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8/31/2011
3
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
• 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