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Chapter 29: Additional Health Conditions

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1 Chapter 29: Additional Health Conditions

2 Role of the Immune System
Collection of disease fighting cells that neutralizes foreign substances Illness results when immune system does not neutralize foreign substances (antigens) Cell-mediated response, humoral immune response (B-cells that produce antibodies), or nonspecific immune response (inflammation) Auto-immune response against the body leads to damage of body’s own tissues

3 Viral Infections Rhinovirus (Common Cold) Etiology
Over 100 different rhinoviruses Transmitted by either direct or indirect contact (cough, sneeze, speaking, touching contaminated article)

4 Sign and Symptoms Management
Begins w/ scratchy, sore throat, stopped-up nose, watery discharge and sneezing Second batch may produce thick yellow nasal discharge, watering eyes, mild fever, sore throat, headache, malaise, myalgia, dry cough Secondary - laryngitis, tracheitis, acute bronchitis, sinusitis, and otis media Management Symptomatic treatment (may last 5-10 days) Non-prescription cold medications Eat a balanced diet, consume 64 oz. of water Avoid emotional stress and extreme fatigue

5 Influenza (Flu) Etiology Sign and Symptoms Management
Caused by myoviruses (A, B, C) Type A is most common Virus enters through cell genetic material Sign and Symptoms Fever ( degrees F), chills, cough, headache, malaise, and inflamed respiratory mucous membrane w/ coryza General aches and pains, headache becomes worse Weakness, sweating, fatigue may persist for many days Management Bed rest and supportive care Symptomatic care should be avoided by those under age 18 ( Reye’s syndrome) Steam inhalation, cough medicines, and gargles

6 Infectious Mononucleosis
Etiology Epstein-Barr virus (member of herpes group) that has incubation period of 4-6 weeks Transmitted through saliva Sign and Symptoms First 3-5 days -severe fatigue, headache, loss of appetite and myalgia Days fever, swollen lymph nodes and sore throat (50% will experience enlarged spleen) Possible jaundice, skin rash, puffy eyelids Management Supportive symptomatic treatment Acetaminophen for headache, fever and malaise Resume training after 3 weeks after onset if spleen not markedly enlarged/painful, athlete is afebrile, liver function is normal, and pharyngitis is resolved

7 Rubella (German Measles)
Etiology Highly contagious viral disease (childhood disease) Results days after exposure May cause developmental difficulties for fetus in pregnant females Sign and Symptoms Temperature elevation, sore throat, drowsiness, swollen lymph glands and red spots on palate Rash Management Prevent by early childhood immunization Measles, mumps, rubella vaccine (MMR)

8 Rubeola (Measles) Etiology Sign and Symptoms Management
Childhood disease Incubation time of 10 days following exposure Sign and Symptoms Sneezing, nasal congestion, coughing, malaise, photophobia, spots in mouth, conjunctivitis, and elevated fever (rash appears - causes itching) Management Inoculation w/ MMR vaccine at months and 4-6 years of age Bed rest, isolation in dark room and use of antipyretic and anti-itching medication

9 Mumps (Parotitis) Etiology Sign and Symptoms Management
Contagious viral disease that results in inflammation of parotid and salivary glands Appear in days following exposure Sign and Symptoms Malaise, headache, chills and moderate fever Pain in neck - swelling of glands may last up to 7 days Pain w/ jaw motion and swallowing; increased or decreased saliva production Management Varicella-zoster immune globulin w/in 96 hours of exposure will prevent clinical symptoms in normal healthy children Acyclovir meds should be administered to adolescents and adults w/ in 24 hours of exposure Anti-itching medications to prevent scratching

10 Respiratory Conditions
Sinusitis Etiology Stems from upper respiratory infection caused by a variety of bacteria Sign and Symptoms Nasal mucous swell and block ostium of paranasal sinus Painful pressure occurring from accumulation of mucus Skin over sinus may be swollen and painful to the touch Headache and malaise; purulent nasal discharge Management If infection is purulent, antibiotics may be warranted Steam inhalation and other nasal topical sprays w/ oxymetazalone can produce vasoconstriction and drainage

