heart failure (hydrops fetalis)can occur.
Common synonyms Rh immune disease
Isiimmunization disease
D isoimmunization
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CONTINUE«
Symptoms and Treatment:
Profound anemia can cause high-output heart
failure, with pallor, enlarged liver and/or spleen,generalized swelling, and respiratory distress.
Before birth , treatment include intrauterinetransfusion. The mother may also undergo plasmaexchange to reduce the circulating levels of
antibody by as much as 75%. After birth, treatment depends on the severity of
the condition, but could include temperaturestabilization and monitoring, phototherapy,transfusion with compatible packed red blood,
exchange transfusion with a blood type compatiblewith both the infant and the mother, sodiumbicarbonate for correction of acidosis and/orassisted ventilation.
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FETAL ABNORMALITIES
NEUR AL TUBE DEFECT :
It is a serious abnormality occurs in early
embryonic development.
Causes :
Anencephaly
Spinabifida
Encephalocele
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DOWN SYNDROME
Its is the most common and serious disorder of the
autosomal chromosomes occurs in 1in 800 lives
births & is a chromosomal disorder caused by the
presence of all or part of an extra 21st chromosome.
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S YMPTOMS :
Ophthalmology and otolaryngology- the two eyes donot move in tandem , Cataracts (opacity of the lens)and glaucoma (increased eye pressures)
The risk for Alzheimer's disease is increased
There is infertility amongst both males and femaleswith Down syndrome; males are usually unable tofather children, while females demonstratesignificantly lower rates of conception relative tounaffected individuals.
increases the risk of Hirschsprung's disease, in whichthe nerve cells that control the function of parts of thecolon are not present.
Thyroid disorders
Malignancies
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OTHER DEFECTS
Preterm delivery
Fetal lung maturity
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