_Molar Pregnancy性葡萄胎妊娠课件.ppt

* * * * * * * * * * * * * * * * History Heavy vaginal bleeding ?which has been stopped. lower abdominal pain which follows the bleeding ?which has been stopped. Examination The cervix is closed U/S showed empty uterine cavity or PROP - Evacuation curettage in the presence of RPOC. Post-abortion management. Retention of products for several weeks No increase in fundal height Absence of FHT Regressions of signs of pregnancy Loss of wight Most of missed abortions are diagnosed accidentally during routine U/S in early pregnancy . In some cases there may be a history of : Episodes of mild vaginal bleeding Regression of early symptoms of pregnancy . Stop of fetal movements after 20 weeks gestation. Examination The uterus may be small for date U/S (which is essential for diagnosis ) diagnosed if two ultrasound ( T/V or T/A) at least 7days apart showed an embryo of 7 weeks gestation ( CRL 6mm in diameter and gestational sac 20 mm in diameter ) with no evidence of heart activity . CBC , blood grouping Platelets count, to exclude the risk of DIC NB : DIC does not occur before 5 weeks of missed abortion or IUFD and if occurred will be of mild grade Options of treatment Conservative treatment: ? if left alone spontaneous expulsion will occur Surgical evacuation of the uterus; by D C: Indicated in 1st trimester missed abortion Medical termination of pregnancy: by Misoprostol (PGE1) Cytotec: Indicated in 1st 2nd trimesters missed abortions. Cytotec vaginal ( is the best) or oral tab. 200 μg, 2 tab/ 3 hrs/ up to 5 doses daily, which can be repeated next day if there is no response in the first day Subsequent surgical evacuation is needed in cases of RPOC The main side effects of cytotec are nausea, vomiting and fever.? Post-abortion management. It is due to an early death and resorption of the embryo with the persistence of the placental tissue It is diagnosed if two ultrasound ( T/V or T/A) at least 7 days apart showed after 7 week