11 Tonsillitis Etiology Sign and Symptoms Management
Acute inflammation and bacterial infection of tonsil epithelium Sign and Symptoms Tonsil appear red, swollen, w/ yellow exudate in pits Pain w/ swallowing, high fever and chills, headache and neck pain Sinusitis, otitis media, tonsillar abscesses may also develop Management Culture to check for streptococcal bacteria and antibiotics for 10 days Gargling w/ saline water, liquid diet, and antipyretic medication Frequent bouts of tonsillitis may necessitate removal

12 Seasonal Atopic (Allergic) Rhinitis
Hay fever, pollinosis from airborne pollens Etiology Reaction to pollen - airborne fungal spores (allergens) resulting in allergic antibodies causing the release of histamine Sign and Symptoms Eyes, throat, mouth and nose begin to itch, followed by watering eyes, sneezing and clear watery discharge Sinus type headache, emotional irritability, difficulty sleeping, red & swollen eyes and nasal mucus membranes, and wheezing cough Management Oral antihistamines and decongestants

13 Pharyngitis (sore throat)
Etiology Caused by virus or streptococcus bacteria Transmitted by direct contact of infected person or one who is a carrier Sign and Symptoms Pain w/ swallowing, fever, inflamed and swollen glands, malaise, weakness and anorexia Mucus membrane may be inflamed and covered w/ purulent matter Management Throat culture Topical gargles and rest Antibiotic therapy for streptococcal infection

14 Acute Bronchitis Etiology Sign and Symptoms Management
Infectious winter disease that follows common cold or viral infection Fatigue, malnutrition or becoming chilled could be predisposing factors Sign and Symptoms Upper respiratory infection, nasal inflammation and profuse discharge, slight fever, sore throat and back muscle pains Fever lasts 3-5 days while cough can last 2-3 weeks Yellow mucus indicates infection Pneumonia can complicate condition Management Avoid sleeping in cold environment, avoid exercise in extreme cold w/ protection Rest until fever subsides, drink 3-4 quarts of water daily, ingest antipyretic analgesic, cough suppressant, and antibiotic

15 Pneumonia Etiology Sign and Symptoms Management
Infection of alveoli and bronchioles from viral, bacterial or fungal microorganisms Irritation from chemicals, aspiration of vomitus Alveoli fill w/ exudate, inflammatory cells and fibrin Sign and Symptoms Bacterial will cause rapid onset High fever, chills, pain on inspiration, decreased breath sounds, rhonchi on auscultation, coughing of purulent, yellowish sputum Management Treat w/ antibiotics; perform deep breathing exercises to removal of sputum through heavy coughing Analgesics and antipyretics may be useful for controlling pain and fever

16 Bronchial Asthma Etiology Sign and Symptoms
Caused by viral respiratory tract infection, emotional upset, changes in barometric pressure or temperature, exercise, inhalation of noxious odor or exposure to specific allergen Sign and Symptoms Spasm of smooth bronchial musculature, edema, inflammation of mucus membrane Difficulty breathing, may cause hyperventilation resulting in dizziness, coughing, wheezing, shortness of breath and fatigue

17 Exercise-Induced Bronchial Obstruction (Asthma)
Etiology Brought on by exercise w/ exact cause unknown Metabolic acidosis, post-exertional hypocapnia, stimulation of tracheal irritant receptor, adrenergic abnormalities, defective catecholamine metabolism and psychological factors, loss of heat and water, sinusitis can also trigger Sign and Symptoms Airway narrowing due to spasm and excess mucus production Tight chest, breathlessness, coughing, wheezing, nausea, hypertension, fatigue, headache, and redness of skin May occur w/in 3-8 minutes of exercise

18 EIA (continued) Management
Regular exercise, appropriate warm-up and cool down, w/ intensity graduated Inhaled bronchodilators may be useful Exercise in warm, humid environment

19 Cystic Fibrosis Etiology Sign and Symptoms Management
Genetic disorder that can manifest as obstructive pulmonary disease, pancreatic deficiency, urogential dysfunction and increased electrolyte sweating Cause of severe lung disease w/ life expectancy of about 30 years Sign and Symptoms Bronchitis, pneumonia, respiratory failure,gall bladder disease, pancreatitis, diabetes and nutritional deficiencies High production of mucus Management Drug therapy to slow progress of disease (ibuprofen) Antibiotics to control pulmonary disease Consistent postural drainage to mobilize secretions High fluid intake to thin secretions and use of humidifier

