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Diseases related to pregnancy

SUCHAT PORNCHAROENPONG

Fertilization and implantation

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fetus

Intrauterine infections

• Placentitis (villitis)

• Chorioamnionitis • Funisitis

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Intrauterine infections

Routes of infection • Hematogenous : transplacental = villitis : TORCH, syphilis • Ascending : prolonged membrane rupture : E.coli, Strep., bacteria

Placental disorders

Placenta accreta • no decidual layer • no placental separation • postpartum hemorrhage Placenta increta Placenta percreta

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Placenta increta

Placental disorders

Placental abruption • abruptio placentae • rupture of spiral artery • retroplacental hemorrhage • placental infarct • antepartum hemorrhage Placenta previa

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Retroplacental hemorrhage

Ectopic pregnancy

• abnormal sites of implantation • 1:150 pregnancies • Tubal pregnancy : 90% of ectopic pregnancy : chronic salpingitis : endometriosis : post-surgical adhesion

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Ectopic pregnancy

• Tubal pregnancy : hematosalpinx : rupture with peritoneal hemorrhage : spontaneous regression : lower abdominal pain with shock, similar to acute appendicitis

Tubal pregnancy

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Ectopic pregnancy

• Ovarian pregnancy : fertilization in follicles • Abdominal pregnancy : drop out from fimbria • Interstitial pregnancy : intrauterine portion of tube

Toxemia of pregnancy

• symptom complex • 6% of pregnancies • primiparas • last trimester • Preeclampsia • Eclampsia

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Toxemia of pregnancy

• Preeclampsia : hypertension : proteinuria : edema • Eclampsia : preeclampsia + : convulsion and coma : DIC

Toxemia of pregnancy

Primary cause (immune mechanism) • obstruction of spiral arteries : acute atherosis, fibrinoid necrosis • decreased PGE, incresed renin • vasoconstriction • hypertension

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Toxemia of pregnancy

Primary cause (immune mechanism) • endothelial injury • intravascular coagulation • DIC • ischemic effects : kidneys - decreased GFR, proteinuria : brain - convulsion, coma

Toxemia of pregnancy

Treatment • rest • balanced diet • antihypertensive drugs • induction of delivery

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Gestational trophoblastic diseases

• Molar pregnancy : complete mole : partial mole • Invasive mole • Choriocarcinoma • Placental site trophoblastic tumor

Molar pregnancy

Hydatidiform mole (ครรภไขปลาอุก)

• hydropic changes of chorionic villi Complete mole ovum + sperm = 46XX from sperm (diploid pattern), androgenesis Partial mole ovum + 2-3 sperms = 69XXY (triploid),

92XXXY (tetraploid)

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Molar pregnancy

Molar pregnancy

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Molar pregnancy

Molar pregnancy

• hyperemesis • enlarged uterus > normal pregnancy • uterine bleeding with moles • increased blood level of HCG • curettage

Invasive mole • infiltration of uterine wall • possibly hematogenous spreading

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Invasive mole

Choriocarcinoma

• malignancy of trophoblasts • 1:150,000 of normal pregnancy • 1:40 of molar pregnancy • hematogenous spreading : lung, brain, liver • high level of HCG

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Choriocarcinoma

Applications

• antenatal care (ANC) • detection of complicated cases • management of complicated cases : antepartum hemorrhage : postpartum hemorrhage : toxemia of pregnancy : molar pregnancy

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When love and skill work together,

expect a masterpiece.

John Ruskin, 1819-1900, writer and artist, England