Question

INSTRUCTIONS: Research the answers to the following questions.

1. Define the following conditions:
a. ABO incompatibility
b. RH incompatibility
c. Ectopic pregnancy
d. Imminent abortion
e. Disseminated intravascular coagulopathy
f. Habitual abortion

2. Explain the pathophysiology for the following conditions:

a. Pregnancy-induced hypertension
b. Toxoplasmosis
c. Abruptio placenta
d. Gestational trophoblastic disease
e. Placenta previa
f. Vasa previa

3. What is the management or treatment for the following conditions:

a. Ectopic pregnancy
b. PCOS
c. Gestational trophoblastic disease
d. Cytomegalovirus
e. HELLP
f. Precipitate labor

Answer 1

1. Define

a. ABO incompatibility- When people who have one blood type receive blood from someone with a different blood type, it may cause their immune system to react. This is called ABO incompatibility

b. RH incompatibility- Rh incompatibility is a condition that develops when a pregnant woman has Rh-negative blood and the baby in her womb has Rh-positive blood

c. Ectopic pregnancy- A pregnancy in which the fertilised egg implants outside the uterus

d. Imminent abortion- An impending miscarriage indicated by bleeding and pain along with an effaced cervix. There is vaginal bleeding prior to 20 weeks gestation.

e. Disseminated intravascular coagulopathy- Disseminated intravascular coagulation is defined as a serious condition that causes abnormal blood clotting throughout the body's blood vessels.

f. Habitual abortion- is defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.

2. 2. Explain the pathophysiology for the following conditions:

a. Pregnancy-induced hypertension- Pregnancy-induced hypertension is associated with significant elevations in total peripheral resistance, enhanced responsiveness to angiotensin II, and marked reductions in renal blood flow and glomerular filtration rate. This leads to decreased renal pressure natriuresis which leads to hypertension.

b. Toxoplasmosis- After tissue cysts or oocysts are ingested by the cat, viable organisms are released and invade epithelial cells of the small intestine where they undergo an asexual followed by a sexual cycle and then form oocysts, which are excreted. The unsporulated oocyst takes 1 to 5 days after excretion to sporulate (become infective). Although cats shed oocysts for only 1 to 2 weeks, large numbers may be shed.

c. Abruptio placenta- In the vast majority of cases, placental abruption is caused by the maternal vessels tearing away from the decidua basalis, not the fetal vessels. The underlying cause is often unknown. In most cases, placental disease and abnormalities of the spiral arteries develop throughout the pregnancy and lead to necrosis, inflammation, vascular problems, and ultimately, abruption. Because of this, most abruptions are caused by bleeding from the arterial supply, not the venous supply. The accumulating blood pushes between the layers of the decidua, pushing the uterine wall and placenta apart. When the placenta is separated, it is unable to exchange waste, nutrients, and oxygen, a necessary function for the fetus's survival. The fetus dies when it no longer receives enough oxygen and nutrients to survive
d. Gestational trophoblastic disease- Gestational trophoblastic disease (GTD) comprises a heterogeneous group of related lesions arising from abnormal proliferation of trophoblast of the placenta. The pathogenesis of GTD is unique, because the maternal lesions arise from fetal, not maternal, tissue. There is abnormality in chromosomal number during fertilization which contributes to the disease.

e. Placenta previa- Placenta previa is initiated by implantation of the embryo in the lower uterus. With placental attachment and growth, the cervical os may become covered by the developing placenta. This causes abnormal vascularization of the endometrium causing scarring or atrophy. These factors may reduce differential growth of lower segment, resulting in less upward shift in placental position as pregnancy advances.

f. Vasa previa- Vasa previa is present when unprotected fetal vessels traverse the fetal membranes over the internal cervical os. These vessels may be from either a velamentous insertion of the umbilical cord or may be joining an accessory placental lobe to the main disk of the placenta.

3. What is the management or treatment for the following conditions:

a. Ectopic pregnancy- expectant management – your condition is carefully monitored to see whether treatment is necessary

medication – a medicine called methotrexate is used to stop the pregnancy growing

surgery – surgery is used to remove the pregnancy, usually along with the affected fallopian tube

b. PCOS- Medications for PCOS include oral contraceptives and metformin. The oral contraceptives increase sex hormone binding globulin production, which increases binding of free testosterone. Besides this, lowering of insulin resistance vessels via weight loss and even taking metformin 500 mg twice a day can be done. Treatment of hirsutism or acne using spironolactone and flutamide.

c. Gestational trophoblastic disease- The first and foremost step is termination of pregnancy. This will lead to relief of symptoms, and also prevent later complications. Suction curettage is the preferred method of evacuation. Hysterectomy is an alternative if no further pregnancies are wished for by the female patient. In addition to this methotrexate has also been used. Methotrexate and dactinomycin are among the chemotherapy drugs used in GTD. Radiotherapy can also be given in case of metastasis.

d. Cytomegalovirus- Ganciclovir treatment. The drug of choice for treatment of CMV disease is intravenous ganciclovir, although valganciclovir may be used for non-severe CMV treatment in selected case. Other drugs used are valganiciclovir, foscarnet, cidofovir, acyclovir and ganciclovir.

e. HELLP- A combination of the breakdown of red blood cells (hemolysis; the H in the acronym), elevated liver enzymes (EL), and low platelet count (LP) occurring in pregnancy. Treatment generally involves delivery of the baby as soon as possible. This is particularly true if the pregnancy is beyond 34 weeks of gestation. Medications may be used to decrease blood pressure and blood transfusions may be required. Corticosteroids may be used to speed development of the baby's lungs, if it is early in pregnancy. magnesium sulfate to prevent seizures. antihypertensive medication to control blood pressure.

f. Precipitate labor- use of tocolytic agents like magnesium sulphate can be taken although results are not conculusive, general anaesthesia use such as nitrous oxide slows the course of labour. Episiotomy to prevent lacerations and intracranial hemorrhage. Topical antibiotics for prevention of infection related to birth. Lastly, proper examination of fetus to detect any injuries or anomalies.