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OV Also known as À  
OV ÷ sist nt naus a and vomiting of p gnancy that is polong d aft  th fist tim st  o is so
s v  that d hydation, nutitional d fici nci s, acidosis and significant w ight loss occu within
th 1st tim st 

2% in p gnant wom n
-p ak incid nc occus b tw n 8-12 w ks AOG usually  solving in th 16th

OV Êh act pathology is not cl aly und stood
OV ‘l vat d HCG that disupts nomal activity of GIÊ by causing  v s p istalsis
OV Êhyoid dysfunction\psychological st ss ʹ d p ssion, ani ty and int p sonal pobl ms

1V ‘c ssiv vomiting not  li v d by odinay m dications p sisting b yond 12 w ks AOG
2V igns of DHN ʹ thist, dy skin, inc as d puls at , w ight loss, conc ntat d uin and l vat d
h matocit in CBC
3V fluid and l ctolyt imbalanc
4V k tonuia

1V diff  ntial diagnosis ʹ ul out oth  possibl disod s associat d with hyp  m sis by t sts lik
liv  and thyoid functions, uinalysis and CBC (monito blood ch misti s)
2V monito I&O

aV N÷O fo th 1st 24 hous ʹ IVF with add d B vitamin
bV Aft  24 hous ʹ cl a fluid th n small quantiti s of dy toast, cack s, o c  al v y 2 o 3
hous, th n gadually advanc s to a soft di t, th n to DAÊ
cV At hom  tak dy cack s, f qu nt f dings and sips of wat  to avoid gastic povocation
and dist ntion, avoid hot and v y cold food and b v ag s
4V Compl m ntay th apy ʹ i  us of ging  to p l flatus and aoma  li v s naus a
5V administ  anti- m tic dugs as od  d
6V avoid noious stimuli that may p cipitat naus a (tight clothing, ion suppl m nt, spicy foods,
stong odos, loud nois s and bight lights)
7V nough  laation and  st
8V nt al o total pa nt al nutition
9V hospitalization wh n s v  DHN and F and ‘ imbalanc 
ÔV IV fluids (LR)
ÔV Vitamin suppl m nts
ÔV N÷O fo 24-48 hous until naus a subsid s
ÔV Oal intak is stat d aft  pati nt is pop ly hydat d and naus a subsid s
ÔV Giv anti- m tics b fo m als
ÔV Gadual f ding
ÔV mall f qu nt f dings
ÔV Do not foc to at
1V Intaut in Gowth R stiction (IUGR)
2V Low-bithw ight
3V ÷ t m bith

OV Implantation of f tiliz d ovum in a sit oth  than th ndom tial lining of th ut us (outsid
th ut us)
OV 77% to 20% of cas s will suff  a  p at ctopic p gnancy
OV it s at which ctopic p gnancy may occu
aV fallopian tub
bV ovay
cV c vi
dV int stin

 " !#
1V Obstuction
aV chonic salphingitis and p lvic inflammatoy dis as (÷ID), ÊD͛s
bV cong nital malfomations
cV p vious tubal sug y
dV ut in tumo p ssing on th poimal nd of th tub
2V Oth s
aV us of IUDs fo contac ption
bV smoking
cV histoy of ctopic p gnancy
1V  m chanical factos ʹ conditions that d lay th passag of ovum in th oviducts and p v nt
it fom  aching th ut us in tim fo implantation (obstuction)
OV alphingitis
OV ÷ itubal adh sions, kinking and naowing
OV Div ticula fomation
OV ÷ vious ctopic p gnancy
OV ÷ vious tubal op ations
OV Êubal tumos
OV ÷ast induc d abotions
2V Functional factos
OV ‘t nal migations of th ovum
OV  nstual  flu
OV Alt  d tubal motility associat d with us of IUD, pog stin only contac ptiv s,
moning-aft  pill
3V Assist d  poduction
OV Ovulation induction associat d with f tility dugs such as Clomid
OV Gam t intafallopian tansf 
OV In vito f tilization
OV Ovum tansf 
4V Fail d contac ption
OV Oal contac ptiv s
OV Condom and diaphagm
OV Êubal ligation
OV Hyst  ctomy

aV Êubal mo than 95% occu in th fallopian tub
OV Ampulla is th most common sit of implantation 55%, uptu s at 8-12 w ks
OV Isthmic-25%, usually uptu s aly at 6 w ks
OV Fimbial- 17%
OV Int stitial-2%
OV Bilat al- v y a
bV Ovaian-05%
cV Abdominal- 1/15,000 p gnanci s
OV ÷imay ʹ oiginal implantation outsid th tub 
OV  conday- implantation is in tub o ovay th n implant d on th abdom n aft 
OV ÷ gnancy t minat s d p nding on sit of implantation, som cay till t m and
f tus di s, it may b com mummifi d and calcifi d (lithop dion) o an adipoc 
(fatty  plac m nt)
dV C vical