20 Muscular Disorders Duchenne Muscular Dystrophy Etiology
Hereditary disease causing degeneration of skeletal muscle (gradual replacement of muscle w/ adipose and connective tissue - decreases circulation and perpetuates condition) Sign and Symptoms In children, exhibited by frequent falls, difficulty standing Muscles tend to shorten as they atrophy, causing scoliosis and other postural abnormalities Management Cannot be cured; consistent exercise can be used to retard atrophy Ambulation w/ braces until the individual is confined to a wheelchair Death generally occurs by age 20

21 Myasthenia Gravis Etiology Sign and Symptoms Management
Autoimmune disease where antibodies attack synaptic junctions Deficiency in acetylcholine producing early fatigue Often occurs in females age 20-40 Sign and Symptoms Drooping of upper eyelids and double vision due to weakness in extraocular muscles Difficulty chewing and swallowing, weakness of extremities and general decrease in muscle endurance Management Treat w/ drugs that inhibit breakdown of acetylcholine Corticosteroids can be used to suppress immune system - reducing production of antibodies that destroy acetylcholine

22 Nervous System Disorders
Meningitis Etiology Inflammation of meninges surrounding spinal cord and brain Caused by infection brought on by meningococcus bacteria Sign and Symptoms High fever, stiff neck, intense headache, sensitivity to light and sound Progress to vomiting, convulsions and coma

23 Meningitis (continued)
Management Cerebrospinal fluid must be analyzed for bacteria and WBC’s. If bacteria is found isolation is necessary for 24 hours (very contagious), antibiotics must be administered immediately Monitored closely in intensive care unit

24 Multiple Sclerosis Etiology Sign and Symptoms Management
Auto-immune inflammatory disease of CNS that causes deterioration and damage to myelin sheath, disrupting nerve conduction Sign and Symptoms Blurred vision, speech deficits, tremors, muscle weakness and numbness in extremities Tremor spasticity, neurotic behavior and mood swings May progress slowly or may be acute attack followed by partial or complete temporary remission Management Deal w/ symptoms as they occur Avoid over exertion, extreme temperatures, and stressful situations Establish exercise routine Drug therapy to slow progression

25 Amyotropic Lateral Sclerosis (Lou Gehrig’s Disease)
Etiology Sclerosis of lateral regions of spinal cord along w/ degeneration of motor neurons and significant atrophy Sign and Symptoms Difficulty in speaking, swallowing and use of hands Sensory and intellectual function remain intact Rapid progression of atrophy resulting in paralysis Management No cure Even after incapacitation, normal intellectual function remains; inability to communicate feelings and ideas

26 Reflex Sympathetic Dystrophy
Etiology Abnormal excessive response of sympathetic portion of autonomic nervous system following injury Sign and Symptoms Commonly seen in hands and feet following immobilization of injured part (change to bone, connective tissue, blood vessels and nerves) Develop extreme hypersensitivity to touch, redness, sweating, burning pain, swelling w/ palpable tightness and shining skin; atrophy Possible psychologic depression

27 Reflex Sympathetic Dystrophy (continued)
Management Early recognition and intervention is critical Must direct sympathetic response (nerve block) AROM exercise through pain free range, use modalities to modify pain and reduce swelling Anti-depressant drugs may be necessary for chronic conditions

28 Blood and Lymph Disorders
Iron Deficiency Anemia Etiology Prevalent in menstruating women and males age 7-14 Three things occur during anemia Small erythrocytes Decreased hemoglobin Low ferritin concentration (compound that contains 23% iron) GI loss of iron in runners is common Aspirin and NSAID’s may cause GI bleeding and iron loss Menstruation accounts for most iron lost in women Vegetarian athletes may also be deficient in intake relative to iron loss

29 Sign and Symptoms Management
First stage of deficiency, performance declines Athlete may feel burning thighs and nausea from becoming anaerobic Ice cravings are common Serum ferritin levels must be assessed Mean corpuscular volume and relative size of erythrocytes must be checked Management Eat a proper diet including more red meat or dark poultry; avoid coffee and tea (hamper iron absorption) Consume vitamin C (enhance absorption) Take supplements (dependent on degree of anemia)

