Gynecological disorders in pregnancy

CA CERVIX WITH PREGNANCY DIAGNOSIS Asymptomatic cases Symptomatic cases EFFECTS OF PREGNANCY ON CA CERVIX Malignant process remain unaffected Rapid spread following vaginal delivery or induced abortion

CA CERVIX WITH PREGNANCY EFFECTS OF CA ON PREGNANCY Abortion Premature labour Secondary cervical dystocia Missed labour Injury to cervix and lower segment PPH Lochiometra and pyometra Uterine sepsis

CA CERVIX WITH PREGNANCY TREATMENT Surgery or radiotherapy First trimester Radical surgery with fetus in situ Radiotherapy – external pelvic radiation Second trimester Uterus is to be evacuated Prophylactic antibiotic Radical surgery after 10 -14 days External pelvic radiation followed by intracavity radiation In operable stage – Palliative radiotherapy Labour – Vaginal delivery not allowed

FIBROID WITH PREGNANCY EFFECTS ON PREGNANCY May be none Pressure symptoms Abortion Malpresentation Non engagement of presenting part Pre term labour and prematurity

FIBROID WITH PREGNANCY EFFECTS ON LABOUR May be unaffected Uterine inertia Dystocia PPH

FIBROID WITH PREGNANCY EFFECTS ON PUERPERIUM Subinvolution Sepsis Secondary PPH Lochiometra Pyometra

FIBROID WITH PREGNANCY EFFECTS OF PREGNANCY ON FIBROID Increase in size Changes in position Changes inn shape – becomes flattened Red degeneration Torsion of pedunculated subserous fibroid Infection

FIBROID WITH PREGNANCY DIAGNOSIS USG

FIBROID WITH PREGNANCY TREATMENT DURING PREGNANCY Uncomplicated Usual ANC Impaction in early months Manual correction Acute pain following red degeneration

FIBROID WITH PREGNANCY TREATMENT LSCS Cervical or broad ligament fibroid Associated complicating factors DURING LABOUR Fibroid situated above the presenting part Fibroid situated below the presenting part Alert PPH and retained placenta

FIBROID WITH PREGNANCY RED DEGENERATION Probably vascular origin CLINICAL FEATURES Acute onset of pain Malaise Dry furred tongue Rapid pulse Constipation Tenderness Rigidity over the tumour Leucocytocis

FIBROID WITH PREGNANCY RED DEGENERATION TREATMENT Patient put to bed Ampicillin 500 mg Analgesics and sedatives Laprotomy