1V Nomal symptoms of p gnancy
2V Vaginal bl ding -painl ss in c vical implantation
3V On -sid d low  abdominal pain ʹ sudd n knif lik pain
4V R f  d should  pain
5V Ai s-t lla  action ʹ ut us will not nlag as in nomal p gnancy
6V Adn al ass o t nd n ss
7V Cull n͛s sign - bluish discoloation aound th umbilicus du to int nal bl ding
8V Had boad lik abdom n
9V hock signs ʹ cyanosis, pallo, cold clammy skin, tachycadia, hypot nsion and oliguia

1V Êansvaginal UÊ 
2V  ial HCG d t mination - in ctopic, HCG is low  than p ct d fo g stational tim and
do s not doubl nomally (HCG doubl s v y 48-72 hous)
3V Culdoc nt sis aspiation of bloody fluid fom cul-d -sac of douglas
4V  um pog st on l v ls ʹ a  sult of g at  than 25 nanogam/ml is usually associat d
with nomal viabl p gnancy A s um l v l of l ss than 5 ng/ml is associat d with abotion
o ctopic
5V Ut in cu ttag ʹ to distinguish non viabl p gnancy o ctopic p gnancy
, if not choionic villi is obtain d fom th ut us, ctopic p gnancy is susp ct d
6V Colpotomy- di ct visualization of oviducts and ovai s
7V Lapaascopy ʹ visualization of p lvis using a fib  optic glass
8V CBC at of falling h matocit can disciminat slow int nal bl ding o sudd n h mohag
of a uptu d tub 
9V ‘l vations in WBC and ul out app ndicitis o ÷ID 
1V Fo unuptu d p gnancy ʹ th ap utic abotion by  thot at (ch mo dug) IV o I
2V aphing ctomy ʹ  moval of tub
3V Ooph  ctomy
4V Hyst  ctomy
5V ÷oducts of conc ption should b compl t ly  mov d to p v nt n w gowth of
tophoblastic tissu

c  & 
  '  (

OV Abnomal polif ation follow d by th d g n ation of th tophoblastic villi

OV Êwo Distinct typ s

)V !%!#%#$
OV Hav only plac ntal pats, foms
wh n a sp m f tiliz s an mpty gg
OV Êh chomosom a ith  46XX o
46XY but a contibut d by only on
pa nt and th chomosom mat ial is
duplicat d
OV It usually l ads to cacinoma

b #!
OV It has 69 chomosom in which th  a
th chomosom s fo v y pai
inst ad of two 23 fom th moth  and
2 s ts fom th fath  Êhis could occu
wh n two c lls f tiliz on gg
OV It a ly l ads to cacinoma

Risk factos
1V High  occu nc in asian
2V Wom n b low 18 and abov 40 y as old
3V Wom n with low socio conomic status who hav low pot in intak
4V Histoy of mola p gnancy

igns and ymptoms

1V Ut us lag  than p ct d fo th duation of th p gnancy
2V Abdominal camping fom ut in dist ntion
3V Vaginal Bl ding
4V Vaginal dischag of cl a, fluid ʹfill d v sicl s
5V / of p clampsia b fo 20 w ks͛ g station
6V  v  naus a and vomiting
7V HCG s um l v ls a abnomally high
8V Ultasound  v als chaact istic app aanc of mola gowth
9V Abs nc of FHR
10Vs/ of an mia

1V uction Cu ttag o dilatation and cu ttag to  mov mol
2V  um hCG monitoing ʹ HCG should b monito d fo 1 y a and should b n gativ 2-8
w ks aft   moval of mol  It is monito d v y 2 w ks until nomal th n monthly fo 6
months th n v y 2 months fo th n t 6 months
3V Ch st  ay may also b don v y 3 months fo 6 months b caus H- mol canc  c lls can
m tastasiz to lungs
4V Oal Contac ptiv us fo 1 y a- th woman is advis d not to g t p gnant y t and pills
should not contain stog n
V  thot at ʹ anti canc  dug fo on y a to p v nt d v lopm nt of malignancy
fV Hyst  ctomy

