Pathological Obstetrics,

Basic Family Planning

and Care of Infants

Rhygen Pactol Pecore, RM, LMT

 Pathological Obstetrics, Basic Family
Planning and Care of Infants

Description:

This course deals with the concept of complications of pregnancy, labor and
delivery, its causes and management, care of infants and children including
integrated management of childhood diseases, and basic family planning.

Objectives:

To develop knowledge, skills and attitude in identifying patients with

complications of pregnancy, labor and delivery, care of growing infants,
implementation of IMCI program, and family planning counseling.

Specific objectives:

 To recognize deviations from normal

 To identify cases of bleeding during the various stages of
pregnancy
 To define characteristics of abnormal labor
 To develop skills in assessing patients with danger signs
 To recognize family planning concepts and methods
 To acquire the skills to counsel/motivate family planning clients
 To identify the different theories of growth and development
 To enumerate the different stages of growth and development
 To recognize the different characteristics of the different stages
of growth and development
 To identify the needs during the different stages of growth and
development
 To identify the health problems of a sick young child
 To assess sick young child with problems

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Course Outline:

I. Complications of Pregnancy
A. First Trimester
1. Hyperemesis gravidarum
2. H-mole
3. Abortion
4. Ectopic Pregnancy
5. Incompetent cervix
B. Second Trimester
1. Abruptio Placenta
2. Placenta previa
3. Toxaemia of Pregnancy
4. Hypertensive vascular disease
C. Third Trimester
II. Diseases affecting pregnancy
A. Diabetes Mellitus
B. Heart Diseases
C. Renal disorders
D. Common infections
1. Rubella
2. Influenza
3. Tuberculosis
4. STD
III. Complications during labor and delivery
A. Powers
1. Dystocia
2. Precipitate labor
3. Ruptured placenta
4. Dysfunctional uterine contraction
B. Passageway
1. Cephalopelvic sisproporrtion
C. Passenger
1. Prolapse cord
2. Cord coil
3. Multiple pregnancy
4. Abnormal presentation

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IV. Responsible parenthood and family planning
A. Population situation of the
1. World
2. Philippines
B. Laws and legislations related to FP
1. P.D. 965
2. P.D. 79
3. P.D. 233
4. P.D. 6365
5. P.D. 69
6. P.D. 148
7. LOI 47
C. Roles and functions of the Midwife
1. Motivator/Counselor
2. Service provider
3. FP manager
D. History of family planning in the Philippines
E. Responsible Parenthood
1. Human sexuality
a. Biophysical profile
b. Psycho-physiological
c. Socio-cultural
2. Benefits of Family Planning
a. Mother
b. Father
c. Children
F. Client health assessment
1. Importance
2. When to conduct health assessment
3. Components of health assessment
G. Counseling
1. Importance of counseling
2. Principles of counseling
3. Components of counseling
4. Steps in counseling
5. Skills in counseling
6. Effective counseling

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 H. Factors affecting couples acceptance and non- acceptance of
FP
I. Methods of family planning
1. Natural
2. Hormonal
3. Barrier
4. Permanent
J. Current Trends in Family Planning
V. Care of Infants
A. Principles of Growth and Development
B. Factors Influencing Growth Development
C. Theories of Growth and Development
1. Freud
2. Erickson
3. Piaget
D. Stages of Growth and Development
1. Fetal or embryonic
2. Neonate
a. Immediate care
b. Characteristics of newborn
c. Appearance of newborn
d. Continuing care of the newborn
3. Infancy
a. Infant profile
b. Developmental task
c. Nutrition
d. Special needs/problems

Integrated Management of Childhood Illness (IMCI)

A. Case Management Process

1. Assessment of sick children
a. History taking
b. Checking of danger signs
c. Checking main symptoms
d. Checking nutritional status
e. Assessing other prob.
2. Treatment procedure for sick children
a. Referral of children age 2 mos.-5years

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 b. Treatment for outpatient clinic
3. Counseling of mothers
4. Follow-up care

The very sick young infant

A. Checking main symptoms

1. Bacterial infection
2. Feeding problems/low weight
B. Checking immunization Status
C. Assessing other problems
D. Treatment procedure
E. Referral
F. Counseling
G. Follow-up care

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 Preface

The content of this module was based on the content as outlined in

CMO No. 33 series of 2007 for this particular course and does not intend to
replace any other references but this will facilitate self-directed learning
especially with the current situation amidst the pandemic wherein face-to-
face instruction is not possible. Generally it has different parts:

Unit title. It contains the main topic or the subject which is specifically
related to the learning outcome.

Learning outcome. It is the statement of expected skills which the

students should be able to demonstrate at the end of the course.

Pre- assessment. This part acknowledged students’ prior learning and

current knowledge based on the subject matter.

Learning content. This part contains the important information related

to the topic which addresses the knowledge components which needs to be
under pinned by the students in relation to the learning outcome.

Learning activity. This part allows students to be engage in processing

the informaiton they have read on the content and promote mastery on the
topic.

Assessment. This part allows assessment on the level of students

learning in relation to the learning outcomes.

On the later part of this material, the answer keys and rubrics were
presented to guides students as they go through the learning process.

I hope this will guide students in learning important concepts and to

widen their perspective about the midwifery profession and to develop their
skill, knowledge and attitude as a future professional midwives.

The Author

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 Table of Contents

Title Page 2

Preface 7

Table of contents 8

Unit 1: Complications of Pregnancy 11

Unit 2: Diseases Affecting Pregnancy 45

Unit 3: Complications During Labor and Delivery

Unit 4: Responsible parenthood and family

Unit 5: Care of Infants

Unit 6: Integrated Management of Childhood Illness (IMCI)

References

Rubrics

Answer Key

Unit 1:

Complications 8
of pregnancy
 Pre-
Assessment
I- Meta cards posting

Instruction:

Write everything on the card that comes up in your mind as you heard
the word Pathologic Obstetrics.

II – Multiple choice

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Choose the letter that correspond to answer.

1. A 21-year old client, 6 weeks’ pregnant is diagnosed with hyperemesis gravidarum. This
excessive vomiting during pregnancy will often result in which of the following conditions?

A. Bowel perforation
B. Electrolyte imbalance
C. Miscarriage
D. Pregnancy induced hypertension (PIH)
2. Which of the following statements best describes hyperemesis gravidarum?

A. Severe anemia leading to electrolyte, metabolic, and nutritional imbalances in the absence of
other medical problems.
B. Severe nausea and vomiting leading to electrolyte, metabolic, and nutritional imbalances in
the absence of other medical problems.
C. Loss of appetite and continuous vomiting that commonly results in dehydration and
ultimately decreasing maternal nutrients
D. Severe nausea and diarrhea that can cause gastrointestinal irritation and possibly internal
bleeding
3. The client with hyperemesis gravidarum is at risk for developing:

A. Respiratory alkalosis without dehydration

B. Metabolic acidosis with dehydration
C. Respiratory acidosis without dehydration
D. Metabolic alkalosis with dehydration
4. A client is being admitted to the antepartum unit for hypovolemia secondary to hyperemesis
gravidarum. Which of the following factors predisposes a client to the development of this?
A. trophoblastic disease
B. maternal age > 35 y.o.
C. malnourished or underweight clients
D. low levels of HCG
5. Which of the following complications can be potentially life threatening and can occur in a
client receiving a tocolytic agent?
A. diabetic ketoacidosis
B. hyperemesis gravidarum
C. pulmonary edema
D. sickle cell anemia

Unit 1:

Complications of pregnancy

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Hyperemesis Gravidarum:

Hyperemesis gravidarum (HG) is an extreme form of morning sickness that

causes severe nausea and vomiting during pregnancy.

HG typically includes nausea that doesn’t go away and severe vomiting that
leads to severe dehydration. This doesn’t allow you to keep any food or
fluids down.

The symptoms of HG begin within the first six weeks of pregnancy. Nausea
often doesn’t go away. HG can be extremely debilitating and cause fatigue
that lasts for weeks or months.

According to the HER Foundation, women with HG may experience a

complete loss of appetite. They may not be able to work or perform their
normal daily activities.

HG can lead to dehydration and poor weight gain during pregnancy. There’s
no known way to prevent morning sickness or HG, but there are ways to
manage the symptoms.

What are the symptoms of hyperemesis gravidarum?

HG usually starts during the first trimester of pregnancy. Less than half of

women with HG experience symptoms their entire pregnancy, notes the HER
Foundation.

Some of the most common symptoms of HG are:

 feeling nearly constant nausea

 loss of appetite

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  vomiting more than three or four times per day

 becoming dehydrated

 feeling light-headed or dizzy

 losing more than 10 pounds or 5 percent of your body weight due to

nausea or vomiting

What causes hyperemesis gravidarum?

Almost all women experience some degree of morning sickness during their
pregnancy. Morning sickness is nausea and vomiting during pregnancy.
Despite the name, morning sickness isn’t confined to the morning. It can
occur at any time.

Morning sickness and HG seem to have a connection to human chorionic

gonadotropin (hCG). This is a hormone created during pregnancy by the
placenta. Your body produces a large amount of this hormone at a rapid rate
early in pregnancy. These levels can continue to rise throughout your
pregnancy.

Who’s at risk for hyperemesis gravidarum?

Some factors that could increase your risk of getting HG are:

 having a history of HG in your family

 being pregnant with more than one baby

 being overweight

 being a first-time mother

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Trophoblastic disease can also cause HG. Trophoblastic disease occurs when
there’s an abnormal growth of cells inside the uterus.

How is hyperemesis gravidarum diagnosed?

Your doctor will ask you about your medical history and your symptoms. A
standard physical exam is enough to diagnose most cases. Your doctor will
look for common signs of HG, such as abnormally low blood pressure or a
fast pulse.

Blood and urine samples may also be necessary to check for signs of
dehydration. Your doctor might also order additional tests to rule out
gastrointestinal problems as a cause of your nausea or vomiting.

An ultrasound might be necessary to find out if you’re pregnant with twins or

if there’s are any problems. This test uses sound waves to create an image
of the inside of your body.

How is hyperemesis gravidarum treated?

Treatment for HG depends on the severity of your symptoms. Doctors may

recommend natural nausea prevention methods, such as vitamin B-6 or
ginger.