30 Runners’ Anemia (hemolysis)
Etiology Caused by impact of foot as it strikes the surface Impact destroys normal erythrocytes w/in vascular system Sign and Symptoms Mildly enlarge cells, increase in circulatory reticulocytes and decreased haptoglobin (bound to hemoglobin) Varies according to training Management Run on soft surfaces, wear well cushioned shoes and run w/ light feet

31 Sickle-Cell Anemia Etiology
Hereditary hemolytic anemia - RBC’s are sickle or crescent shaped (irregular hemoglobin) Less ability to carry oxygen, limited ability to pass through vessels, causing clustering and clogging of vessels (thrombi) Severe cases can result in death if embolus develops and travels to lungs Exercise factors - 1)acidosis, 2) hyperthermia, 3)dehydration, 4) severe hypoxemia Can be brought on by high altitudes

32 Sickle Cell Anemia (continued)
Sign and Symptoms Fever, pallor, muscle weakness, pain in limbs Pain in upper right quadrant indicating possible splenic infarction Headaches and convulsions are also possible Management Provide anticoagulants and analgesics for pain

33 Hemophilia Etiology Sign and Symptoms Management
Hereditary disease caused by absence of clotting factors Prolonged coagulation time, failure of blood to clot and abnormal bleeding Sign and Symptoms Physical exertion can cause bleeding into muscles and joints -- may be extremely painful Joints may become immobilized Management If bleeding occurs, athlete should be taken to a medical care facility No cure Clotting factors have been developed to control bleeding for several days Avoid trauma and wear medical alert bracelet

34 Lymphangitis (blood poisoning)
Etiology Inflammation of lymphatic channels Caused by streptococcal bacteria Sign and Symptoms Usually occurs in extremities Deep reddening of the skin, warmth, lymphandentitis and raised border over affected area (particularly in case of infection) Chills and high fever w/ moderate pain and swelling Management Patient should be hospitalized and vital signs monitored Following evaluation warm compresses should be applied to the extremity Antibiotic administration and fluid intake (restore fluid balance)

35 Diabetes Mellitus Most common forms are Type I (insulin-dependent diabetes mellitus) and Type II (non-insulin-dependent diabetes mellitus) Etiology Result of interaction between physical and environmental factors Involves a complete or partial decrease in insulin secretion

36 Sign and Symptoms Management
IDDM is most commonly seen in childhood with sudden symptoms of frequent urination, constant thirst, weight loss, constant hunger, tiredness, weakness, itchy dry skin and blurred vision NIDDM occurs later in life and is usually associated with being overweight Body either does not produce enough insulin or resist insulin that is being produced Management Monitor and control glucose levels Diet, doses of insulin Vigorous exercise increases peripheral insulin action and enhances glucose tolerance ATC must be aware that extreme temperatures and unpredictable activity levels may require the administration of rapid-acting carbohydrates

37 Diabetic Coma Etiology Sign and Symptoms Management
Loss of sodium, potassium and ketone bodies through excessive urination (ketoacidosis) Sign and Symptoms Labored breathing, fruity smelling breath (due to acetone), nausea, vomiting, thirst, dry mucous membranes, flushed skin, mental confusion or unconsciousness followed by coma. Management Early detection is critical as this is a life-threatening condition Insulin injections may help to prevent coma

38 Insulin Shock Etiology Sign and Symptoms Management
Occurs when the body has too much insulin and too little blood sugar Sign and Symptoms Tingling in mouth, hands, or other parts of the body, physical weakness, headaches, abdominal pain Normal or shallow respiration, rapid heart rate, tremors along with irritability and drowsiness Management Adhere to a carefully planned diet including snacks before exercise

39 Seizure Disorders Defined as recurrent paroxysmal disorder of cerebral function characterized by periods of altered consciousness, motor activity, sensory phenomena or inappropriate behavior caused by abnormal cerebral neuron discharge Etiology For some forms of epilepsy there is genetic predisposition Brain injury or altered brain metabolism

40 Sign and Symptoms Management
Periods of altered consciousness, motor activity, sensory phenomena or inappropriate behavior caused May last 5-15 seconds (petit mal seizure) or longer (grand mal seizure) Include unconsciousness and uncontrolled tonic-clonic muscle contractions Management Individuals that experience daily or weekly seizures should be prohibited from participating in collision sports (blow resulting in unconsciousness could result in serious injury) Must be careful with activities involving changes in pressure Can be managed with medication