G stational tophoblastic tumos
OV Choiocacinoma ʹ choionic villi b com s canc  c lls, can b tansf  d to diff  nt
pats of body by ciculation and ymphatic dainag
OV Invasiv mol ʹ c ssiv fomation of tophoblastic villin that p n tat s
myom tium
OV ÷lac ntal sit tophoblastic tumo ʹ canc  c lls aising fom th plac ntal sit

OV Chaact iz d by a painl ss dilation of th c vical os without contactions of th
ut us, dilation of c vi p matu ly (mo than 3 cm), chi f caus of habitual
abotion du to m chanical d f ct that occus in th 2nd to aly 3d tim st 
follow d by polaps d of m mban s into th vagina, uptuation of m mban s and
pulsion of poducts of conc ption
OV 20-25% of all s cond tim st  loss s
AV Cong nital Factos
BV Acqui d Factos
ÔV Inf ction
ÔV Inflammation
ÔV ubclinical ut in activity
ÔV C vical tauma
ÔV Con biopsy o Lat s cond tim st  l ctiv abotion
ÔV ultipl g station

CV Bioch mical/Homonal Factos

1V Inc as d  lain l v ls

1V Associat d findings
aV Histoy of c vical tauma
bV Histoy of  p at d, spontan ous, s cond tim st  t minations
cV ÷ossibly spontan ous uptu of m mban s

2V A common clinical manif station is app ciabl c vical dilatation with polaps d of th
m mban s though th c vi without contactions

1V anually by p lvic amination/int nal amination to ass ss dilatation and ffac m nt
d g
2V Ultasonogaphy to vi w c vical os and canal Diagnosis is mad if dilatation is g at  than
25 cm o l ngth of c vi is shot n d to 20 mm som tim s funn ling is also s n wh  th
int nal potion of int nal os has b gun to ffac 
1V ÷ainl ss vaginal bl ding/pinkish show accompani d by c vical dilatation
2V Ruptu of m mban s and passag of amniotic fluid

1V b d  st
2V avoidanc of h avy lifting
3V abstin nc to s ual activity
4V c vical c clag ʹ sutuing of c vi at aound 14 w ks AOG to p v nt dilatation
( quisit s c vi has not dilat d b yond 3 cm, m mban s a intact, and no vaginal
bl ding and ut in clamping)
aV cdonald- t mpoay and stitch s a  mov d by 38-39 w ks AOG to allow vaginal
d liv y, it is n c ssay to  mov sutu s b fo labo b gins to p v nt lac ations
bV hiodka ʹ p man nt, f tus is d liv  d by C
cV Aft  sutuing
1V B d st fo 24 hous to s v al days
2V Obs v fo bl ding, ut in contactions, and uptu of BOW
3V R pot passag of fluid o signs of uptu d BOW, sutu s th n a  mov d to
p v nt inf ction
4V If contactions occu, Ritodin is giv n to stop it
5V R stict activiti s fo 2 w ks aft  poc du (s )

OV ost common bl ding disod  in aly p gnancy
OV Êh pulsion of th f tus and oth  poducts of conc ption fom th ut us b fo
th f tus is viabl (viability) that is b fo 20 w ks AOG fom L÷ o b fo th
f tus w ighs 500 gams
OV pontan ous abotion occus in 15-20% of  cogniz d p gnancy
#$+!#!- B fo 12 w ks AOG
 +!#! ʹ 12-20 w ks AOG, wh  bl ding is mo lik ly sinc d finitiv plac nta and
blood supply has b gun to fom
+!#- f tus that is abot d w ighing l ss than 500 gams
%#$ʹ zygot abot d b fo p gnancy is diagnos d/ cogniz d
&,!-ʹ small mac at d f tus, som tim s th  is no f tus suound d by fluid insid an
op n sac
,!%! ʹ calcifi d f tus/ mbyo
## . ʹ infant d liv  d having bithw ight of 500-1000 gams

1V D v lopm ntal anomali s ʹ 60% of cas s
2V Chomosomal abnomaliti s
3V Implantation abnomaliti s

