1. Bleeding causes in the first trimester pregnancy
Threatened abortion
Ectopic pregnancy
Cervical polyps
Hydatidiform mole
Cervicitis

2. Abortion Threatened abortion Inevitable abortion Complete abortion
Incomplete abortion
Missed abortion

3. Bleeding and uterine cramping without cervical dilation
Threatened abortion
Bleeding and uterine cramping without cervical dilation

4. Inevitable abortion
Profuse haemorrhaging, rupture of the membranes, cramping with a dilated cervical os

5. Incomplete abortion
When some products of conception are expelled but some tissue remains in the uterine cavity.

6. RECURRENT PREGNANCY LOSS (RPL)
The loss of tree or more spontaneous and consecutive pregnancies, occuring before the period of viabity
PRIMARY RPL
SECONDARY RPL

7. Causes of RPL Chromosomal 1,8- 4,6% Anatomic 1-28% Immunologic 6-65%
Hormonal 5- 29%
Infectious
Unexpained 15-50%

8. Genetic causes Trisomy 40-50% Monosomy 15-25% Triploidy 15%
tetraploidy 5%

9. Anatomic abnormalities
Uterine congenital abnormalieties ( septate uterus, bicornuate or unicornuate uterus)
Intrauterine adhaesiones
Leiomyomata
Cervical incompetence

10. Endokrinologic causes
The luteal phase deficiency
Thyroid disease
diabetes

11. Infections Listeria monocytogenes Mycoplasma hominis
Ureaplasma urealiticum
Toxoplasmosis
Cytomegalia
Rubella

12. Enviromental factors
Smoking
Alkohol
Ansthetic gases
Toxins
Radiations

13. Missed abortion
Death of the fetus or embryo without the onset of labour or the passage of tissue

14. Diagnosis of abortion
Clinical examination ( bleeding, abdominal pain, cramping)
Ultrasonography

15. Medical conditions associated with pregnancy loss
Collagen vascular diseases
Thyroid disease
Diabetes mellitus
Chronic active hepatitis
Infections
Endometriosis
Thrombo-embolic disease
Chronic renal disease
Chronic cardiovascular disease

16. Immune theories of RPL
In the alloimmune theory state, the maintenance of normal pregnancy requires the immune system to recognize the implanting embryo as foreign
the autoimmune theory state, in whichwomen’s immune system may produce antiphospholipid antibodies

17. Criteria for the antiphospholipid antiboby syndrome

18. Criteria for anti-phospholipid antibody syndrome
Laboratory findings
Persistently elevated anti-phospholipid antibodies (ACA)
Lupus anticoagulant (LA)
Clinical findnings
Thrombosis (venous or arterial)
Recurrent pregnancy loss
Thrombocytopenia

20. The target cells for antiphospholipid antibodies
Endothelial cells
Throphoblastic cells
Blood platelets
Embyonic tissue cells
Coagulation factors
Proteins involved in the coagulation cascade or in antibodies bindings

21. Molar pregnancy (microscopic features)

22. Molar pregnancy (microscopic features)
Complete mole
Marked oedema and enlargement of the villi
Dissappearance of the villous blood vassels
Proliferation of lining trophoblast of the villi
Absence of the fetus, cord ar amniotic membrane
A normal kariotype
Partial mole
Marked swelling of the villi with atrophic throphoblastic cells
Presence of normal villi
Presence of fetus, cord and amniotic membrane
An abnormal karyotype

23. Symptoms: Bleeding The uterus is often larger than expected
Nausea and vomiting
Preeclampsia
Clinical hyperthyroidism
Abdominal pain secondary to theca lutean cysts

24. Diagnosis Passage of vesicular tissue
A quantitative HCG > uIU/ml
Ultrasonography ( snow storm)

25. Clinical classification of gestational thropfoblastic disease
Molar pregnancy (hydatidiform mole)
Compete mole
Partial mole
Gestational throphoblastic neoplasia

26. Persistent gestational throphoblastic neoplasia
Histologically benign
Persistent histologically benign
Persistent histologically malignant

27. Benign GTD Low socioeconomic status Older women
Spontaneous remission in 80-85% after dilatation and evacuation
Choriocarcinoma develops in 3- 5% of moles

28. Malignant GTD 1 : 20 000 pregnancies A/ molar pregnancy (50%)
B/ normal pregnancy (25%)
C/ abortion and ectopic pregnancy (25%)

29. Management Suction curetage Primary hysterectomy
Prophylactic chemiotherapy

30. Follow–up examination include
HCG determinations every 1-2 weeks until they are negative twice, then montly for 1 year
Contraception for 1year
Physical examination every 2 weeks until remission, then every 3 months for 1 year
Chest film initially and repeated if the HCG plateau or rises
Chemiotherapy should be started if the HCG titer rises or is stable if metastases are detected at any time

31. Abortion Spontaneous Induced Early ( before 12 weeks)
Late (after 12 weeks)

32. Abortion The termination of pregnancy before viability,
(22 weeks from the first day of the last normal menstrual bleeding).