Try eating smaller, more frequent meals and dry foods, such as crackers.
Drink plenty of fluids to stay hydrated.

Severe cases of HG may require hospitalization. Pregnant women who are

unable to keep fluids or food down due to constant nausea or vomiting will
need to get them intravenously, or through an IV.

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Medication is necessary when vomiting is a threat to the woman or child.
The most commonly used anti-nausea drugs
are promethazine and meclizine. You can receive either through an IV or as
a suppository.

Taking medication while pregnant can cause potential health problems for
the baby, but in severe cases of HG, maternal dehydration is a more
concerning problem. Talk to your doctor about the risks associated with any
method of treatment.

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 Hydatidiform Mole

Pregnancy happens after an egg is fertilized and burrows into the womb.

Sometimes, though, these delicate beginning stages can get mixed up.
When this happens, a pregnancy may not go the way it should — and this
can be heartbreaking, even though it’s no one’s fault.

A molar pregnancy occurs when the placenta doesn’t develop normally.

Instead, a tumor forms in the uterus and causes the placenta to become a
mass of fluid-filled sacs, also called cysts. About 1 in every
1,000 pregnancies (0.1 percent) is a molar pregnancy.

This kind of pregnancy doesn’t last because the placenta typically can’t
nourish or grow a baby at all. In rare cases, it may also lead to health risks
for mom.

A molar pregnancy is also called a mole, a hydatidiform mole, or gestational

trophoblastic disease. You can have this pregnancy complication even if you
have had a typical pregnancy before. And, the good news — you can have a
completely normal, successful pregnancy after having a molar pregnancy.

Complete vs. partial molar pregnancy

There are two kinds of molar pregnancy. Both have the same result, so one
isn’t better or worse than the other. Both kinds are usually benign — they
don’t cause cancer.

A complete mole happens when there’s only placenta tissue growing in the
womb. There’s no sign of a fetus at all.

In a partial mole, there is placenta tissue and some fetal tissue. But the fetal
tissue is incomplete and could never develop into a baby.

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What causes a molar pregnancy?

You can’t control whether or not you have a molar pregnancy. It’s not
caused by anything you did. A molar pregnancy can happen to women of all
ethnicities, ages, and backgrounds.

It sometimes happens because of a mix-up at the genetic — DNA — level.

Most women carry hundreds of thousands of eggs. Some of these might not
form correctly. They’re usually absorbed by the body and put out of
commission.

But once in a while an imperfect (empty) egg happens to get fertilized by a

sperm. It ends up with genes from the father, but none from the mother.
This can lead to a molar pregnancy.

In the same way, an imperfect sperm — or more than one sperm — may
fertilize a good egg. This can also cause a mole.

Share on Pin terest

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Risk factors

There are some risk factors for a molar pregnancy. These include:

 Age. Although it can happen to anyone, you may be more like to have

a molar pregnancy if you’re younger than 20 or older than 35 years.

 History. If you’ve had a molar pregnancy in the past, you’re more

likely to have another one. (But again — you can also go on to have a
successful pregnancy.)

What are the symptoms of a molar pregnancy?

A molar pregnancy may feel just like a typical pregnancy at first. However,
you’ll likely have certain signs and symptoms that something is different.

 Bleeding. You may have bright red to dark brown bleeding in the first
trimester (up to 13 weeks). This is more likely if you have a complete
molar pregnancy. The bleeding might have grape-like cysts (tissue
clots).

 High hCG with severe nausea and vomiting. The hormone hCG is

made by the placenta. It’s responsible for giving many pregnant
women a certain amount of nausea and vomiting. In a molar
pregnancy, there may be more placenta tissue than normal. The
higher levels of hCG might lead to severe nausea and vomiting.

 Pelvic pain and pressure. Tissues in a molar pregnancy grow faster

than they should, especially in the second trimester. Your stomach
may look too large for that early stage in pregnancy. The fast growth
can also cause pressure and pain.

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How is a molar pregnancy diagnosed?

Sometimes a molar pregnancy is diagnosed when you go for your usual

pregnancy ultrasound scan. Other times, your doctor will prescribe blood
tests and scans if you have symptoms that might be caused by a molar
pregnancy.

A pelvis ultrasound of a molar pregnancy will typically show a grape-like

cluster of blood vessels and tissue. Your doctor may also recommend other
imaging — like MRI and CT scans — to confirm the diagnosis.

Share on PinterestA molar pregnancy, although not dangerous by itself, has

the potential to become a cancer. Image source: Wikimedia

High levels of hCG in the blood might also be a sign of a molar pregnancy.
But some molar pregnancies may not raise hCG levels — and high hCG is
also caused by other standard kinds of pregnancies, like carrying twins. In
other words, your doctor won’t diagnose a molar pregnancy based on hCG
levels alone.

What are the treatment options for a molar pregnancy?

A molar pregnancy can’t grow into a normal, healthy pregnancy. You must
have treatment to prevent complications. This can be really, really hard
news to swallow after the initial joys of that positive pregnancy result.

With the right treatment, you can go on to have a successful pregnancy and
healthy baby.

Your treatment may involve one or more of the following:

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Dilation and curettage (D&C)

With a D&C, your doctor will remove the molar pregnancy by dilating the
opening to your womb (cervix) and using a medical vacuum to remove the
harmful tissue.

You’ll be asleep or get local numbing before you have this procedure.
Although a D&C is sometimes done as an outpatient procedure at a doctor’s
office for other conditions, for a molar pregnancy it’s typically done at a
hospital as an inpatient surgery.

Chemotherapy drugs

If your molar pregnancy falls into a higher risk category — due to cancer
potential or because you have had difficulty getting proper care for whatever
reason — you may receive some chemotherapy treatment after your D&C.
This is more likely if your hCG levels don’t go down over time.

Hysterectomy

A hysterectomy is surgery that removes the entire womb. If you don’t wish
to get pregnant again, you might choose this option.

You’ll be fully asleep for this procedure. A hysterectomy is not a common

treatment for a molar pregnancy.

RhoGAM

If you have Rh-negative blood, you’ll receive a drug called RhoGAM as part

of your treatment. This prevents some complications related to developing
antibodies. Be sure and let your doctor know if you have A-, O-, B-, or AB-
blood type.

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After-care

After your molar pregnancy is removed, you’ll need more blood tests and
monitoring. It’s very important to make sure that no molar tissue was left
behind in your womb.

In rare cases, molar tissue can regrow and cause some types of cancers.
Your doctor will check your hCG levels and give you scans for up to a year
after treatment.

Later-stage treatment

Again, cancers from a molar pregnancy are rare. Most are also very
treatable and have a survival rate of up to 90 percentTrusted Source. You
may need chemotherapy and radiation treatment for some cancers. Common,
but they can happen to women of all ages and backgrounds. A molar pregnancy can
be a long and emotionally draining experience.

The treatment and waiting period can also take a toll on your emotional, mental, and
physical health. It’s important to take the time to grieve for any kind of pregnancy loss
in a healthy way.

Noreen Iftikhar, MD on August 30, 2019

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Threatened Abortion (Threatened Miscarriage)

 Symptoms

 Risk Factors

 Diagnosis

 Treatments

 Outlook

 Prevention

What Is a Threatened Abortion?

A threatened abortion is vaginal bleeding that occurs in the first 20 weeks of

pregnancy. The bleeding is sometimes accompanied by abdominal cramps.
These symptoms indicate that a miscarriage is possible, which is why the
condition is known as a threatened abortion or threatened miscarriage.

Vaginal bleeding is fairly common among pregnant women. About 20 to 30

percent of women will experience bleeding during the first 20 weeks of
pregnancy. Approximately 50 percent of these women will carry their baby
to term.

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The exact cause of a threatened abortion usually isn’t known. However, it’s
more common among women who have previously had a miscarriage.

What Are the Symptoms of a Threatened Abortion?

Any vaginal bleeding during the first 20 weeks of pregnancy can be a

symptom of a threatened abortion. Some women also have abdominal
cramps or lower back pain.

During an actual miscarriage, women often experience either a dull or sharp

pain in the abdomen and lower back. They may also pass tissue with clot-
like material from the vagina.

Call your doctor or obstetrician immediately if you’re pregnant and

experiencing any of these symptoms.

Who Is at Risk for a Threatened Abortion?

The actual cause of a threatened abortion isn’t always known. However,

there are certain factors that may increase your risk of having one. These
include:

 a bacterial or viral infection during pregnancy

 trauma to the abdomen

 advanced maternal age (over age 35)

 exposure to certain medications or chemicals

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Other risk factors for a threatened abortion include obesity and uncontrolled
diabetes. If you’re overweight or have diabetes, speak with your doctor
about ways to stay healthy during pregnancy.

You should also tell your doctor about any medications or supplements
you’re taking. Some may be unsafe to use during pregnancy.

How Is a Threatened Abortion Diagnosed?

Your doctor may perform a pelvic exam if a threatened abortion is

suspected. During a pelvic exam, your doctor will examine your reproductive
organs, including your vagina, cervix, and uterus. They’ll look for the source
of your bleeding and determine whether the amniotic sac has ruptured. The
pelvic exam will only take a few minutes to complete.

An ultrasound will be done to monitor the heartbeat and development of the

fetus. It can also be done to help determine the amount of bleeding.
A transvaginal ultrasound, or an ultrasound that uses a vaginal probe, is
typically more accurate than an abdominal ultrasound in early pregnancy.
During a transvaginal ultrasound, your doctor will insert an ultrasound probe
about 2 or 3 inches into your vagina. The probe uses high-frequency sound
waves to create images of your reproductive organs, allowing your doctor to
see them in more detail.

Blood tests, including a complete blood count, may also be performed to

check for abnormal hormone levels. Specifically, these tests will measure the
levels of hormones in your blood called human chorionic gonadotropin (HCG)
and progesterone. HCG is a hormone that your body produces during
pregnancy, and progesterone is a hormone that supports pregnancy.
Abnormal levels of either hormone may indicate a problem.

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How Is a Threatened Abortion Treated?

A miscarriage often can’t be prevented. In some cases, however, your doctor

may suggest ways to lower your risk of having a miscarriage.