+)V #.!#
1V Ag ʹ isk inc as s with inc asing ag
ÔV B low 35 y as old ʹ 15%
ÔV B tw n 35-39 y as old ʹ 20-25%
ÔV B tw n 40-42 y as old ʹ 35%
ÔV Abov 42 y as old - > 50%
2V tuctual abnomaliti s of  poductiv tact
ÔV Cong nital ut in d f cts
ÔV C vical incomp t nci s
3V Inad quat pog st on poduction
4V yst mic inf ction ʹ ub lla vius, cytom galovius, tooplasmosis
5V Chonic mat nal dis as s
ÔV ÷olycystic ovay syndom
ÔV Uncontoll d D
ÔV R nal dis as
ÔV yst mic Lupus ‘ythomatosus
ÔV Unt at d thyoid dis as
ÔV  v  H÷N
6V Ing stion of t atog nic dugs (pohibit d o p scib d)
7V Chonic smoking
8V Ing stion of alcohol
9V ‘posu to adiation and high dos s of caff in

1V H mohag
2V Inf ction/s ptic abotion
3V Diss minat d intavascula coagulation (DIC) if miss d abotion is  tain d b yond 1 month,
common in lat abotion
1V Ê   
 ʹ chaact iz d by camping and vaginal bl ding in aly p gnancy with no
c vical dilatation Êh  is a possibl loss of th poducts of conc ption 25-20 of all p gnanci s hav
som bl ding but only l ss than a half poc d to compl t miscaiag  It may subsid o an
incompl t abotion may follow
$%!light vaginal bl ding, no o mild ut in camping

1V Ask L÷ as if it is mo than 20 w ks AOG, it may b du to plac nta p via and not
abotion, do not do int nal amination
2V Instuct moth  to sav all pads consum d fo amination of pass d mat ials
3V Ass ss pain ʹ usually in th supapubic a a that adiat in th low  back, buttocks,
g nitalia and p in um, if occuing in only on sid , consid  ctopic p gnancy o
uptu d ovaian cyst Wh n th pain subsid s, it may sugg st compl tion of th
4V B d st until 3 days aft  bl ding has stopp d, if bl ding and pain p sist , advis to
go to hospital
5V No coitus up to 2 w ks aft  bl ding stopp d

2V |

 ʹ chaact iz d by bl ding, camping and c vical dilation and th
t mination can not b p v nt d
  $%! mod at to pofus bl ding, mod at to s v  ut in camping,
dilatation of c vi, uptu of m mban s, no tissu has pass d y t
 hospitalization, dilatation and cu ttag , oytocin aft  D and C, motional

3V |    

 ʹ Chaact iz d by pulsion of only a pat of th poducts of conc ption
(usually th f tus) and bl ding occus with c vical dilation
  $%! h avy vaginal bl ding, s v  ut in camping, op n c vi, pasaag of
tissu , UÊ shows that som poducts of p gnancy a still insid ut us

D and C and ut us must  main contact d aft , flat position and massag th
ut us, monito fo should  pain and abdominal pain that may sugg st p foation of ut us,
monito vital signs fo shock/ monito blood loss, monito I and O and blood studi s

4V m   
 ʹ chaact iz d by compl t pulsion of all th poducts of conc ption
  $%!lightvaginal bl ding, abdominal pain and passag of tissu th n no pain
and t nd n ss aft  th passag , no o mild camping, clos d c vi and in UÊ , mpty ut us

 usually n ds no futh  m dical o sugical t atm nt but monito still fo
continuous bl ding o signs of inf ction ʹ th s a indicatos that not all tissu w  p ll d,
 st and no int cous and douching fo upto 2 w ks, RhoGA administation, advis to s k
consultation if with pofus bl ding, s v  p lvic pain, and high gad f v 

5V 
 ʹ chaact iz d by aly f tal intaut in d ath without pulsion of th poducts of
conc ption Êh c vi is clos d and th cli nt may  pot dak bown vaginal dischag 
$%!abs nc of FHÊ, c ssation of s/s of p gnancy (ut in nlag m nt, no HCG
l v l doubling)
ins tion of 20 mg dinoposton (postaglandin) suppositoy in th vagina v y 3-
4 hous as n c ssay to poduc contactions to p l poducts of p gnancy, D and C may b
n d d to  mov fagm nts of plac nta

