Abnormal Pregnancy

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Abnormal Pregnancy
CAPT Mike Hughey, MC, USNR
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Incidence of Miscarriage

• 1 in every 6 pregnancies
• Risk of subsequent miscarriage 1/6
• Bedrest will not prevent miscarriage but may
  postpone it

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Causes of Miscarriage

• 60 chromosome abnormalities
• 30 placental malformation
• 10 miscellaneous, but not -trauma
  -climbing mountains -intercourse
  -medication -too much activity, etc.

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Threatened Abortion

• 1 in every 4 pregnancies
• 1st TM bleeding/cramping
• Half will abort, Half will be OK
• Bedrest will not prevent abortion but may
  postpone it.

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Complete Abortion

• Passage of all tissue
• Rest for a day or two
• Ergotrate, Oxytocin
• Antibiotics
• Rhogam
• DC?

9-week spontaneous complete abortion
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Incomplete Abortion Diagnosis

• Some tissue remains behind
• Continuing bleeding/cramping
• Tissue in cervical os
• Uterus tender
• Fever if infection present
• Ultrasound helpful if available

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Incomplete Abortion Treatment

• Convert it to a Complete Abortion
• If tissue visible in the os, remove it
• Ergotrate, Oxytocin
• Antibiotics
• Rhogam
• DC

Tissue removed from os
Tissue still inside uterus
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Inevitable Abortion

• No tissue has been passed
• Cervix dilated or hemorrhage
• Ergotrate, Oxytocin
• Antibiotics
• Rhogam
• DC

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Septic Abortion

• Any abortion complicated by infection
• Fever, Tenderness
• Ergotrate, Oxytocin
• Antibiotics
• MEDEVAC
• DC

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Septic Abortion Antibiotics

• Clindamycin Gentamicin IV
• Flagyl Gentamicin IV
• Cefoxitin IV

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Unruptured Ectopic Pregnancy

• HCG
• Unilateral pelvic pain and tenderness
• Pelvic mass?
• DD CL cyst, Appy, PID
• Lie still
• MEDEVAC

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Ruptured Ectopic Diagnosis

• Pelvic right shoulder pain
• Sudden onset
• Shock
• Positive pregnancy test
• Rebound Rigidity late
• Ultrasound
• Culdocentesis

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Ruptured Ectopic Treatment

• Surgery
• MEDEVAC
• IVs, oxygen, lie still
• Maintain urine output(Foley)
• MAST suit?

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Blood Transfusion

• O Negative blood
• Blood collection bags
• Direct Donor to Patient 16 needle 3-4
  feet gravity feed 10 minutes
• Have a plan before you need it

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Placental Abruption

• gt20 weeks
• Uterine pain, tenderness, and contractions
• Bleeding
• Coagulopathy
• Lie still, IV Fluids
• MEDEVAC, Cesarean Section

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Placenta Previa

• gt20 weeks
• Painless vaginal bleeding
• No pelvic exam unless instructed by an OB-GYN
• Pelvic exam may cause torrential hemorrhage,
  exsanguination and death within minutes
• Rest, IVs, MEDEVAC

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Toxemia of Pregnancy

• Elevated BP (gt140/90)
• Proteinuria (gt300 mg in 24 hours)
• Weight Gain (gt2 pounds/week)
• Swelling (?)
• Increased reflexes (Clonus)

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Pre-Eclampsia

• BP, Protein
• Stable and unstable
• Risk of IUGR
• Risk of Abruption
• Risk of maternal seizures
• Risk of HELLP syndrome
• Hemolysis
• Elevated Liver Enzymes
• Low Platelets

Naval Hospital Jacksonville
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Eclampsia

• Siezures
• Risk of maternal death
• Risk of HELLP syndrome
• Hemolysis
• Elevated Liver Enzymes
• Low Platelets

Naval Hospital Guam
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Treatment of Toxemia of Pregnancy

• Delivery is definitive treatment
• If delivery is to be postponed (prematurity),
  then consider hospitalization for unstable
  patients
• Magnesium sulfate
• Watch for HELLP syndrome

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