41 Hypertension Etiology
Primary hypertension accounts for 90% of all cases with no other disease association Secondary hypertension is associated with kidney disorder, overactive adrenal glands, hormone-producing tumor, narrowing of aorta, pregnancy and medications Long term cases increase the chances of premature mortality and morbidity due to coronary artery disease, congestive heart failure and stroke

42 Sign and Symptoms Management
Primary hypertension is generally asymptomatic until complications arise May cause dizziness, flushed appearance, headache, fatigue, epistaxis and nervousness Management Thorough examination must be performed to determine type of hypertension Primary hypertension can be controlled through lifestyle changes (diet, exercise, weight loss) When conditions associated with secondary hypertension are cured, blood pressure commonly returns to normal

43 Cancer Etiology Condition where cellular activity becomes abnormal and cells no longer perform normal function Cells do not multiply at increased rate but continue to develop ultimately taking over normal tissue Tumors may be benign or malignant Malignancies are classified based on the types of tissue they invade Variety of causes including, ultraviolet radiation, chemicals (tobacco), alcohol, fatty diet, combination of heredity and environmental factors

44 Sign and Symptoms Management
Vary tremendously depending on type of cancer Warning signs include change in bowel and bladder habits, sore throat that does not heal, unusual bleeding or discharge, development of lump in breast or elsewhere, indigestion, change in wart or mole Management Early detection is critical Effective forms of treatment include surgery, radiation and chemotherapy

45 Sexually Transmitted Infections (STI’s)

46 Chlamydia Etiology Sign and Symptoms Management
Caused by bacterial organism Sign and Symptoms May result in pelvic inflammation and is important cause of infertility and ectopic pregnancy in females In males, inflammation occurs along with purulent discharge 7-28 days after intercourse Painful urination and traces of blood in urine, vaginal discharge Can cause conjunctivitis and pneumonia in newborns Management Identify infection and exact organism present Treat with antibiotics

47 Genital Herpes Etiology Sign and Symptoms Management
Caused by type 2 herpes simplex virus Sign and Symptoms Develops 4-7 days following sexual contact Begins to crust days in primary genital herpes and 10 days in secondary Females may be asymptomatic while males will experience itching and soreness Development of lesions Management Herpes and pregnancy No cure just systemic medication (antiviral medications) to lessen early symptoms or the disease

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49 Trichomoniasis Etiology Sign and Symptoms Management
Caused by the flagellate protozoan trichomonas vaginalis Sign and Symptoms Vaginal discharge that is greenish yellow and frothy Causes irritation of the vulva, perineum and thighs Painful urination Males tend to by asymptomatic but may experience purulent urethral discharge Management 2 grams of metronidazole cures up to 95% of cases in women Males require 500mg twice daily for 7 days Complete cure is required before engaging in intercourse

50 Genital Candidiasis Etiology Sign and Symptoms Management
Transmitted through sexual activity and appear as warts on the glans penis, vulva or anus Sign and Symptoms Cauliflower-like wart or can be singular Soft, moist pink or red swellings that develop cauliflower-like head May be mistaken as secondary syphilis or carcinoma Management When moist % polophyllin Dry warts - may be frozen with liquid nitrogen

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52 Gonorrhea (clap) Etiology Sign and Symptoms Management
Caused by organism infection - gonococcal bacteria which is spread through intercourse Sign and Symptoms In men - experience tingling of urethra followed by 2-3 hours of greenish yellow discharge and painful urination 60% of women are asymptomatic Females will experience vaginal discharge May result in sterility if not treated or arthritis Management Penicillin Avoid sexual contact until it is known that the disease is no longer active

53 Syphilis Etiology Sign and Symptoms
A spirochete bacteria is the organism related to syphilis and enters body through mucous membranes or skin lesions Sign and Symptoms 4 stages Incubation is usually 3-4 weeks but could be anywhere from 1-13 weeks; painless chancre or ulcer forms that health w/in 4-8 weeks (can occur on penis, urethra, vagina, cervix, mouth, hand, foot or around eye) Secondary stage occurs 6-12 weeks after initial infection and is characterized by a rash, lymph swelling, body aches, mild flu-like symptoms and possible hair loss Latent syphilis is characterized by no or few symptoms - but if untreated it may result in tertiary syphilis