6V a   
 ʹ is spontan ous abotion of th o mo cons cutiv p gnanci s
c vical c clag , f tility dugs to impov stog n and pog st on poduction fo
b tt  ut in nouishm nt (Clomiph n , ÷ gonal), Aspiin o mini-h pain to p v nt of fibinog n
clot fomation within small blood v ss ls, if caus is du to ut in polyps, tumos and adh sions
co ction of th s conditions b fo p gnancy is again att mpt d, t atm nt of m dical illn ss as
D, L‘, thyoid dis as s, ÊD͛s b fo att mpting p gnancy

7V %+!#!0du to diss mination of bact ia o toins in mat nal ciculation oft n associat d
with induc d abotion by untain d p sons by non st il t chniqu 
  $%!foul sm lling vaginal dischag , ut in camping, f v , chills, p itonitis,
l ukocytosis, s ptic shock
 t at abotion, high dos IV antibiotic th apy (p nicillin, clindamycin and
tobamycin), D and C if incompl t abotion

OV Êh plac nta implants in th low  ut in s gm nt, n a o ov  th c vical os Êh
d g to which it cov s th os l ads to th diff  nt classifications
OV Wh n th plac nta implant d low, th siz and th magin a aff ct d by chang s in
th low  ut in s gm nt sp cially in th 3d tim st  wh n it b gins to st tch and
shot n in p paation fo labo causing t a o b akag in plac ntal attachm nt
OV Êh low  ut in s gm nt is not as muscula as th upp  potion making it unabl
to ffici ntly contact should a bl ding occus du to this b akag 
aV !%%#- ʹ occus wh n th plac nta compl t ly cov s th int nal os
bV #%%#- ʹ occus wh n th plac nta patially cov s th int nal os
cV !1 $ !# !1 %! % %#- ʹ occus wh n th plac ntal bod   ach s
th bod  of th int nal os

1V Conditions that may mak implantation in upp  s gm nt und siabl du to d c as d blood
aV ultipaity
bV ÷ vious mola p gnancy
cV ‘ndom titis
dV ÷ vious C
V Abotion
fV D and C
2V ultipl p gnancy du to adjustm nt fo 2 plac ntas
3V Advanc d mat nal ag , ov  35 y as of ag b caus and old  ut us is not as vascula as
young  ut us
4V D c as d blood supply to ut in wall by smoking, ÷IH, dug abus and diab t s
5V hot umbilical cod fo this will som tim s slid th plac nta to implant in low  s gm nt
du to w ight of f tus
6V Abnomal plac ntas ʹ inc ta and acc ta
7V Lag plac nta
1V Diss minat d Intavascula Coagulation
2V Inf ction
3V Abnomal adh sion of plac nta
4V R nal failu s conday to h mohag and DIC
5V An mia
6V ÷ostpatum h mohag
7V o lac ation
8V F tal ff cts d ath, p matuity, h mohag , an mia, small fo g stational ag , bain

1V udd n/Abupt, Bight  d, painl ss vaginal bl ding-b gins 24 to 30 w ks AOG, bight
bl ding may b int mitt nt o in gush s a ly continuous
2V F tus may assum tansv s li fo som tim s th low implant d plac nta p v nts f tal
h ad to nt  th tu p lvis pop ly
3V D c as d uin output du to h mohag
4V Confim d and diagnos d by UÊ

1V B d  st with bathoom pivil g s
2V Vaginal ams a containdicat d o may b don in doubl s t ʹup (don in th OR)
3V onitoing of blood loss, pain and ut in contactility
4V ‘valuation of FHR
5V onito mat nal V/s
6V Compl t laboatoy valuation
7V Administation of IV Fluids
8V ÷ossibl blood tansfusion
9V ‘valuation of f tal matuity by amnioc nt sis to nabl sch dul of d liv y
10VAdministation of b tam thason to sp d up lung matuity
11VIf woman is in activ labo, tocolytics lik itodin o magn sium sulfat is giv n to stop
contactions, if in vitabl , d liv y is don
12VC is mo p f  d sp cially in total plac nta p via
13VIf vaginal d liv y is possibl (maginal and low) ʹ position is s mi fowl  so f tal h ad can
s v as tamponad fo bl ding, how v  t nd l nbug in l ft lat al  cumb nt position
fo (total/patial) b caus p ssu on th plac nta by f tal h ad aggavat s bl ding
14V÷ostpatum ca  monito fo bl ding and k p ut us contact d, inf ction and an mia and
t at/ manag as appopiat ly

