Maternal

• Ectopic Pregnancy


  1. Implantation occurs outside the uterine cavity

  2. Fertilization occurs in the distal third of the fallopian tube

  3. Obstruction may be present causing the zygote to implant in the fallopian tube instead of the uterus

  4. Second most frequent cause of bleeding early in pregnancy
• Fallopian tube sites for ectopic pregnancy

  • Ampullar portion 80%
  • Isthmus 12%
  • Interstitial or fimbrial 8%
• Cullen sign is a hemorrhagic discoloration of the umbilical area due to intraperitoneal hemorrhage from any cause
• Therapeutic Management of Ectopic Pregnancy

  1. Oral administration of methotrexate

  2. Hysterosalpingogram or UTZ performed after therapy

  3. For ruptured ectopic pregnancy, laparoscopy to ligate bleeding vessels and remove or repair the damaged fallopian tube

  4. If a tube is removed, the woman is theoretically only 50% fertile
• Abdominal Pregnancy


  1. Embryo or fetus grows and develops outside the womb in the abdomen

  2. Placenta may escape into the pelvic cavity and implant on an organ

  3. Fetal outline usually palpable through the abdomen
• How dangerous is Abdominal Pregnancy?
• Probability of Survival for fetus in abdominal pregnancy is 60%
• What will happen if the fetus comes to term?

  1. Infant must be born through LAPAROTOMY

  2. Placenta may be difficult to remove after birth and may be absorbed spontaneously

  3. Treatment with METHOTREXATE if placenta does not absorb
• Gestational Trophoblastic Disease is also known as Hydatidiform Mole or H-Mole
• Molar pregnancies


  1. Abnormal proliferation and degeneration of trophoblastic villi

  2. Molar pregnancies categorized as partial moles or complete moles
• Signs and Symptoms of Gestational Trophoblastic Disease
• Molar pregnancy


  1. No embryo or fetus

  2. No amniotic fluid

  3. A thick cystic placenta nearly filling the uterus

  4. Ovarian cysts
• Partial molar pregnancy


  1. A growth-restricted fetus

  2. Low amniotic fluid

  3. A thick cystic placenta
• Factors increasing the risk of molar pregnancy

  • Low protein intake
  • Age older than 35
  • Asian heritage
  • Blood type "A" for women and blood type "O" for men
• Incidence rate of molar pregnancy is approximately 1 in every 1,500 pregnancies
• Therapeutic Management of Molar Pregnancy

  1. Suction Curettage (S&C) - uses aspiration to remove uterine contents through the cervix

  2. hCG analysis every 2 weeks until levels are normal
• Cervical Insufficiency, also known as Premature Cervical Dilatation, refers to a cervix that dilates prematurely and cannot retain a fetus until term. It occurs in 1% of women
• Therapeutic Management of Cervical Insufficiency

  CERVICAL CERCLAGE, also known as a cervical stitch, is a treatment for cervical incompetence or insufficiency. After cerclage surgery, women remain on bed rest. Sutures are removed at weeks 37-38 AOG so the fetus can be born vaginally
• Disseminated Intravascular Coagulation is an acquired disorder of blood clotting where fibrinogen levels fall below effective limits. It occurs due to extreme bleeding and rush of platelets and fibrin to a site
• Underlying causes of Disseminated Intravascular Coagulation

  • Premature separation of the placenta
  • Hypertension of pregnancy
  • Amniotic fluid embolism
  • Placental retention
  • Septic abortion
  • Retention of dead fetus
• Therapeutic Management of Disseminated Intravascular Coagulation includes halting the underlying cause, stopping marked coagulation, administering HEPARIN, and transfusing fresh frozen plasma or platelets
• Preterm Labor is labor that occurs before the end of 37 weeks AOG and is potentially serious due to fetal immaturity
• Causes of Preterm Labor

  • Dehydration
  • UTI
  • Periodontal disease
  • Chorioamnionitis
  • Large fetal size
  • Strenuous jobs during pregnancy
  • Work that leads to extreme fatigue
  • Intimate partner violence and trauma
• Common Symptoms of Preterm Labor include backache, vaginal spotting, pelvic pressure, cramping, increased vaginal discharge, uterine contractions, and intestinal cramping
• Therapeutic Management of Preterm Labor

  Preterm labor can be stopped if certain conditions are met. The woman should be confined in a hospital and placed on bed rest to relieve pressure
• Signs and Symptoms of preterm labor

  • Cramping
  • Increased vaginal discharge
  • Uterine contractions
  • Intestinal cramping
• Therapeutic Management of preterm labor

  1. Fetal membranes have not ruptured

  2. Fetal distress is absent

  3. No bleeding

  4. Cervix is not dilated 4-5 cm

  5. Effacement is not more than 50%
• Therapeutic Management of preterm labor

  1. Woman should be confined in a hospital and placed on bed rest to relieve the pressure of the fetus on the cervix

  2. External fetal monitor should be attached

  3. Intravenous fluid therapy

  4. Rule out UTI
• Drug Administration for preterm labor

  1. TERBUTALINE may be used off-label as a tocolytic agent but should not be used for over 48-72 hours due to potential maternal heart problems and death

  2. MAGNESIUM SULFATE for its potential to reduce the ability of the uterus to contract

  3. BETAMETHASONE for the formation of lung surfactant for the fetus

  4. ISOXSUPRINE relaxes the uterine smooth muscles
• Labor that cannot be Halted

  1. Preterm labor that is too far advanced

  2. Membranes have ruptured and the cervix is 50% effaced and 4-5 cm dilated

  3. CS birth if the fetus is very immature to reduce pressure on the fetal head and reduce the possibility of subdural or intraventricular hemorrhage

  4. Ensure fetal heart monitor attached

  5. Following birth, the cord of the preterm is not clamped immediately because this extra amount of blood can help reduce the possibility of preterm anemia and the need for post-birth transfusion
• Normal Amniotic Fluid Volume
• Normal Amniotic Fluid Index
• Premature Rupture of Membranes (PROM)
• POTTER-like syndrome components


  • P - Pulmonary hypoplasia
  • O - Oligohydramnios
  • T - Twisted skin (wrinkly skin)
  • T - Twisted face (potter's face)
  • E - Extremities defects
  • R - Renal agenesis (bilateral)
• Therapeutic Management for PROM

  1. UTZ to determine remaining amniotic fluid index

  2. Avoid doing routine IE because the risk of infection rises significantly when digital examinations are performed after PROM

  3. Labor contractions may be induced by administration of IV Oxytocin if the fetus is already at term

  4. If the fetus is not at the point of viability, place the woman on bed rest and administer Corticosteroid to hasten lung maturity
• Hydramnios (Polyhydramnios)
• Signs and Symptoms of Hydramnios

  • Unusually rapid enlargement of the uterus
  • Small parts of the fetus become difficult to palpate because the uterus is unusually tense
  • Difficult to auscultate fetal heart rate
  • Woman experienced SOB
  • Woman develops lower extremity varicosities and hemorrhoids
  • Increased weight gain
• Therapeutic Management for Hydramnios

  1. Confinement to the hospital for further evaluation and bed rest

  2. Maintaining bed rest helps to increase uteroplacental circulation and reduces pressure on the cervix to prevent preterm labor

  3. Instruct woman to avoid straining during defecation

  4. Suggest a stool softener if diet is ineffective

  5. Assess v/s and edema frequently

  6. AMNIOCENTESIS
• Bed rest


  Helps to increase uteroplacental circulation and reduces pressure on the cervix thus preventing preterm labor
• Amniocentesis


  Can be performed to remove some of the extra fluid