As you recover, your doctor may tell you to avoid certain activities. Bed rest
and avoiding sexual intercourse may be suggested until your symptoms go
away. Your doctor will also treat any conditions known to increase the risk of
complications during pregnancy, such as diabetes or hypothyroidism.

Your doctor may also want to give you an injection of progesterone to

increase levels of the hormone. Your doctor will also administer Rh
immunoglobulin if you have Rh-negative blood and your developing baby has
Rh-positive blood. This stops your body from creating antibodies against
your child’s blood.

Ectopic pregnancy:

also called extrauterine pregnancy, condition in which the

fertilized ovum (egg) has become imbedded outside the uterine cavity. The
site of implantation most commonly is a fallopian tube; however,
implantation can occur in the abdomen, the ovary, or the uterine cervix.
Ectopic pregnancy occurs in an estimated 1 to 2 percent of women
worldwide and is a major cause of sickness and death among women in the
first trimester (first 12 weeks) of pregnancy.

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normal and abnormal implantation; pregnancy

Normal and abnormal sites of implantation of the fertilized ovum in the

female human reproductive tract. (A) Normal implantation in the upper part
of the corpus. (B) Implantation in the lower corpus with later development of
a placenta praevia. (C) Low implantation. (D) Implantation in the interstitial
portion of the fallopian tube. (E) Implantation in the isthmic part of the tube.
(F) Implantation in the ampulla of the tube. (G) Implantation in the
infundibulum of the tube. (H) Implantation in the ovary. (I) Implantation on
the peritoneum with the development of an abdominal pregnancy. (J)
Implantation in the cornu of a double or rudimentary horn of a uterus.

Symptoms of ectopic pregnancy often begin with those typical of pregnancy,

such as breast tenderness, missed menstrual period, and nausea. As the
condition progresses, many women experience lower back pain, lower
abdominal pain, cramping on one side of the pelvic area, or light vaginal
bleeding. If the tissue surrounding the abnormally implanted ovum ruptures,
internal bleeding may become severe. Pooling of blood in the abdomen can

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place pressure on the rectum or on certain nerves, producing symptoms
such as shoulder pain and sharp abdominal pain. Bleeding is accompanied by
light-headedness and fainting, which may be followed by shock. As the blood
supply supporting the ovum decreases, hormonal support for the pregnancy
declines, and the decidua (endometrial tissue modified for pregnancy) begins
to slough off and is excreted vaginally. The embryo, however, remains and
frequently must be removed by surgery. Treatment with the
drug methotrexate may be effective in less-severe cases or for cases that
are detected early.

Tubal pregnancy, in which the ovum becomes implanted in one of

the fallopian tubes, may be brought about by factors that interfere with the
propulsion of the fertilized ovum from the fallopian tube toward the uterine
cavity. Examples include inflammation of the fallopian tube, developmental
malformation of the sacs within its canal, or kinking of the tube. If transport
to the uterus is sufficiently delayed, the ovum becomes too large for easy
passage and becomes imbedded in the wall of the fallopian tubule.
Depending on the part of the tube in which the ovum has become implanted,
the tubal pregnancy can abort, through tubal rupture, any time from 6 to 18
weeks after cessation of menstrual periods (on occasion there will be no
history of missed periods). Surgical exploration of the abdomen and removal
of the affected tube and replacement of lost blood may be essential to
prevent death.

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Ovarian ectopic pregnancy and cervical ectopic pregnancy are relatively

rare conditions. In ovarian pregnancy, the ovum is fertilized before its

discharge from the follicle, resulting in the ovum’s implantation in or on the

ovary. Ovarian pregnancies typically abort early, and the most common

symptom is abdominal pain, with minor vaginal bleeding. Although risk of

ovarian pregnancy is thought to be increased by history

of endometriosis or pelvic inflammatory disease or by the use of assisted

reproductive technologies or an intrauterine device (IUD), none of these

factors has been shown definitively to cause the condition. In cervical

pregnancy, the ovum implants in the uterine cervix or in the isthmus (the

opening into the cervix). Cervical pregnancy may be associated with

significant vaginal bleeding, and, in severe cases, hysterectomy is required.

Risk for the condition may be associated with previous operations such

as Cesarean section or dilation and cutterage, with in vitro fertilization, or

with IUD use.

Abdominal ectopic pregnancy occurs when the placenta is attached to

some part of the peritoneal cavity other than the uterus, ovary, or fallopian

tube. Although a few of these pregnancies are a result of implantation in the

abdominal lining, most are the result of expulsion of a tubal pregnancy. The

condition can be suspected in the first three months of pregnancy if pain and

bleeding are experienced. Abdominal pregnancy can reach term. Prompt

surgical removal of the fetus is necessary, because an unrecognized and

27
untreated abdominal pregnancy can result in infection or calcification leading

to the formation of a lithopedion (calcified dead fetus) and death of the

mother. https://www.britannica.com/science/ectopic-pregnancy

Overview

An incompetent cervix: also called a cervical insufficiency, occurs

when weak cervical tissue causes or contributes to premature birth or the

loss of an otherwise healthy

pregnancy.

Before pregnancy, your cervix —

the lower part of the uterus that

opens to the vagina — is normally

closed and firm. As pregnancy

progresses and you prepare to

give birth, the cervix gradually

softens, decreases in length (effaces) and opens (dilates). If you have an

incompetent cervix, your cervix might begin to open too soon — causing you

to give birth too early.

An incompetent cervix can be difficult to diagnose and treat. If your cervix

begins to open early, or you have a history of cervical insufficiency, your

doctor might recommend preventive medication during pregnancy, frequent

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ultrasounds or a procedure that closes the cervix with strong sutures

(cervical cerclage).

Symptoms

If you have an incompetent cervix, you may not have any signs or

symptoms during early pregnancy. Some women have mild discomfort or

spotting over the course of several days or weeks starting between 14 and

20 weeks of pregnancy.

Be on the lookout for:

 A sensation of pelvic pressure

 A new backache

 Mild abdominal cramps

 A change in vaginal discharge

 Light vaginal bleeding

Risk factors

Many women don't have a known risk factor. Risk factors for cervical

insufficiency include:

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  Cervical trauma. Some surgical procedures used to treat cervical

abnormalities associated with an abnormal Pap smear can result in

cervical insufficiency. Other surgical procedures such as a D&C could

also be associated with cervical insufficiency. Rarely, a cervical tear

during a previous labor and delivery could be associated with an

incompetent cervix.

 Race. Black women seem to have a higher risk of developing cervical

insufficiency. It isn't clear why.

 Congenital conditions. Uterine abnormalities and genetic disorders

affecting a fibrous type of protein that makes up your body's connective

tissues (collagen) might cause an incompetent cervix. Exposure to

diethylstilbestrol (DES), a synthetic form of the hormone estrogen,

before birth also has been linked to cervical insufficiency.

Complications

An incompetent cervix poses risks for your pregnancy — particularly during

the second trimester — including:

 Premature birth

 Pregnancy loss

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Prevention

You can't prevent an incompetent cervix — but there's much you can do to

promote a healthy, full-term pregnancy. For example:

 Seek regular prenatal care. Prenatal visits can help your doctor

monitor your health and your baby's health. Mention any signs or

symptoms that concern you, even if they seem silly or unimportant.

 Eat a healthy diet. During pregnancy, you'll need more folic acid,

calcium, iron and other essential nutrients. A daily prenatal vitamin —

ideally starting a few months before conception — can help fill any

dietary gaps.

 Gain weight wisely. Gaining the right amount of weight can support

your baby's health. A weight gain of 25 to 35 pounds (about 11 to 16

kilograms) is often recommended for women who have a healthy weight

before pregnancy.

 Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs

are off-limits, too. In addition, get your doctor's OK before taking any

medications or supplements — even those available over-the-counter.

If you've had an incompetent cervix during one pregnacy, you're at risk of

premature birth or pregnancy loss in later pregnancies. If you're considering

31
getting pregnant again, talk with your doctor to understand the risks and

what you can do to promote a healthy pregnancy

ABRUPTIO PLACENTA

Placental abruption (abruptio placentae) is an uncommon yet serious

complication of pregnancy. The placenta develops in the uterus during

pregnancy. It attaches to the wall of the uterus and supplies the baby with

nutrients and oxygen.

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Placental abruption occurs

when the placenta partly or

completely separates from the

inner wall of the uterus before

delivery. This can decrease or

block the baby's supply of

oxygen and nutrients and

cause heavy bleeding in the

mother.

Placental abruption often happens suddenly. Left untreated, it endangers

both the mother and the baby.

Products & Services

Symptoms

Placental abruption is most likely to occur in the last trimester of pregnancy,

especially in the last few weeks before birth. Signs and symptoms of

placental abruption include:

 Vaginal bleeding, although there might not be any

 Abdominal pain

 Back pain

33
  Uterine tenderness or rigidity

 Uterine contractions, often coming one right after another

Abdominal pain and back pain often begin suddenly. The amount of vaginal

bleeding can vary greatly, and doesn't necessarily indicate how much of the

placenta has separated from the uterus. It's possible for the blood to

become trapped inside the uterus, so even with a severe placental

abruption, there might be no visible bleeding.

In some cases, placental abruption develops slowly (chronic abruption),

which can cause light, intermittent vaginal bleeding. Your baby might not

grow as quickly as expected, and you might have low amniotic fluid or other

complications.

Causes

The cause of placental abruption is often unknown. Possible causes include

trauma or injury to the abdomen — from an auto accident or fall, for

example — or rapid loss of the fluid that surrounds and cushions the baby in

the uterus (amniotic fluid).

Risk factors

Factors that can increase the risk of placental abruption include:

34
  Placental abruption in a previous pregnancy that wasn't caused by

abdominal trauma

 Chronic high blood pressure (hypertension)

 Hypertension-related problems during pregnancy, including

preeclampsia, HELLP syndrome or eclampsia

 A fall or other type of blow to the abdomen

 Smoking

 Cocaine use during pregnancy

 Early rupture of membranes, which causes leaking amniotic fluid before

the end of pregnancy

 Infection inside of the uterus during pregnancy (chorioamnionitis)

 Being older, especially older than 40

Complications

Placental abruption can cause life-threatening problems for both mother and

baby.

