ANANCEPHALY

 ANANCEPHALY:

Out line 

Diagnosis 

Prevention 

Mangment 

Complication 

DIAGNOSIS:

In early pregnancy, i.e. around 13 weeks of gestation, there is an increased level of alpha-fetoprotein in amniotic fluid and/or maternal serum.

PREVENTION:

To prevent the occurrence of neural tube defects, supplementation with folic acid in the dosage of 4 mg daily must be started 1 month prior to conception.

MANAGEMENT:

If the diagnosis of anencephaly has been confirmed before 20 weeks of gestation, pregnancy may be terminated after adequate counseling of the parents because this congenital anomaly is incompatible with extrauterine life.

Prostaglandin E2 gel may be required in cases  which are refractory to stimulation of oxytocin. Shoulder dystocia can be managed by cleidotomy

COMPLICATIONS:

DURING PREGNANCY

- Hydramnious 

-malpresentation(face, breech, )

- premature labour

Tendency for post maturity

DURING LABOUR:

-shoulder dystocia

-obstructed labour

OVARIAN CYST

 

-

 

 

 

DIAGNOSIS:

RISKS FACTORS:

• Infertility treatment - Patients being treated for infertility by ovulation induction with gonadotropins or other agents, such as clomiphene citrate or letrozole, may develop cysts as part of ovarian hyperstimulation syndrome

• Tamoxifen - Tamoxifen can cause benign functional ovarian cysts that usually resolve following discontinuation of treatment

• Pregnancy - In pregnant women, ovarian cysts may form in the second trimester, when hCG levels peak

• Hypothyroidism - Because of similarities between the alpha subunit of thyroid-stimulating hormone (TSH) and hCG, hypothyroidism may stimulate ovarian and cyst growth 

• Maternal gonadotropins - The transplacental effects of maternal gonadotropins may lead to the development of neonatal and fetal ovarian cysts.

• Cigarette smoking - The risk of functional ovarian cysts is increased with cigarette smoking; risk from smoking is possibly increased further with a decreased body mass index (BMI).

• Tubal ligation - Functional cysts have been associated with tubal ligation sterilizations.

  FIBROIDS:

  

   

  TYPES OF FIBROID

  Depending on their location, different types of fibroids may be classified as:

  • Interstitial or intramural

  • Subperitoneal or subserous

  • Submucous.

  RISK FACTORS:

  • Heredity: Patients with a positive family history of fibroid, especially in the first degree relatives (mother or sister) are especially at an increased risk of developing fibroids.

  • Race: Black women are more likely to have fibroids than the women of other racial groups.

  • High estrogen levels: High estrogen levels predispose a woman to develop fibroids. Some factors which may be responsible for an increased.

  risk of fibroids related to hyperestrogenism are as follows:

  – Exposure to OCPs at the age of 13–16 years is associated with a high risk for development of uterine fibroids.

  – Obesity increases the risk probably due to higher levels of endogenous estrogen.

  – Smoking reduces the risk of fibroids by decreasing the levels of endogenous estrogen.

  – Childbearing during the reproductive years (25–29) provides the greatest protection against myoma development by producing amenorrhea (thereby reduced estrogen levels) during pregnancy.

  • There is a positive association between fibroids and the pelvic inflammatory disease

  ENDOMETRIOSIS:

  

  Chocolate cyst of ovaries represents the most important manifestation of endometriosis

  SITES:

  The common sites for the occurrence of endometriosis include the ovaries, the pouch of Douglas, uterosacral ligaments and serosal surface of the uterus, bladder, sigmoid colon, appendix, cecum, uterine scars, etc. The ovary is the most common site for endometriosis.

  APPEARANCE OF ENDOMETRIOTIC LESION:

  • Brown/black (Powder burn/gunmetal lesions)

  • Clear (atypical) nodules

  • Peritoneal windows

  • Classic blue-black blisters

  • Flame-like blisters

  • White plaques

  • Macroscopically normal peritoneum may have microscopic endometrial glands

  MECHANISM OF INFERTILITY IN ENDOMETRIOSIS:

  The possible mechanisms for infertility in patients with endometriosis are as follows:

  • Deformity of pelvic organs

  • Alteration of peritoneal environment

  • Increase in macrophages

  • Reduced sperm motility

  • Phagocytosis of spermatozoa

  • Interference with oocyte pickup.

  ENDOMETRIAL CARCINOMA:

  

  COUVELAIRE UTERUS

  

This condition has been found to be associated with severe forms of concealed placental abruption and is known as the Couvelaire uterus. However, Couvelaire uterus per se is not an indication for cesarean hysterectomy. In this case, cesarean hysterectomy was performed to save the patient’s life due to severe uncontrollable PPH.

HYDATIDIFORM MOLE/VESICULAR MOLE:

This is a specimen showing a cluster of grayish/pinkish-brown colored, translucent vesicles/grape-like structures, which are connected to each other by strands of connective tissues. The vesicles may be of variable size, varying in diameter from 2 cm to 5 cm. The vesicles are filled with a clear fluid, rich in hCG.

The hydatidiform moles could be of two types: partial and complete mole.

CLASSIFICATION:

Benign forms (90%)
• Complete hydatidiform mole
• Partial hydatidiform mole

Malignant forms (10%)
• Invasive mole
• Choriocarcinoma
• Placental site trophoblastic tumor
• Epithelioid trophoblastic tumor

FIGO STAGING OF VESICULAR MOLE:

Stage I Disease confined to the uterus

Stage II GTN extends outside the uterus but is limited to the genital structures (adnexa, vagina, broad ligament)

Stage III GTN extends to the lungs with or without genital tract involvement

Stage IV All other metastatic sites.

CLINICAL EXAMINATION OF VESICULAR MOLE:

GENERAL PHYSICAL EXAMINATION:

• Signs suggestive of preeclampsia: Signs suggestive of preeclampsia such as high blood pressure, proteinuria, and swelling in ankles, feet and legs, may be observed.

• Signs suggestive of hyperthyroidism: Signs including warm, moist skin, heat intolerance, restlessness, tremors in hands, etc. may be observed.

• Signs suggestive of early pregnancy: These may include signs like amenorrhea, positive pregnancy test, breast changes suggestive of pregnancy, etc.

• Extreme pallor: The patient may appear extremely pale. The pallor may be disproportionate to the amount of blood loss due to concealed hemorrhage.

SYSTEMIC EXAMINATION:

Abdominal Examination

• On the abdominal examination the uterine size is usually abnormal in relation to the period of gestation. In most of the cases of CHM the uterine size may be larger than the period of gestation, whereas in cases of PHM the uterine size may be smaller in relation to the period of gestation.

• The uterus may appear doughy in consistency due to lack of fetal parts and amniotic fluid.

• Fetal movements and fetal heart sounds are absent.

• Fetal parts are usually not palpable.

• External ballottement is absent.

Vaginal Examination

• There may be some vaginal bleeding or passage of grape like vesicles.

• Internal ballottement cannot be elicited due to lack of fetus.

• Unilateral or bilateral enlargement of the ovaries in form of theca lutein cysts may be palpable.