OV Êh p matu s paation of a nomally implant d plac nta aft  th 20th w k of
p gnancy, typically with s v  h mohag 

aV C ntal
bV aginal
cV Compl t
1V Gad 0 ʹ no symptoms, diagnos d aft  d liv y wh n plac nta is amin d
and found to hav  toplac ntal clot
2V Gad 1 ʹ som t nal bl ding, ut in t tany, t nd n ss may o may not
b not d, abs nc of f tal dist ss and shock
3V Gad 2 ʹ t nal bl ding,ut in t tany, ut in t nd n ss, f tal dist ss
4V Gad 3 ʹ int nal and t nal bl ding (mo than 1000 cc), ut in t tany,
mat nal shock, pobably f tal d ath and DIC
1V ild l ss than 1/6 of plac nta is s paat d bl ding may o
may not b p s nt (<250 cc), som ut in iitability with
no f tal dist ss, th  may o may not b vaginal bl ding,
vagu backach
2V od at  1/6-2/3 s paation Dak vaginal bl ding (<1000
mL), with f tal dist ss, ut in t nd n ss
3V  v   mo than 2/3 is s paat d, ut in t nd n ss,
igidity, dak vaginal bl ding (>1000 mL) how v  it may b
abs nt t nally, f tal dist ss and f tal d ath, if s paat d
nti ly- mat nal shock and f tal d ath, s v  pain, DIC
1 Êh caus is unknown
2 Risk factos may includ 
a Ut in anomali s
b ultipaity
c ÷ clampsia - at nal H÷N
d ÷ vious ca saian bith
 R nal and vascula dis as
f Êauma to th abdom n
g ÷ vious thid tim st  bl ding
h Abnomally lag plac nta
i hot umbilical cod
j udd n  l as of AF
3 B havioal factos
a ciga tt smoking, m thamph tamin , cocain abus
b mat nal alcohol consumption (14 o mo dinks p  w k)

1V hap, stabbing pain high in th ut in fundus
2V H avy vaginal bl ding if s paation b gins at plac ntal dg s
3V Conc al d bl ding if th c nt  of th plac nta s paat s fist
4V Ut us fim to boad-lik , t ns o igid
5V s/s of an mia
6V s/s of hypovol mic shock

1V hospitalization
2V FHR monitoing
3V at nal V/ monitoing, I and O monitoing, abdominal cicumf  nc and fundic h ight-
sudd n inc as may indicat int nal bl ding, ut in contactions s conday to  l as of
postaglandins by plac ntal s paation
4V ÷op  positioning ʹ b d st at sid lying position
5V IV Fluid administation ʹ LR is usually giv n at 125 cc p  hou
6V Blood typing and coss matching
7V Oyg n administation
8V No p lvic, abdominal o vaginal amination
9V Administ  p scib d m dications b tham tason , tocolytic th apy (t butalin (itodin ),
gO4) fo mild abuption plac nta but containdicat d in mod at to s v  cas s fo it may
conc al s/s of pop  diagnosis and valuation
10VCa sa an bith Is p f  d
11VVaginal d liv y is possibl if f tus is al ady d ad, th  is minimal bl ding and moth  is stabl


OV pontan ous uptu of th choion and amnion b fo th ons t of labo It is
b li v d that f tal m mban s uptu du to p ssu of ut in contactions and
th physiologic w ak ning wh n th c vi dilat s
OV Occus b tw n 36-40 w ks AOG just b fo tu labo b gins
OV ÷ t m ÷RO R sponsibl fo 30-40% of all p t m d liv i s
OV ÷olong d RO wh n uptu occus mo than 24 hous b fo th bith of th

aV incomp t nt c vi
bV c vicitis ʹ most common caus is inf ction
dV Amnioc nt sis
V ÷lac nta p via
fV Abuption plac nta
gV Hydamnios /ov dist ntion of ut in wall
hV Êauma
iV ultipl g station
jV at nal g nital tact anomali s
kV Ciga tt smoking
lV C clag application

aV Choioamnionitis
bV ndom titis
cV abuption plac nta
aV ÷ matuity
bV N onatal inf ction/s psis
cV F tal hypoia du to cod comp ssion
dV F tal pulmonay hypoplasia
V Facial anomali s
fV Limb position d f cts
gV F tal gowth  stiction

1V Fluid l aking in th vagina
2V Nitazin pap  t st  sult of blu -g n o blu
3V high alpha-f topot in (AF÷) l v l in th vagina
4V may complain constant w tn ss in th und w a
5V c vical dilatation
6V ut in camping
7V p lvic p ssu
8V f ning patt n in micoscopic t st of di d AF