For the mother, placental abruption can lead to:

 Shock due to blood loss

35
  Blood clotting problems

 The need for a blood transfusion

 Failure of the kidneys or other organs resulting from blood loss

 Rarely, the need for hysterectomy, if uterine bleeding can't be controlled

For the baby, placental abruption can lead to:

 Restricted growth from not getting enough nutrients

 Not getting enough oxygen

 Premature birth

 Stillbirth

Prevention

You can't prevent placental abruption, but you can decrease certain risk

factors. For example, don't smoke or use illegal drugs, such as cocaine. If

you have high blood pressure, work with your health care provider to

monitor the condition.

Always wear your seatbelt when in a motor vehicle. If you've had abdominal

trauma — from an auto accident, fall or other injury — seek immediate

medical help.

36
If you've had a placental abruption, and you're planning another pregnancy,

talk to your health care provider before you conceive to see if there are ways

to reduce the risk of another abruption.

PLACENTA PREVIA

What Is Placenta Previa?

Placenta previa is when a pregnant woman's placenta blocks the opening to the

cervix that allows the baby to be born. It can cause severe bleeding during

pregnancy and delivery.

The placenta is an organ that grows inside the lining of your uterus

during pregnancy. It connects to the umbilical cord and carries oxygen

and nutrients from you to your unborn child. It also moves waste away from

your baby.

37
Placenta previa happens when the placenta partly or completely covers

the cervix, which is the opening of the uterus. Your baby passes into the

cervix and through the birth canal during a vaginal delivery. Normally, the

placenta attaches toward the top of the uterus, away from the cervix.

Here's what happens with placenta previa: As your cervix opens during labor, it

can cause blood vessels that connect the placenta to the uterus to tear. This

can lead to bleeding and put both you and your baby at risk. Nearly all women

who have this condition will have to have a C-section to keep this from

happening.

Types of placenta previa

You may have different outcomes depending on the type of placenta previa

you have.

  Complete previa is when the placenta covers the entire opening of

the cervix.

  Marginal previa, also called low-lying placenta, is when the placenta

is close to the opening of the cervix but doesn't cover it. It may get

better on its own before the baby is due.

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Placenta Previa Symptoms

You might notice:

 Bright red bleeding from the vagina during the second half of your

pregnancy. It can range from light to heavy, and it's often painless. 

  Contractions along with the bleeding. You might feel the cramping or

tightening that comes with contractions, or feel pressure in your back. 

Placenta Previa Risk Factors

Placenta previa happens in about 1 out of every 200 pregnancies. You may

be more likely to get it if you:

 Smoke cigarettes or use cocaine

 Are 35 or older

 Have been pregnant before

 Have had a C-section before

 Have had other types of surgery on your uterus

 Are pregnant with more than one baby

 Are a person of color

Placenta Previa Diagnosis

Doctors often diagnose placenta previa during an ultrasound on one of your

routine prenatal visits. The test uses sound waves to show if your placenta

39
covers the opening from your womb to your cervix. They'll start with a

device called a transducer placed on your abdomen, but if they need a better

look they'll use a transducer that goes inside your vagina. 

Placenta Previa Treatment

There's no cure for placenta previa. The goal of treatment is to limit the

bleeding so you can get as close as possible to your due date. Most women

whose placenta previa doesn't get better on its own will need a C-section.

PRE-ECLAMPSIA

What Is Preeclampsia?

Preeclampsia, formerly called toxemia, is when a pregnant woman

has high blood pressure, protein in her urine, and swelling in her legs,

feet, and hands. It can range from mild to severe. It usually happens late

in pregnancy, though it can come earlier or just after delivery.

40
Preeclampsia can lead to eclampsia, a serious condition that can have health

risks for mom and baby and, in rare cases, cause death. Women with

preeclampsia who have seizures have eclampsia.

Pregnancy-induced hypertension (PIH) 

Pregnancy-induced hypertension (PIH) is one of the most common

complications of pregnancy. This occurs during the 20 th week of gestation or

late in the second trimester of pregnancy. This is a health condition wherein

there is a rise in the blood pressure and disappears after the termination of

pregnancy or delivery. PIH was formerly called toxaemia or the presence of

toxins in the blood. This is because its occurrence was not well understood in

41
the clinical field. Its common manifestations are hypertension, proteinuria

(presence of protein in the urine), and edema. There are 2 main types of

pregnancy-induced hypertension namely: pre-eclampsia and eclampsia.

TYPES

1. Pre-eclampsia—this is the non-convulsive form of PIH. This affects

7% of all pregnant women. Its incidence is higher in lower socio-

economic groups. It may be classified either mild or severe.

2. Eclampsia—this is the convulsive form of PIH. It occurs with 5% of

all pre-eclampsia cases. The mortality rate among mothers is nearly

20% and fetal mortality is also high due to premature delivery.

NORMAL ANATOMY AND PHYSIOLOGY

Anatomy

There are a lot of bodily changes that happen during a normal pregnancy.

There are external changes that are noticeable, and there are internal

changes that can only be appreciated through thorough clinical

examinations. Most of the changes are the body’s response to the changes

in levels of hormones and the growing demands of the fetus.

42
The two dominant female hormones, estrogen and progesterone, change in

a normal level. Along with this, a significant rise/appearance of 4 more

major hormones take place; these are 1. human chorionic gonadotropin

(HCG), 2. human placental lactogen, 3. prolactin, and 4. oxytocin. All these

6 hormones interact with each other simultaneously to maintain a normal

pregnancy as it progresses.

The following are the major effects of these hormones in the body:

Breast Ovaries Uterus Cervix

 enlarged  ovum  amenorrhea(abse  Goodell’s
 darkend production nce of sign(softening)
areola stops menstruation)  Chadwick’s
 producti
 corpus
 Hegar’s sign sign(blue-purple
on of (increased discoloration)
colostru luteum vascularity of the  Edema
m(first continues lower segment of  Hyperplasia
milk) production the uterus)  Thickening of
of hormones  there is growth mucous lining
up to 10-12 due to  increased
hypertrophy and mucus
weeks of

43
 gestation, or hyperplasia of production
until the muscles and  (+) mucus plug
placenta connective tissues by the end of
 there is the 2nd
takes over
continuous rise of month
the fundal height  shorter*
 more elastic
 thickend

Vagina Perineum

*Chadwick’s sign *increased insize

(deeper
*deepenedcolor
color)

*hypertrophy

*hyperplasia

*acidity: pH 4.0-6.0

Unit II
Diseases affecting pregnancy

Diabetes Mellitus
Diabetes mellitus is a condition defined by persistently high levels of sugar
(glucose) in the blood. There are several types of diabetes. The two most
common are called type 1 diabetes and type 2 diabetes.

44
During digestion, food is broken down into its basic components.
Carbohydrates are broken down into simple sugars, primarily glucose.
Glucose is a critically important source of energy for the body’s cells. To
provide energy to the cells, glucose needs to leave the bloodstream and get
inside the cells.

An organ in the abdomen called the pancreas produces a hormone

called insulin, which is essential to helping glucose get into the body's cells.
In a person without diabetes, the pancreas produces more insulin whenever
blood levels of glucose rise (for example, after a meal), and the insulin
signals the body's cells to take in the glucose. In diabetes, either the
pancreas's ability to produce insulin or the cells' response to insulin is
altered.

Type 1 diabetes is an autoimmune disease. This means it begins when the

body's immune system mistakenly attacks other cells in the body. In type 1
diabetes, the immune system destroys the insulin-producing cells (called
beta cells) in the pancreas. This leaves the person with little or no insulin in
his or her body. Without insulin, glucose accumulates in the bloodstream
rather than entering the cells. As a result, the body cannot use this glucose
for energy. In addition, the high levels of blood glucose cause excessive
urination and dehydration, and damage the body's tissues.

45
Type 2 diabetes occurs when your body's cells become less responsive to
insulin's efforts to drive glucose into the cells, a condition called insulin
resistance. As a result, glucose starts to build up in the blood.

In people with insulin resistance, the pancreas "sees" the blood glucose level
rising. The pancreas responds by making extra insulin to try to usher the
glucose into the cells. At first, this works, but over time, the body's insulin
resistance gets worse. In response, the pancreas makes more and more
insulin. Finally, the pancreas gets "exhausted." It cannot keep up with the
demand for more and more insulin. As a result, blood glucose levels rise and
stay high.

Type 2 diabetes is also called adult-onset diabetes. That’s because it almost

always used to start in middle or late adulthood. However, more and more
children and teens are now developing this condition.

Type 2 diabetes is much more common than type 1 diabetes. It tends to run
in families. Obesity also increases your risk of type 2 diabetes. It is truly a

46
different disease than type 1 diabetes, although both types involve a high
blood glucose level and the risk of complications associated with it.

Another kind of diabetes, called gestational diabetes, happens in women who

have higher-than-expected blood sugar levels during pregnancy. Once it
occurs, it lasts throughout the remainder of the pregnancy. Like the other
types of diabetes, gestational diabetes happens when the hormone insulin
can't efficiently move sugar (glucose) into the body's cells so it can be used
as fuel. In gestational diabetes, the body does not respond well to insulin,
unless insulin can be produced or provided in larger amounts.

In most women, the disorder goes away when the pregnancy ends, but
women who have had gestational diabetes are at increased risk of
developing type 2 diabetes later.

Symptoms

Diabetes initially might not cause any symptoms. It can sometimes be

caught early with a routine blood test before a person develops symptoms.

When diabetes does cause symptoms, they may include:

 excessive urination
 excessive thirst, leading to drinking a lot of fluid
 weight loss.

People with diabetes also have an increased susceptibility to infections,

especially yeast (Candida) infections.

When the amount of insulin in the blood stream is too low, extremely high
blood sugar levels can lead to dangerous complications. The body can
become too acidic, a condition called diabetic ketoacidosis. Or the blood

47
sugar level gets so high, the person becomes severely dehydrated. It’s
called hyperosmolar syndrome.

The symptoms of these complications include confused thinking, weakness,

nausea, vomiting, and even seizures and coma. In some cases, diabetic
ketoacidosis or hyperosmolar syndrome is the first sign that a person has
diabetes.