54 Sign and Symptoms Management Penicillin is used for all stages
Late stage is characterized by deep penetration of spirochetes that damage skin, bone, cardiovascular system and nervous system Late stage may develop w/in 3-10 years of infection and cause neurosyphilis - muscle weakness, paralysis and various types of psychoses Management Penicillin is used for all stages Other drugs may be required due to increased resistance

55 Menstrual Irregularities and the Female Reproductive System
Physiology of the Menstrual Cycle Menarche Onset of menses and puberty normally occur between ages 9-17 Female becomes capable of reproduction May be delayed through strenuous sports training

56 Menstrual Cycle Irregularities
Menstruation 28 day cycle that consist of follicular and luteal phases (each lasting ~14 days) Result of cyclic hormone pattern Follicle stimulating hormone stimulates maturation of ovarian follicle while luteinizing stimulates development of corpus luteum and encourages secretion of progesterone and estrogens Progesterone will ultimately inhibit LH Menstrual Cycle Irregularities Strenuous training may alter cycle (25-38 day long cycles) Oligomenorrhea - diminished flow (refers to fewer than 3-6 cycles per year)

57 Amenorrhea Etiology Sign and Symptoms Management
Exercise related is often a hypothalamic dysfunction Gonadotropin-releasing hormone is often deficient Must rule out pregnancy, abnormal reproductive or genital tract as well as ovarian failure and pituitary tumors Sign and Symptoms Complete cessation of menstrual cycle Management Re-establishment of normal hormone levels Thorough medical examination, nutritional counseling, reduction of exercise intensity and emotional stress Estrogen replacement may be considered

58 Dysmenorrhea Etiology Sign and Symptoms Management
Painful menstruation prevalent in active women May be caused by hormonal imbalance, ischemia of the pelvic organs, endometriosis Most common menstrual disorder Sign and Symptoms Cramps, nausea, lower abdominal pain, headache, occasionally emotional lability Management Mild to vigorous exercise that help to ameliorate dysmenorrhea are usually prescribed Continued activity as long as performance levels do not drop

59 The Female Athlete Triad
Etiology Relationship between disordered eating, amenorrhea and osteoporosis Driven to meet standards of sport or to meet a specific athletic image to attain goals Sign and Symptoms Disordered eating - bulimia and anorexia Osteoporosis - premature bone loss in young women, inadequate bone development Management Prevention is key; identify and educate

60 Bone Health Etiology Sign and Symptoms Management
Decrease in bone is seen commonly in older women and is linked to declines in FSH, LH, progesterone, and estrogen Athletic women with irregular menses Sign and Symptoms Increased risk of stress fractures Decreased bone mineral density Management Decrease training volume, increase total caloric intake and increase calcium supplementation Estrogen replacement therapy

61 Contraceptives and Reproduction
Oral contraceptives Should not be used to delay menstruation during competition May result in nausea, vomiting, fluid retention, amenorrhea, hypertension, double vision and thrombophlebitis Use under supervision of a physician Low dose preparations (<50mg of estrogen) provide little risk to healthy women Intrauterine devices Not recommended for adolescents that have not given birth

62 Pregnancy Physical activity and competition can be engaged in up to the 3rd month unless complications present May even be able to continue up through the seventh month Impact on performance No indication that exercise is harmful to the fetal growth patterns Extreme exercise may result in low birth weight

63 Contraindications include
Should avoid activities that involve severe body contact, jarring or falls Contraindications include Pregnancy induced hypertension Pre-term rupture of membranes Pre-term labor during the prior or current pregnancy or both Incompetent cervix or cerclage Persistent second or third trimester bleeding Intrauterine growth retardation

64 Ectopic Pregnancy Etiology Sign and Symptoms Management
Fertilized egg implants outside the uterine cavity due to inflammation of fallopian tubes or mechanical blockage Sign and Symptoms Amenorrhea, tenderness and soreness on affected side, referred pain to shoulder, pallor, possible shock and/or hemorrhaging Management Operative treatment is necessary to terminate nonviable pregnancy and control hemorrhaging


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