1. Abnormal Pregnancy
CAPT Mike Hughey, MC, USNR

2. Incidence of Miscarriage
1 in every 6 pregnancies
Risk of subsequent miscarriage 1/6
Bedrest will not prevent miscarriage but may postpone it

3. Causes of Miscarriage 60% chromosome abnormalities
30% placental malformation
10% miscellaneous, but not: -trauma -climbing mountains -intercourse -medication -too much activity, etc.

4. Threatened Abortion 1 in every 4 pregnancies 1st TM bleeding/cramping
Half will abort, Half will be OK
Bedrest will not prevent abortion but may postpone it.

5. Complete Abortion Passage of all tissue Rest for a day or two
Ergotrate, Oxytocin
Antibiotics
Rhogam
D&C?
9-week spontaneous complete abortion

6. Incomplete Abortion: Diagnosis
Some tissue remains behind
Continuing bleeding/cramping
Tissue in cervical os
Uterus tender
Fever if infection present
Ultrasound helpful if available

7. Incomplete Abortion: Treatment
Convert it to a Complete Abortion
If tissue visible in the os, remove it
Ergotrate, Oxytocin
Antibiotics
Rhogam
D&C
Tissue removed from os
Tissue still inside uterus

8. Inevitable Abortion No tissue has been passed
Cervix dilated or hemorrhage
Ergotrate, Oxytocin
Antibiotics
Rhogam
D&C

9. Septic Abortion Any abortion complicated by infection
Fever, Tenderness
Ergotrate, Oxytocin
Antibiotics
MEDEVAC
D&C

10. Septic Abortion: Antibiotics
Clindamycin & Gentamicin IV
Flagyl & Gentamicin IV
Cefoxitin IV

11. Unruptured Ectopic Pregnancy
+ HCG
Unilateral pelvic pain and tenderness
±Pelvic mass?
DD: CL cyst, Appy, PID
Lie still
MEDEVAC

12. Ruptured Ectopic: Diagnosis
Pelvic & right shoulder pain
Sudden onset
Shock
Positive pregnancy test
Rebound & Rigidity late
Ultrasound
Culdocentesis

13. Ruptured Ectopic: Treatment
Surgery
MEDEVAC
IVs, oxygen, lie still
Maintain urine output (Foley)
MAST suit?

14. Blood Transfusion O Negative blood Blood collection bags
Direct Donor to Patient #16 needle feet gravity feed minutes
Have a plan before you need it

15. Placental Abruption >20 weeks
Uterine pain, tenderness, and contractions
±Bleeding
Coagulopathy
Lie still, IV Fluids
MEDEVAC, Cesarean Section

16. Placenta Previa >20 weeks Painless vaginal bleeding
No pelvic exam unless instructed by an OB- GYN
Pelvic exam may cause torrential hemorrhage, exsanguination and death within minutes
Rest, IVs, MEDEVAC

17. Toxemia of Pregnancy Elevated BP (>140/90)
Proteinuria (>300 mg in 24 hours)
Weight Gain (>2 pounds/week)
Swelling (?)
Increased reflexes (Clonus)

18. Pre-Eclampsia BP, Protein Stable and unstable Risk of IUGR
Risk of Abruption
Risk of maternal seizures
Risk of HELLP syndrome
Hemolysis
Elevated Liver Enzymes
Low Platelets
Naval Hospital Jacksonville

19. Eclampsia Siezures Risk of maternal death Risk of HELLP syndrome
Hemolysis
Elevated Liver Enzymes
Low Platelets
Naval Hospital Guam

20. Treatment of Toxemia of Pregnancy
Delivery is definitive treatment
If delivery is to be postponed (prematurity), then consider hospitalization for unstable patients
Magnesium sulfate
Watch for HELLP syndrome