The treatment of diabetes also can produce symptoms. Too much glucose-
lowering medicine, relative to dietary intake, can lead to a blood sugar level
that has dropped too low (called hypoglycemia). Symptoms of hypoglycemia
include:

 sweating
 trembling
 dizziness
 hunger
 confusion
 seizures and loss of consciousness (if hypoglycemia is not recognized
and corrected).

You can correct hypoglycemia by eating or drinking something that has

carbohydrates. This raises your blood sugar level.

Long-term diabetes can have other complications, including:

 Atherosclerosis — Atherosclerosis is fat buildup in the artery walls.

This can impair blood flow to all parts of the body. The heart, brain,
and legs are affected most often.
 Retinopathy — Tiny blood vessels in the retina (the part of the eye
that sees light) can become damaged by high blood sugar. The
damage can block blood flow to the retina, or can lead to bleeding into

48
 the retina. Both reduce the retina's ability to see light. Caught early,
retinopathy damage can be minimized by tightly controlling blood
sugar and using laser therapy. Untreated retinopathy can lead to
blindness.
 Neuropathy — This is another term for nerve damage. The most
common type is peripheral neuropathy, which affects nerves in the
feet and hands. The nerves to the legs are damaged first, causing pain
and numbness in the feet. This can advance to cause symptoms in the
legs and hands. Damage to the nerves that control digestion, sexual
function, and urination can also occur.
 Foot problems — Any sores, injuries, or blisters on the feet can lead
to the following complications:
o If peripheral neuropathy causes numbness, a person may not
feel any irritation or injury that occurs on the foot. The skin can
break down and form an ulcer, and the ulcer can get infected.
o Blood circulation can be poor, leading to slow healing of any foot
injuries. Left untreated, a simple sore can become very large
and get infected. If medical treatment cannot heal the sore, an
amputation may be required.
 Nephropathy — This refers to damage to the kidneys. This
complication is more likely if blood sugars remain elevated and high
blood pressure is not treated aggressively.

Diagnosis

Diabetes is diagnosed through blood tests that detect the level of glucose in
the blood.

 Fasting plasma glucose (FPG) test. A blood sample is taken in the

morning after you fast overnight. A normal fasting blood sugar level is

49
 between 70 and 100 milligrams per deciliter (mg/dL). Diabetes is
diagnosed if the fasting blood sugar level is 126 mg/dL or higher.
 Oral glucose tolerance test (OGTT). Your blood sugar is measured
two hours after you drink a liquid containing 75 grams of glucose.
Diabetes is diagnosed if the blood sugar level is 200 mg/dL or higher.
 Random blood glucose test. A blood sugar of 200 mg/dL or greater
at any time of day, combined with symptoms of diabetes, is sufficient
to make the diagnosis.
 Hemoglobin A1c (glycohemoglobin). This test measures your
average blood glucose level over the prior two to three months.
Diabetes is diagnosed if the hemoglobin A1c level is 6.5% or higher.

Expected Duration

Type 1 diabetes is a lifelong illness. Usually, type 2 diabetes is also life-long.

However, people with type 2 diabetes can sometimes restore their blood
sugar levels to normal just by eating a healthy diet, exercising regularly, and
losing weight.

Gestational diabetes usually goes away after childbirth. However, women

with gestational diabetes are at high risk for developing type 2 diabetes later
in life.

In people with diabetes, aging and episodic illnesses can cause the body's
insulin resistance to increase. As a result, additional treatment typically is
required over time.

Prevention

Type 1 diabetes cannot be prevented.

You can decrease your risk of developing type 2 diabetes.

50
If a close relative—particularly, a parent or sibling—has type 2 diabetes, or if
your blood glucose test shows "pre-diabetes" (defined as blood glucose
levels between 100 and 125 mg/dL), you are at increased risk for developing
type 2 diabetes. You can help to prevent type 2 diabetes by

 maintaining your ideal body weight.

 exercising regularly—such as a brisk walk of 1-2 miles in 30 minutes—
at least five times a week, even if that does not result in you achieving
an ideal weight. That’s because regular exercise reduces insulin
resistance even if you don’t lose weight.
 eating a healthy diet.
 taking medication. The medication metformin (Glucophage) offers
some additional protection for people with pre-diabetes.

If you already have type 2 diabetes, you can still delay or prevent
complications by doing the following.

Keep control of your blood sugar. This helps reduce the risk of most
complications.

Lower your risk of heart-related complications. Aggressively manage

other risk factors for atherosclerosis, such as:

 high blood pressure

 high cholesterol and triglycerides
 cigarette smoking
 obesity

Treatment

Type 1 diabetes is always treated with insulin injections.

51
In most cases, type 2 diabetes treatment begins with weight reduction
through diet and exercise. A healthy diet for a person with diabetes is low in
total calories, free of trans fats and nutritionally balanced, with abundant
amounts of whole grains, fruits and vegetables, and monounsaturated fats.

Most people with type 2 diabetes need drug therapy to control blood sugar.
However, it is possible to achieve normal blood sugar levels with weight loss,
a healthy diet and regular exercise.

Even if medications are required, diet and exercise remain important for
controlling diabetes.

The medications used for type 2 diabetes include pills and injections. They
work in many different ways. They include medications that:

 reduce insulin resistance in the muscles and liver

 increase the amount of insulin made and released by the pancreas
 provide additional insulin
 cause a burst of insulin release with each meal
 delay the absorption of sugars from the intestine
 slow your digestion
 reduce your appetite for large meals
 decrease the conversion of fat to glucose.

Heart Disease & Pregnancy

During pregnancy, changes occur to the heart and blood vessels. These
changes put extra stress on a woman’s body and require the heart to work
harder. The following changes are normal during pregnancy. They help
ensure that your baby will get enough oxygen and nutrients.

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  Increase in blood volume. During the first trimester, the amount of
blood in the body increases by 40 to 50 percent and remains high.
 Increase in cardiac output. Cardiac output refers to the amount of
blood pumped by the heart each minute. During pregnancy, the output
increases by 30 to 40 percent because of the increase in blood volume.
 Increase in heart rate. It is normal for the heart rate to increase by
10 to 15 beats per minute during pregnancy.
 Decrease in blood pressure. Blood pressure may decrease by 10
mmHg during pregnancy. This drop can be due to hormone changes
and because there is more blood directed toward the uterus. Most of
the time, the decrease does not cause symptoms and no treatment is
needed. Your healthcare provider will check your blood pressure during
your prenatal appointments and will tell you if blood pressure changes
are cause for concern.

These changes cause fatigue (feeling overtired), shortness of breath and

light-headedness. All of these symptoms are normal

Congenital heart conditions and pregnancy

Congenital heart defects are the most common heart problems that affect
women of childbearing age. These include shunt lesions, obstructive lesions,
complex lesions and cyanotic heart disease.

Shunt lesions

Shunt lesions are the simplest and most common congenital heart defects.
Shunts include atrial septal defect (ASD), which is a hole between the
upper chambers of the heart; ventricular septal defect (VSD), which is a
hole between the lower chambers of the heart; and patent ductus
arteriosus (PDA), which means there is abnormal blood flow between the
aorta and pulmonary artery. If the hole is large, a fair amount of blood from
the left side of the heart will flow back into the right side of the heart. The
53
blood gets pumped back to the lungs again and causes strain on the heart.
This can lead to an enlarged heart, abnormal heart rhythms and increased
pressure in the lungs (pulmonary hypertension). Pulmonary hypertension,
when severe, can cause the blood flow across the shunt to move in reverse.
This can cause low levels of oxygen in the blood (cyanosis). In such cases,
pregnancy is not recommended due to the high risk of the mother dying.

Obstructive Lesions

Obstructive lesions reduce the amount of blood flow to the heart and the
body’s major blood vessels. One such lesion, aortic coarctation is a
narrowing in the descending aorta, which is the largest artery in the body.
Aortic coarctation can cause a pregnant woman to have high blood pressure.
The condition can also keep the placenta (the collection of blood vessels that
supplies the baby with blood) from getting enough blood. Depending on how
severe the narrowing is, you may need a procedure before or during
pregnancy to keep you and the baby safe during pregnancy.

Complex lesions

Complex lesions include transposition of the great arteries. This means

the aorta and pulmonary arteries are attached to the wrong ventricles
(bottom chambers of the heart). Surgery to repair the problem can cause
problems with the heart chambers, especially if the right ventricle pumps
blood out to the body (this is usually the job of the left ventricle). In this
case, the problem can cause heart failure and leaky heart valves, and the
conditions can become worse during pregnancy. If you have this condition,
you will need to be closely followed during pregnancy.

Cyanotic heart disease includes tetralogy of Fallot. This is a condition

that includes a VSD, narrowing of the pulmonary valve and abnormal
configuration of the aorta. Treatment usually keeps cyanosis from recurring.
However, the repair can cause a leaky pulmonary valve, and that problem
can lead to heart failure and heart rhythm disturbances. If you have a leaky
pulmonary valve, you may need to have it corrected before you become
pregnant.

In general, most women with congenital heart defects, especially those who
have had corrective surgeries, can safely become pregnant. However, the

54
outcome of the pregnancy and risk of complications depends on the type of
heart defect you have, how severe your symptoms are, and whether you
have heart muscle dysfunction, heart rhythm disturbances or pulmonary
hypertension with related lung disease. Your pregnancy can also be affected
if you have had particular types of heart surgery.

Valve disease and pregnancy

Aortic valve stenosis means the aortic valve (the valve between the left
ventricle and the aorta) is narrowed or stiff. If the narrowing is severe, the
heart has to work harder to pump the increased blood volume out of the
narrowed valve. This, in turn, can cause the left ventricle (the major
pumping chamber of the heart to enlarge – a condition called hypertrophy).
Over time, symptoms of heart failure can occur or become worse and
increase the risk of long-term complications for the mother.

One common cause of aortic valve stenosis is bicuspid aortic valve disease.
This is a congenital heart condition in which there are only two leaflets (also
called cusps), instead of the normal three leaflets inside the valve. The
leaflets open and close to keep blood flowing in the right direction and
prevent backflow. Without the third leaflet, the valve can become narrowed
or stiff.

Women with bicuspid aortic valve disease or any type of aortic valve stenosis
need to be evaluated by a cardiologist before planning a pregnancy. In some
cases, surgery is recommended to correct the valve before pregnancy.

