pregnancy disorders

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PREGNANCY DISORDERS



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



CONTINUE««..



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



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



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.



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.



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



M ATERNAL AND FETAL HEATH ASSESSMENT

For optimum healthcare :

Evaluation of medical , reproductive and family

history.

Physical examination

Laboratory tests.



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.



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



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



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.



Surgically removed, formalin-fixed

fallopian tube has been opened to reveal

human embryo and placenta.



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



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



TREATMENTS

Anti-Hypertensive Therapy

Magnesium sulphate

Dietary and nutritional factors

Aspirin supplementation

Exercise

Induction of paternal tolerance

Administration of immune factors



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.



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.



LIVER DISEASE

Unique liver disorders of pregnancy are:

HYPEREMESIS GRAVIDARUM :

CHOLESTASIS OF PRAGNANCY:

F ATTY LIVER OF PRAGNANCY :



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



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.



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.



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.



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



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.



FETAL ABNORMALITIES

NEUR AL TUBE DEFECT :

It is a serious abnormality occurs in early

embryonic development.

Causes :

Anencephaly

Spinabifida

Encephalocele



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.



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



OTHER DEFECTS

Preterm delivery

Fetal lung maturity

pregnancy disorders

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