1V hospitalization
2V B d  st to p v nt cod polaps d- if with cod polaps d hav moth  position d in kn
ch st o modifi d t nd l nbug
3V onitoing of mat nal V/ v y 2-4 hous und  nomal conditions, mo f qu ntly if with
s/s of inf ction, monito FHÊ v y hou, vaginal dischag (sm ll, colo, amount) and ut in
contactions (duation, int nsity, f qu ncy, int val)
4V R gula laboatoy valuation
5V ÷ lvic R st͟
6V ÷ophylactic antibiotics o if with inf ction, to t at it
7V B tam thason administation
8V ÷op  p in al ca



$%#!0a blood p ssu  ading in two occasions of at l ast 140/90 o a is of 30 mmHg systolic
and 15 mmHg diastolic Blood p ssu should b tak n in 2 occasions 4-6 hous apat
c!  B÷ 140/90 mmHg d v lops fo th fist tim duing p gnancy, but th  is no
pot inuia and within 12 w ks postpatum th B÷ is nomal
#$  H÷N that d v lops aft  th 20th w k of g station to a p viously nomot nsiv
woman ÷IH includ p clampsia, clampsia and g stational H÷N
#% ʹ is a hyp t nsiv disod  of p gnancy d v loping aft  20 w ks͛ g station and
chaact iz d by d ma, hyp t nsion and pot inuia (300mg/24 hous)

% ʹ is an t nsion of p clampsia and is chaact iz d by ons t of s izu activity

Contibutoy Factos
aV ultipl p gnancy
bV ÷imipaity <20 y as old o >40 y/o
cV ÷ isting dis as s- Diab t s m llitus, collag n vascula dis as , chonic H÷N, chonic  nal
dV Low socio conomic status ʹ inad quat p natal ca
V ÷oo nutition
fV ÷ gnancy complications ʹ H-mol , g stational D, Rh incompatibility
gV H  ditay
hV Black ac

1V No d finit caus
2V G n tic p disposition
3V Autoimmun  action
4V ÷ot in d fici ncy and poo nutition
5V ‘ndoth lin th oy- vasoconstictos

 (accoding to typ )

1V ild p - clampsia
aV B÷ of 140/90 mmHg o high 
bV ÷ot inuia (+1 to +2 by dispticks, 300 mg/24 hous uin coll ction)
cV W ight gain ʹ 2 lb/w k
dV ild d ma in upp  t miti s o fac ʹ digital, d p nd nt d ma
V Liv  nzym s slightly l vat d
gV Uin output is not l ss than 400 mL/24 hous
hV Occasional h adach s
iV DÊR ʹ nomal to +3
jV No pigastic pain

2V  v  p - clampsia
aV B÷ of 160/110 mmHg
bV ÷ot inuia (+2 to +4, 5 g/24 hous uin coll ction)
cV Oliguia
dV C  bal distubanc s
V Cadiopulmonay involv m nt du to pulmonay d ma
fV ‘t nsiv p iph al d ma ʹ pitting d ma +4, g n aliz d d ma
gV H patic dysfunction ʹ liv  nzym s mak dly l vat d
hV o apid w ight gain
iV ‘pigastic pain
jV Hyp  fl ia (+4)
kV ÷hotophobia and visual distubanc s
lV  v  h adach
mV Naus a and vomiting
nV Oliguia

3V ‘clampsia
OV / of p - clampsia to includ 
aV  izu
bV coma

..!. #% %

1V Cadiovascula Chang s
OV d c as d cadiac output du to vasospasm
OV failu of blood volum to pand which nomally occus in p gnancy
OV inc as d l v ls of clotting factos du to damag to ndoth lium of blood v ss ls s conday
to vasospasm
OV abnomal fomation of RBC with shot lif span
2V ndocin and m tabolic chang s
aV inc as d l v ls of  nin, angiot nsin II ( l vat s B÷), aldost on (Na  absoption
and fluid  t ntion), anti-diu tic homon , HCG
bV d ma
3V R nal chang s
OV R duc d  nal p fusion and filtation
OV ‘l vat d c atinin , uic acid and u a (du to inability of kidn y to ffici ntly filt  wast
OV D c as d uin output
OV ÷ot inuia (du to damag to  nal stuctu s s conday to poo p fusion)
1V Abuption plac nta
2V C  bal h mohag and isch mia
3V H patic failu
4V Acut  nal failu
5V ÷ matuity
6V ÷ inatal d ath
7V at nal d ath