Mitral valve stenosis means the mitral valve (the valve between the left
atrium and left ventricle) is narrowed. This condition is often caused
by rheumatic fever.

The increased blood volume and increased heart rate that occur during
pregnancy can make symptoms of mitral stenosis get worse. The left atrium
can become bigger and cause a rapid, irregular heart rhythm called atrial
fibrillation. In addition, the problem can cause heart failure
symptoms (shortness of breath, irregular heart beat, fatigue and
swelling/edema). This can increase the risk to the mother. If you have mitral
valve stenosis, you may need to take medications while you are pregnant.
Your doctor may also recommend an catheter-based procedure, called

55
percutaneous valvuloplasty, to correct the narrowed valve while you are
pregnant. It is important to have mitral stenosis evaluated before you
become pregnant. In some cases, surgery or valvuloplasty to correct the
valve will be recommended before pregnancy.

Mitral valve prolapse is a common condition that usually doesn’t cause

symptoms or require treatment. Most patients with mitral valve prolapse
tolerate pregnancy well. If the prolapse causes a severe leak, you may need
treatment before you become pregnant. Be sure to talk to your doctor if you
plan to become pregnant and follow any recommendations.

Cardiovascular disorders that may develop during pregnancy

Peripartum cardiomyopathy

Peripartum cardiomyopathy is a rare condition. It is when heart

failure develops in the last month of pregnancy or within five months after
delivery. The cause of peripartum cardiomyopathy remains unknown.
Certain patients, including those with multiple pregnancies and those of
African descent, are at greatest risk. Women with peripartum
cardiomyopathy have symptoms of heart failure. After pregnancy, the heart
usually returns to its normal size and function. But, some women continue to
have poor left ventricular function and symptoms. Women with peripartum
cardiomyopathy have an increased risk of complications during future
pregnancies, especially if the heart dysfunction continues.

Hypertension (high blood pressure)

About 6% to 8% of women develop high blood pressure, also called

hypertension, during pregnancy. This is called pregnancy-induced
hypertension (PIH) and is related to preeclampsia, toxemia, or toxemia of
pregnancy. Symptoms of PIH include high blood pressure, swelling due to
fluid retention, and protein in the urine. Pregnancy-induced hypertension can
be harmful to the mother and the baby.

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Myocardial infarction

Heart attack (myocardial infarction) is fortunately a very rare but potentially

deadly complication that can occur during pregnancy or during the first few
weeks afterwards. A heart attack can be caused by many things. Patients
with coronary artery disease (“hardening of the arteries”) can have a
myocardial infarction if the plaque inside their arteries ruptures. This
problem is becoming more common, since many women wait until later in
life to become pregnant. Other causes of a heart attack include a
spontaneous blood clot inside a coronary vessel (because pregnancy
increases the risk of blood clots) and coronary dissection (a weakening of
the vessel wall that leads to a spontaneous tear and clotting). If you have a
heart attack, it is critical to get emergency help. Treatment will be focused
on ensuring your survival.

Heart Murmur

Sometimes, the increase in blood volume during pregnancy can cause

a heart murmur (an abnormal “swishing” sound). In most cases, the
murmur is harmless. But in rare cases, it could mean there’s a problem with
a heart valve. Your doctor can evaluate your condition and determine the
cause of the murmur.

Arrhythmias and pregnancy

Abnormal heartbeats (arrhythmias) during pregnancy are common. Women

who have never had an arrhythmia or heart problem may first develop an
arrhythmia during pregnancy. When an arrhythmia develops during
pregnancy, it can be a sign of a heart condition you didn’t know you had.

57
Most of the time, the arrhythmia causes little in the way of symptoms and
does not require treatment.

Renal Disorders

Physiologic Changes in Pregnancy

There are significant hemodynamic and immunologic shifts that occur

during the course of healthy pregnancy. The major hemodynamic changes in
pregnancy include increased blood volume, decreased systemic vascular
resistance, and increased cardiac output. There are increased systemic levels
of vasodilators, such as nitric oxide and relaxin, and relative resistance to
vasoconstrictors, such as angiotensin II. There is typically a decrease in
systemic blood pressure (BP), usually reaching a nadir by 20 weeks’
gestation. Glomerular filtration rate (GFR) increases by w50%, resulting in a
physiologic reduction in serum creatinine (Scr) level in the setting of hyper

58
filtration. The normal Scr level in pregnancy is in the 0.4- to 0.6-mg/dL
range. The combination of smooth muscle relaxation due to progesterone
and mechanical compression by the enlarging uterus can cause physiologic
hydronephrosis and retention of urine in the collecting system during
pregnancy. Urine protein excretion increases during the course of normal
pregnancy, from 60 to 90 mg/d to 180 to 250 mg/d, as measured by a 24-
hour urine collection. As a consequence of this physiologic increase in
proteinuria, the threshold for elevated proteinuria in pregnancy has been set
at a higher level of protein excretion of 300 mg/d. This increase in
proteinuria has been attributed to hyperfiltration, as described, but may also
be due to changes in glomerular permeability. Some studies have
demonstrated an increase in tubular proteinuria, reflected as an increase in
urinary retinol binding protein, as opposed to an increase in albuminuria,
which would reflect a glomerular source. The use of spot urine protein-
creatinine ratio (UPCR) has gained favor in the diagnosis of preeclampsia,
which is typically characterized by proteinuria (UPCR > 0.3 g/g). UPCR is a
faster test that has acceptable sensitivity and specificity. There may be
increased UPCR in the absence of hypertension or kidney disease, a
phenomenon known as isolated proteinuria, present in as many as 15% of
pregnancies.

Last, there are several changes in the function of the innate and adaptive
immune systems in pregnancy that may have important impacts on the
behavior of autoimmune diseases, a common cause of reduced kidney
function in young women. Normal pregnancy is characterized by a shift from
a T helper (TH) cell type 1 (TH1; cell-mediated immunity) to a TH2
(humoral-mediated immunity) phenotype, which is important for tolerance
to fetal antigens, trophoblast invasion, and placental formation. In addition,
the number of regulatory T cells, which promote immune tolerance, is
increased in normal pregnancy, further contributing to establishing fetal

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tolerance. In autoimmune diseases, such as systemic lupus erythematosus
(SLE), alterations in the number and function of regulatory T cells may
correlate with increased risk for pregnancy complications, such as
preeclampsia, and poor fetal and maternal outcomes.

Box 1. Physiologic Changes in Pregnancy

Increased

• Blood volume

• Cardiac output

• Levels of nitric oxide and relaxin

• Relative resistance to vasoconstrictors

• GFR by 50%

• Urine protein excretion

• TH2 phenotype

• Circulation of Tregs

Decreased

• Systemic vascular resistance

• Systemic blood pressure

• Serum creatinine

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 D. Common
Infections
Rubella (German measles) in pregnancy
What is rubella?

Rubella, commonly known as German measles, is an infection that affects

the skin and lymph nodes. It is caused by a virus. Rubella is serious in
pregnant women because of the effect it can have on an unborn child.

What are the symptoms of rubella?

When children get rubella, it’s usually a mild illness. Sometimes they have
no symptoms at all, but they can still spread the infection to others.

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Symptoms include:

 A low-grade fever and mild aches and pains, sometimes red eyes. 
 A rash of pink or light red spots that start on the face and spread
down to the rest of the body.
 Neck glands may swell up and feel tender, especially behind the ears.

The sickness lasts about 3 days and generally gets better on its own
without any complications. In teens and adults rubella can be a more
serious disease. Joint pain is common. 

How is rubella spread?

The rubella virus passes from person to person through droplets from the
nose or throat of someone with rubella. These droplets may land in the
nose or mouth of someone who is close by, especially when the infected
person coughs or sneezes.

Rubella is most contagious a few days before and after the rash appears.

What about pregnant women and rubella?

Rubella in pregnancy is now very rare in Canada because most women

have been vaccinated against it. 

 If a pregnant woman gets rubella during the first 20 weeks of

pregnancy, she usually passes the disease on to her unborn baby
(fetus). The baby will have congenital rubella.
 If the fetus gets rubella during the first 12 weeks of pregnancy, the
baby will likely be born with many life-long problems. The most
common are eye problems, hearing problems and damage to the
heart.

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  If the fetus gets rubella between 12 and 20 weeks of pregnancy,
problems are usually milder.
 There are rarely problems if the fetus gets rubella after 20 weeks of
pregnancy.
 Babies with congenital rubella are contagious for more than a year. 

There is no treatment for rubella infection.

Influenza

What is the flu?

Influenza (also called flu) is a virus that can cause serious illness. It’s more
than just a runny nose and sore throat. The flu can make you very sick, and
it can be especially harmful if you get it during or right after pregnancy

How does the flu spread?

The flu spreads easily from person to person. When someone with the flu
coughs, sneezes or speaks, the virus spreads through the air. You can get
infected with the flu if you breathe it in or if you touch something (like a
door handle or a phone) that has the flu virus on it and then touch your
nose, eyes or mouth.

People with the flu may be able to infect others from 1 day before they get
sick up to 5 to 7 days after. People who are very sick with the flu or young
children may be able to spread the flu longer, especially if they still have
symptoms. 

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How can the flu harm your pregnancy?

Health complications from the flu, like a lung infection called pneumonia, can
be serious and even deadly, especially if you’re pregnant. If women get the
flu during pregnancy, she’s more likely than other adults to have serious
complications. It’s best to get a flu shot before pregnancy. Getting a flu shot
can help reduce the risk of getting the flu, having serious flu complications
and needing treatment in a hospital. 

Pregnant women who get the flu are more likely than women who don’t get
it to have preterm labor (labor that happens before 37 weeks of pregnancy)
and premature birth (birth that happens before 37 weeks of pregnancy.
Fever from the flu may be linked to birth defects, like neural tube defects,
and other problems in your baby. A birth defect is a health condition that is
present at birth. Birth defects change the shape or function of one or more
parts of the body. They can cause problems in overall health, how the body
develops, or in how the body works. Neural tube defects are birth defects of
the brain and spinal cord.

How does the flu shot help protect you from flu?

The flu shot contains a vaccine that helps prevent you from getting the flu.
The flu shot can’t cause the flu. It’s safe to get a flu shot any time during
pregnancy, but it’s best to get it before flu season (October through May).. 

