Common Problems In Pregnancy
There are so many problems that can arise during pregnancy, We shall treat only a few of them here.
Formal Problems In Pregnancy
- In the first trimester, the common problems are vomiting and bleeding.
- In the second trimester it hemoglobin and anemia especially if the woman had low hemoglobin just before regnancy.
- I the third trimester the problems are bleeding pre-eclampsia and eclampsia, premature rupture of the membrane, and preterm labor.
Bleeding that occurs in a pregnant woman before the 28th week is termed abortion.
Definition of Abortion
By definition, abortion is the expulsion of products of conception before legal viability.
In Nigeria, the gestational age of legal viability is 28 weeks. It is usually associated with reduced progesterone secretion.
Cause Of Abortion
The causes of abortion may be due to defective implantation of the fetus, congenital malformation of the fetus, psychological problems of the pregnant woman, general diseases in the pregnant woman such as fever and syphilis, and uterine abnormalities such as retroversion, co-existing fibroid, and cervical incompetence.
Although not established defective sperm has also been implicated. Abortion occurs due to the separation of the ovum by minute hemorrhages in the decidual.
The altered environment of the uterus Stimulates onset of uterine contraction with subsequent expulsion.
Types Of Abortions
All types of abortion are characterized by a period of amenorrhea followed by vaginal bleeding with or without abdominal pain. Classification is based on finding when the patient first present in the clinic.
A period of amenorrhoea followed by slight vaginal bleeding with or without abdominal pain.
On examination, the fundal height corresponds with the date. The cervical Os is closed and the cervix is uneffaced.
- Bed rest with reassurance
- Mild sedative such as valium 5mg b.d X⅝
If there is abdominal pain with bleeding;
- Im Baralgin 5cc stat.
- Im Primolut depot (progesterone) 1 ampoule dly x¾
- Tab Baralgin – tds ¾
- Tab Ventolin 4mg ids x⅝
if bleeding continues after the above give the primolut depot one ampoule weekly x doses.
Do an ultrasound scan to rule out the mole, blighted ovum, and fetal abnormality.
Amaka is a twenty five year old pregnant woman. Her pregnancy is ten weeks old. She presented in your clinic with
a story of slight vaginal bleeding and slight abdominal discomfort for the past four hours. She had earlier the same day attended antenatal clinic without any complaint.
When the midwife examined her, the fundal height corresponded with the date, and the cervical Os was closed. She looked very worried.
What is her problem?
Read answer below
What will be your line of management?
- Answer to 1 and 2 Questions :
Based on the vaginal bleeding, closed cervical Os in a ten week old pregnant woman, diagnosis of Threatened abortion is entertained
The patient must as a rule beadmitted for bed rest. She has to be reassured, thatall will be well
- 1m Primolut Depot one ampole daily x 3/7
- 1m Baralgin 5cl stat
- Tab Baraiginti tds x 3/7
- Tab Ventolin 4mg tds x 5/7
- Tab Diazepam 5mg bdx 5/7