1V c ning and aly diagnosis
OV Roll ov  t st
OV Êol anc Hyp baic t st ʹ h lpful fo aly d t ction b fo clinical signs could app a Êh
p gnant woman w as a potabl B÷ cuff and monitos and  cods int mitt nt B÷  adings
ov  a 48 hou p iod
2V Initial hospitalization
OV CBC, BUN c a and uic acid l v ls
OV Liv  function t sts
OV 24- hou uin pot in and c atinin cl aanc d t mination
OV Daily w ight
OV DÊR ass ssm nt
aV 0 ʹ no  spons
bV 1+ diminish d
cV 2+ nomal
dV 3+ bisk  than av ag , possibly d v loping dis as
V 4+ hyp activ , associat d with clonus, d v loping dis as
OV Êo ass ss clonus at th ankl joint, dosifl  th foot and obs v fo mov m nt wh n it is
 l as d Rhythmic j king is p s nt If abs nt clonus, foot  tuns to planta position
without j king

3V Ambulatoy manag m nt

OV Hom manag m nt is allow d only if B÷ is 140/90 o b low, th  is low pot inuua, no
IUGR and w ll f tal w ll b ing
OV B d  st
OV L ft lat al position wh n lying down
OV R gula ch ck up ʹ v y 2 w ks
OV Di t high in CHON and CHO ʹ CHON at l ast 15 g/kg of body w ight/day, mod at Na
 stiction of l ss than 2 g/day, calcium 1200 mg/day, avoid salty food, high at high fib , 8-
10 glass s of wat 
OV Êak w ight daily and monito and  cod intak and output, B÷ monitoing 2 a day, count
f tal mov m nts (3/h)
OV ust  pot to th hospital if ʹ inc asing B÷, pigastic pain, visual distubanc s, s v 
h adach , N/V, w ight gain mo than 1 lb/w k, abnomal f tal mov m nts

4V Hospital anag m nt
OV Êh only cu fo p clampsia is d liv y
OV D t mination of f tal matuity (b am thason may b giv n to sp d up lung matuity)
OV Fluid th apy of cystalloids (LR and N 100 to 125 mL/ hou)
OV  dications
aV gO4 (dug of choic ) to t at convulsions by  ducing  l as of ac tylcholin at
myon ual junctions,  duc d ma,  duc B÷
bV Loading dos of 4 g infus d ov  20 minut s follow d by continuous infusion of 2-3
g/ hou
cV Ch ck ff b fo adm  spiation should b abov 14 B÷, UO should b at l ast
100 mL/4 hou, DÊR a p s nt (loss/abs nc of DÊR is a sign of toicity to gO4)
dV  um g l v ls a monito d p iodically 7-8 mg/dL is th ap utic G at  than
is toicity
V If toicity d v lops (abs nt DÊR, d p ss d RR, UO l ss than 25 mL/h) ʹ giv
antidot 1 g (10 mL) 10% calcium gluconat IV ov  2 minut s and notify physician
fV gO4 is giv n upto 24 hous aft  d liv y o fom th last convulsion if it occus
duing postpatum
gV If giv n postpatum, monito fo atony that can l ad to h mohag ͛
hV id ff cts moth  CN d p ssion, hypo fl ia, flushing, confusion,
F tus tachycadia, hypoglyc mia, hypocalc mia, hypomagn s mia
iV Hydalazin (ap solin ) ʹ Antihyp t nsiv , initial bolus of 5 mg IV follow d by 5-
10 mg v y 20 minut s if diastolic p ssu is 110 mmHg o mo 
OV B d  st
OV onito pati nt clos ly ʹ V/, I and O, f tal w ll-b ing, s/s of convulsions
OV af ty m asu s
aV Goal ʹ maintain pat nt aiway and p v nt injuy
bV ais padd d sid ails, put b d at low st position, hav m g ncy quipm nts
availabl ʹ suction appaatus, gO4, Ca gluconat , oyg n, aft  sizu position
pati nt in sid lying to dain oal s c tions

OV ÷ f  d d liv y is vaginal but C fo s iously ill

OV In postpatum ʹ monito B÷, convulsions, I and O and ut in atony, liv  nzym s and CBC,
got poducts a containdicat d b caus th y a hyp t nsiv
5V 2 y as should laps b fo p gnancy is again att mpt d