There are many different flu viruses, and they’re always changing. Each year
a new flu vaccine is made to protect against three or four flu viruses that are
likely to make people sick during the upcoming flu season. Protection from a
flu shot only lasts about a year, so it’s important to get a flu shot every
year.

What are signs and symptoms of the flu?

Signs of a condition are things someone else can see or know about you, like
you have a rash or you’re coughing. Symptoms are things you feel yourself

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that others can’t see, like having a sore throat or feeling dizzy. Common
signs and symptoms of the flu include:

 Being very tired or sleepy (also called fatigue)

 Cough

 Fever (100 F or above), chills or body shakes. Not everyone who has the
flu has a fever.

 Headache, or muscle or body aches

 Runny or stuffy nose

 Sore throat

 Vomiting (throwing up) or diarrhea (more common in children)

The flu often comes on quickly. Fever and most other symptoms can last a
week or longer. But some people can be sick from the flu for a long time,
including children, people older than 65, pregnant women and women who
have recently had a baby.

Call 911 and get medical care right away if you have any of these signs or
symptoms:

 Feeling your baby move less or not at all

 High fever that doesn’t go down after taking acetaminophen (Tylenol®).

Don’t take any medicine without checking with your provider first.

 Pain or pressure in the chest or belly

 Sudden dizziness or confusion

 Trouble breathing or shortness of breath

 Vomiting that’s severe or doesn’t stop

 Flu signs or symptoms that get better but then come back with fever and
a worse cough 

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How can you stop the flu from spreading?

When you have the flu, you can spread it to others. Here’s what you can do
to help prevent it from spreading:

 Stay home when you’re sick and limit contact with others.

 Don’t kiss anyone.

 Cough or sneeze into a tissue or into your arm. Throw used tissues in the
trash.

 Try not to touch your eyes, nose or mouth.

 Wash your hands with soap and water before touching anyone. You also
can use alcohol-based hand sanitizers. Use enough hand sanitizer so that
it takes at least 15 seconds for your hands to dry.

 Use hot, soapy water or a dishwasher to wash your dishes and utensils.

 Don’t share your dishes, glasses, utensils or toothbrush.

Why is the flu so harmful during pregnancy? 

The flu can be dangerous during pregnancy because pregnancy affects your
immune system, heart and lungs. Your immune system is your body’s way
of protecting itself from illnesses and diseases. When your body senses
something like a virus that can harm your health, your immune system
works hard to fight the virus.

When a woman is pregnant, her immune system isn’t as quick to respond to

illnesses as it was before pregnancy. Her body knows that pregnancy is OK
and that it shouldn’t reject your baby. So, the body naturally lowers the
immune system’s ability to protect you and respond to illnesses so that it
can welcome the growing baby. But a lowered immune system means you’re
more likely get sick with viruses like the flu.

Another reason the flu can be harmful during pregnancy is that the lungs
need more oxygen, especially in the second and third trimesters. The

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growing belly puts pressure on the lungs, making them work harder in a
smaller space. You may even find yourself feeling shortness of breath at
times. The heart is working hard, too. It’s busy supplying blood to you and
your baby. All of this means the body is stressed during pregnancy. This
stress on the body can make more likely to get the flu. If a woman is
pregnant or had a baby within the last 2 weeks, she’ll more likely than other
women to have serious health problems from the flu.

Tuberculosis in pregnancy
The highest probability of women having tuberculosis (TB) is during the
childbearing years of 15 (post-puberty) to 49 (up to menopause). During
pregnancy, when the immune system is more susceptible to infections,
chances of contracting this disease are even higher. TB in pregnancy can
have serious consequences if it goes untreated.
Complications that have been reported in pregnant women with TB include
spontaneous abortion, delayed growth of the baby in the womb, and
suboptimal weight gain. Other complications include preterm labour, low
birth weight and increased neonatal mortality. In very rare cases, the baby
is born with the infection.
While treating TB in pregnancy is absolutely essential, the process can be a
little tricky. Doctors and expecting mothers need to be extra cautious about
getting the right treatment and maintaining the health of the baby as well as
the mother. Treating a pregnant woman for tuberculosis may be a little
complicated, but it’s not nearly as dangerous as leaving the infection
untreated.

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Timely diagnosis is critical
Late diagnosis is an independent factor, which may increase maternal
morbidity about four folds, while the risk of preterm labour may be increased
nine folds. Maternal morbidity is an overarching term that refers to any
physical or mental illness or disability directly related to pregnancy and/or
childbirth. Hence, early diagnosis is critical for treatment of TB in pregnant
women.
GeneXpert is the recommended test for detection of TB. The GeneXpert is a
molecular test which diagnoses the disease by detecting the presence of TB
bacterial DNA, as well as testing for resistance to the commonly used drug
Rifampicin for TB treatment. The test has been widely proven to be reliable
and faster in delivering results.
Types of TB and treatment in pregnancy
Latent Tuberculosis
In cases of Latent Tuberculosis, there are no visible symptoms and people
with latent TB infection cannot spread it to others. However, there is a
possibility of them developing TB in the future. A pregnant woman if
diagnosed with Latent TB should hold off on treatment until about two or
three months after she has had her baby.
Active Tuberculosis
Pregnant women who are diagnosed with Active Tuberculosis should be
treated immediately to prevent serious complications.
Managing Tuberculosis during Pregnancy
While medication is unavoidable, certain key factors like sufficient nutrition
to the mother must be ensured. According to the United Nations Multiple
Micronutrient Preparation, all pregnant women and lactating mothers with
active TB should receive multiple micronutrient supplements. These
supplements contain iron and folic acid and other necessary vitamins and
minerals, to complement their maternal micronutrient needs.

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In accordance with WHO recommendations, for pregnant women with active
TB in settings where calcium intake is low, calcium supplementation is
recommended as a part of pre-birth care. This is critical for prevention of
pre-eclampsia, particularly among those pregnant women at higher risk of
developing hypertension.
Note to expecting mothers diagnosed with TB
· Do not ignore any side effects like headaches, changes in vision, nausea,
etc. and inform your doctor about them.
· Avoid being in highly polluted or crowded places.
· Maintain a healthy diet as nutrition levels get significantly impacted.
· Don’t miss any doctor appointments and prescribed doses of medicines.
· New mothers who choose to breastfeed and are still undergoing treatment
for tuberculosis can safely do so.

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 Pregnancy: Sexually Transmitted Diseases

Are you prepared to protect your health from sexually transmitted diseases
and infections? Some of these infections are more familiar—you’ve probably
heard of chlamydia, gonorrhea, genital herpes, and HIV. But many more are

70
less talked about. You can protect yourself and your loved ones from future
health problems by understanding these common STDs.

In this article we answer some of your tricky and sometimes uncomfortable

questions about STD symptoms and diseases. You will learn why herpes is
sometimes considered a sexually transmitted disease, what sexual disease is
nicknamed “the clap,” and which kinds can lie dormant for a long time. You
will also find information on the best treatments for herpes, HIV, chlamydia
and various other sexually-transmitted diseases.

STD or STI?

Some experts prefer the term “STI” (sexually transmitted infection). STIs
include all infections that can be transmitted sexually.

Genital Warts (HPV)

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It's not necessary to have sexual intercourse for a sexually-transmitted
disease (STD) to harm your health. The human papillomavirus (HPV), the
disease that causes genital warts, can be transmitted by close skin-to-skin
contact. Some types of HPV cause cervical or anal cancer, and vaccines are
available to protect against the most dangerous types. Other HPV types
cause genital warts, which can be raised, flat, or cauliflower-shaped. HPV
can be transmitted even by people who have no visible warts or other
symptoms.

HPV Symptoms

Genital warts can be big or small, flat or raised. They generally appear as a
small bump or group of bumps in the genital region, and may be shaped like
a cauliflower.

HPV Vaccine

A vaccine to prevent HPV is given in three shots. The second shot is given a
month or two after the first shot. The third shot comes six months after the
first shot.

The Centers for Disease Control recommends boys and girls be vaccinated at
ages 11 or 12.

If they did not get the HPV vaccine as children, women can get the HPV
vaccine through age 26. Men can get it through age 21. The CDC
recommends HPV vaccination for men through age 26 for men who have sex
with men or men with compromised immune systems, including HIV.

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Pubic Lice (Crabs STD)

Pubic lice are colloquially known as "crabs." This name refers to the shape of
these parasites, which is different from that of body lice. Pubic lice live in
pubic hair and are spread among people during close contact. Pubic lice can
be treated with over-the-counter lice-killing medications.

Pubic Lice (Crabs) Symptoms

 Severe itching
 Visible crawling lice or eggs attached to pubic hair

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Scabies

Like pubic lice, scabies is another parasitic STI. This parasite is not
necessarily sexually transmitted, since it can affect any area of the skin.
However, scabies is often spread during sexual contact.

Scabies Symptoms

 Extreme itching that is worse at night.

 The skin appears to have a pimple-like rash, as shown in the above
photo.
 Both the itching and rash may be across the body or limited to the
wrist, elbow, armpit, webbing between fingers, nipple, penis, waist,
belt-line or buttocks.
 Tiny blisters (vesicles) and scales may appear.
 Tiny burrows left by the tunneling of female scabies mites may be
visible on the skin. They appear as tiny raised and crooked grayish-
white or skin-colored lines.

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The only way to prevent this STI is to avoid touching people, as any skin-to-
skin contact can spread this highly contagious mite. Condoms, while good at
preventing many diseases, will not prevent scabies.

Fortunately, this STI is treatable. Prescription creams can cure a scabies

infestation. Protect your health by visiting a doctor if you believe you may
have this STI.

Gonorrhea (The Clap)

Gonorrhea is an easily transmitted disease that affects both men and

women. It can harm your health by causing infertility in men and women if it
is left untreated. There may be no early symptoms of this common STD.

Gonorrhea Symptoms

 Burning during urination

 Vaginal or urethral discharge

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  Pelvic pain in women
 Men may experience swelling of the testes and discharge from the
penis

In some cases, the symptoms are mild and the condition is mistaken for a
UTI or yeast infection. Visit your health care provider if this sounds like you.

Syphilis

Syphilis can be cured with antibiotics, but many people don't notice its early
STD symptoms. It can play havoc with your health, leading to nerve
damage, blindness, paralysis, and even death over time if not treated.

Syphilis Symptoms

 A round, firm, painless sore on the genitals or anal area (often the first
sign)

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  A rash can develop later on the soles of the feet, palms, or other parts
of the body
 Enlarged lymph nodes
 Fever
 Fatigue
 Hair loss
 Late-stage syphilis can cause damage to many different organ
systems. That's why early detection is so critical to your health.

Chlamydia

Chlamydia is a very common STD. It can cause infertility if not treated. The
symptoms may not be noticed, or they may be vague and nonspecific. Some
people experience no health effects at all.

Chlamydia Symptoms

 Burning or itching of the genitals

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  Discharge
 Painful urination

Chlamydia infections can also develop in the rectum and throat.

Oral Herpes (Herpes Simplex 1 Virus)

Cold sores or "fever blisters" on the lips are a sign of herpes virus infection,
usually caused by the type of herpes virus known as human herpes virus 1,
also known as oral herpes.

Oral herpes is usually not considered a sexually transmitted disease. It can

be transmitted through kissing or household contact. However, it can also
spread to the genitals. (While this type of herpes can be contracted on the
genitals, it is different from the disease known as genital herpes). There is
no cure for herpes infection, but medications can reduce the severity and
duration of outbreaks.

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Oral Herpes

 Itching of the lips or skin around the mouth

 Burning near the lips or mouth area
 Tingling near the lips or mouth area
 Sore throat
 Swollen glands
 Painful swallowing
 A rash may form on your gums, lips, mouth or throat

Symptoms of oral herpes usually appear 1-3 weeks after first infection.
When symptoms return, they are typically milder than the initial herpes
outbreak.

Genital Herpes (Herpes Simplex 2 Virus)

In contrast to oral herpes, genital herpes infections are caused by a different

virus known as HSV-2 HHV-2. The genital herpes virus spreads through
direct genital contact and is considered an STD. More than 87% of those

79
infected with genital herpes are unaware of their infection due to very mild
or nonexistent symptoms.

Genital Herpes Symptoms

 Painful, fluid-filled blisters and crusted sores on the genital area,

buttocks, thighs, or anus.
 Mild tingling or shooting pain in the legs, hips, or buttocks may occur
hours to days before a genital herpes outbreak.

After the first infection, less severe outbreaks are common in the first year.
Outbreaks tend to decrease over time, though the infection may stay in the
body indefinitely.

A genital herpes infection can spread to the lips through oral contact. As with
oral herpes, medications can reduce the severity of genital herpes, but there
is no cure.

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Hepatitis B

Hepatitis B is a virus that spreads through contact with body fluids and
blood, so it can be transmitted through sexual intercourse. Hepatitis B
infection is also possible through sharing of needles, razors, and
toothbrushes. Babies can become infected at birth from an infected mother.
It's possible to go for years without symptoms of this STI.

Hepatitis B Symptoms

 Nausea
 Abdominal pain
 Jaundice (yellowing of the skin and whites of the eyes)
 Over time, scarring of the liver (cirrhosis) and liver cancer can
develop.

Although there is no cure, there is a vaccine to prevent hepatitis B infection.

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HIV/AIDS

The HIV virus (AIDS virus) weakens the body's immune system. It is spread
through sexual contact, needle sharing, or from an infected mother to baby.
There may be no symptoms for years, but a blood test can tell if you have
been infected. With appropriate treatment, many serious illnesses can be
prevented.

HIV Symptoms

 Flu-like symptoms 1 to 2 months after first infection, including like

swollen lymph nodes, fever, and headaches
 Chills
 Rash
 Night sweats

Muscle Aches

 Sore throat

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  Swollen lymph nodes
 Mouth ulcers

AIDS Symptoms

 Rapid weight loss

 Recurring fever or profuse night sweats
 Extreme and unexplained tiredness
 Prolonged swelling of the lymph glands in the armpits, groin, or neck
 Diarrhea that lasts for more than a week
 Sores of the mouth, anus, or genitals
 Pneumonia
 Red, brown, pink, or purplish blotches on or under the skin or inside
the mouth, nose, or eyelids
 Memory loss, depression, and other neurologic disorders

HIV Testing

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There are accurate tests to identify whether or not you have been infected
with the HIV virus. These can be done in the clinic or at home with the FDA-
approved Home Access test kit. The test can be performed anonymously,
with only a number to identify you. However, sometimes people may not
test positive in the initial 3-4 weeks to 6 months after infection. This time
period is referred to as the "window period" in which antibodies may not
have developed enough for a positive test. You can still transmit the virus to
others during this time.

HIV/AIDS Treatment Options

While there is no cure for HIV, there are medications that can suppress the
amount of virus multiplying inside the body. People take a combination of
antiviral drugs in hopes of preventing the infection from advancing to AIDS.
Additional treatments can help prevent or fight off serious infections, if the
immune system has weakened.

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Trichomoniasis (“Trich”)

Trichomoniasis is a parasitic infection (caused by Trichomonas vaginalis) that

is spread during sexual contact. It affects both men and women and can be
cured with medications. Most affected men have no specific symptoms.

Trichomoniasis Symptoms

 Men: minor discharge or burning with urination

 Women: yellowish-green vaginal discharge with a prominent odor,
itching of the vaginal area, or painful sex or urination

Symptoms can develop anywhere from 5 to 28 days after contracting the

infection.

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Chancroid

Chancroid is an STD that is rarely seen in the U.S. It is more common in

Africa and Asia. It causes painful lumps in the genital area that can progress
to open sores. Antibiotics can cure the infection; chancroid is caused by
bacterial infection with Haemophilus ducreyi.

Chancroid Symptoms

 One or more sores or raised bumps on the genitals. A narrow, red

border surrounds the sores. The sores become filled with pus and
eventually rupture into a painful open sore.
 About half the time when untreated, the chancroid bacterial infection
spreads to the groin's lymph glands, causing the groin to enlarge and
become hard and painful.

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Lymphogranuloma venereum (LGV)

Lymphogranuloma venereum (LGV) is a type of chlamydial infection, but it is

caused by a different type of chlamydia (Chlamydia trachomatis) than the
usual chlamydial disease. Like other chlamydial infections, it can be cured by
antibiotic treatment.

Early Lymphogranuloma venereum Symptoms (3-12 Days After

Exposure)

 Soft red, painless sores on or near the genitals or anus

 Similar sores in the throat or mouth following oral sex

Later Lymphogranuloma venereum Symptoms (2-6 Weeks After

Exposure)

 Open sores in the genitals

 Swollen lymph nodes in the groin
 Headache

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  Anal sores and rectal discharge or bleeding if the infection was
acquired through anal sex
 Painful urination
 Constipation
 Rectal bleeding
 Pain in lower back/abdomen
 Pus-filled or bloody diarrhea
 Fever, chills, joint pain, decreased appetite and fatigue

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is not a specific STD. Rather, it is a

complication that can develop from various diseases, particularly gonorrhea
and chlamydia. In PID, bacteria spread to the uterus and female
reproductive tract. Infertility may result if the condition is not treated right
away.

Pelvic Inflammatory Disease Symptoms

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  Fever
 Pelvic or low abdominal pain
 Painful urination
 Discharge
 Painful intercourse
 Light bleeding

Who's at Risk of Sexually Transmitted Diseases?

It's estimated that half of sexually active young adults acquire at least one
of these STIs by age 25. In fact, sexual diseases are the most commonly
reported type of infection in America. Though more common in teens and
young adults, anyone who is sexually active is potentially at risk. The risk is
raised by having multiple sex partners. The incidence of some sexually
transmitted diseases, including LGV and syphilis, is increasing in men who
have sex with men.

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Can Virgins Get Sexually Transmitted Diseases?

Many of these diseases can spread through any type of sexual activity. This
can include skin-to-skin contact and oral sex. This means that people who
have not yet had sexual intercourse can still get infected.

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Preventing Infection

Abstinence from any sexual contact (or skin-to-skin contact) is the only
absolute way to prevent STIs. Being in a long-term, monogamous
relationship also is a good way to avoid them.

There are also steps you can take to decrease the chance of getting an STD
if you are sexually active, including:

 Asking partners if they have ever been infected.

 Using condoms.
 Avoiding sexual activity with a partner who shows STD symptoms.
 Asking partners to be tested before having sex.
 Being aware of symptoms and signs of these conditions.

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The Limits of Condoms

Condoms can prevent the spread of some STDs, but they aren't 100%
effective. They are less effective at protecting against herpes, syphilis, and
genital warts, since these STDs can be transmitted by contact with skin
lesions that are not covered by a condom. Condoms also do not protect
against crabs and scabies infestations.

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How to Tell Your Partner You Are Infected

It may be difficult, but it is important to tell your partner as soon as possible

if you believe you may be infected. Even if you are being treated, you may
still be able to spread the infection. For some diseases, both partners should
be treated at the same time.

It can be difficult to share this information, so some people find that

preparing a script in advance can be helpful. Here are some facts that can
help the conversation go more smoothly:

 Discovering a sexually transmitted disease is not necessarily evidence

of cheating. It may very well have come from either your past
relationship or that of your partner.
 An estimated one in two sexually active people will contract such a
condition by the time they reach age 25. Most of these don't know
they have an infection. Many STD symptoms are subtle or don’t even
show up when first contracted and may be discovered much later.

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It's normal to be nervous about this topic. But by being bold and taking
action, you can actively promote better health for you and your partner.

STDs and Pregnancy

Some STDs can cause premature labor in pregnant women, and many STDs
can be passed to the baby either during pregnancy or childbirth. So all
pregnant women should be checked for STDs. STDs can cause numerous
problems in babies, like low birth weight, stillbirth, nerve problems,
blindness, serious infections, and liver problems. Treatment during
pregnancy can reduce the risks of these complications and can cure many
types of infections.

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Can STDs Come Back?

In most cases, new exposures to STDs that you have already acquired in the
past can cause you to get the infection again. Most treatments don't protect
you from developing the STD at a future time. If your partner has not been
treated, you may pass the infection back and forth. Without the right
precautions, you could acquire a second STD or a recurrence of the same
infection. In addition, genital herpes virus infections can be recurrent after a
single exposure.

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Unit III

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