Placenta praevia (placenta previa AE) is an obstetric complication in which the placenta is attached to the uterine wall close

to or covering thecervix. It can sometimes occur in the later part of the first trimester, but usually during the second or third. It is a leading cause of antepartum haemorrhage (vaginal bleeding). It affects approximately 0.5% of all labours. Placenta praevia is hypothesized
[who?] [1]

to be related to abnormal vascularisation of

the endometrium caused by scarring or atrophy from previous trauma, surgery, or infection. In the last trimester of pregnancy the isthmus of the uterus unfolds and forms the lower segment. In a normal pregnancy the placenta does not overlie it, so there is no bleeding. If the placenta does overlie the lower segment, as is the case with placenta praevia, it may shear off and a small section may bleed. Intervention An initial assessment to determine the status of the mother and fetus is required. Although mothers used to be treated in the hospital from the first bleeding episode until birth, it is now considered safe to treat placenta praevia on an outpatient basis if the fetus is at less than 30 weeks of gestation, and neither the mother nor the fetus are in distress. Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother are in distress. Blood volume replacement (to maintain blood pressure) and blood plasma replacement (to maintain fibrinogen levels) may be necessary. There is debate as to whether vaginal delivery or delivery by Caesarean section is the safest method. In cases of fetal distress a Caesarean section is indicated. Caesarian section is contraindicated in cases of disseminated intravascular coagulation. A problem exists in places where a Caesarean section cannot be performed, due to the lack of a surgeon or equipment. In these cases the infant can be delivered vaginally. There are two ways of doing this with a placenta praevia: The baby's head can be brought down to the placental site (if necessary with Willet's forceps or a vulsellum) and a weight attached to his scalp A leg can be brought down and the baby's buttocks used to compress the placental site

The goal of this type of delivery is to save the mother, and both methods will often kill the baby. These methods were used for many years before Caesarean section and saved the lives of both mothers and babies with this condition.
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The main risk with a vaginal delivery with a praevia is that as you are trying to bring down the head or a leg, you might separate more of the placenta and increase the bleeding. Placenta praevia increases the risk of puerperal sepsis and postpartum haemorrhage because the lower segment to which the placenta was attached contracts less well post-delivery.

Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a diagnostic gynecological procedure. D&C normally is referred to a procedure involving a curette, also called sharp curettage. However, some sources use the term D&C to refer more generally to any procedure that involves the processes of dilation and removal of uterine contents, which includes the more common suction curettage procedures of manual and electric vacuum aspiration. Complications Any intrauterine procedure (hysteroscopy or D and C) carries with it a risk of infection, bleeding or uterine perforation. These complications are quite low and should not dissuade a patient from undergoing such procedures when necessary.Another risk is intrauterine adhesions, or Asherman's syndrome. This risk is extremely low in an uncomplicated setting but when infection exists it may increase the risk. Salpingo-oophorectomy is a surgical procedure involving the removal of one or both of the fallopian tubes (salpingectomy) and one or both ovaries (oophorectomy).In a unilateral salpingo-oophorectomy procedure, only one fallopian tube and one ovary are removed. In the bilateral procedure, both fallopian tubes and both ovaries are removed. In premenopausal women, an attempt is made whenever possible to preserve ovarian function by removing only one ovary or a part of one ovary. A salpingo-oophorectomy may be performed to remove fluid-filled sacs (ovarian cysts) that do not respond to conservative treatment,benign tumors (fibromas or teratomas), or abscesses. It is also done to treat chronic inflammation of the fallopian tubes (chronicsalpingitis or tuberculous salpingitis), infections caused by pelvic inflammatory disease, and endometrial cells in the pelvic cavity (endometriosis). The procedure is used to remove the results of a pregnancy that develops in a fallopian tube rather than in the uterus (ectopic pregnancy), if a simple incision into the fallopian tube to remove the pregnancy (salpingostomy) cannot be performed.Salpingo-oophorectomy is used to treat ovarian cancer and may also be performed with a hysterectomy as a part of the treatment for uterine cancer or for treatment of a cancerous tumor derived from placental tissue (choriocarcinoma). Salpingo-oophorectomy is used in breast cancer cases when the physician considers that a reduction in the amount of hormones produced by the ovaries (estrogens) may slow the growth of the cancer. Besides treating existing ovarian cancer, the procedure is sometimes used to remove healthy ovaries as a preventive (prophylactic) measure in reducing the risk of breast or ovarian cancer in high-risk women. Tubo-ovarian abscess is an advanced form of pelvic inflammatory disease most often caused by spread of bacteria from the lower genital tract. (The most common bacterial pathogens are anaerobic.) Risk factors for pelvic inflammatory disease include those associated with increased risk of contracting a sexually transmitted disease: early age of first sexual encounter, multiple sexual partners, history of sexually transmitted disease, and douching. In addition, women using IUDs are at increased risk for pelvic inflammatory disease and tubo-ovarian abscess. Diverticulitis and appendicitis are also potential causes.Complications of pelvic inflammatory disease and tubo-ovarian abscesses include infertility due to tubal occlusion, increased risk of ectopic pregnancy, and chronic pelvic pain as the result of adhesions.The typical ultrasonographic appearance of a tubo-ovarian abscess is a multilocular, cystic, complex adnexal mass often with debris and thick septations.This patient was unresponsive to a triple antibiotic regimen of ampicillin, clindamycin, and flagyl. Her condition required surgical intervention.
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An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication. Most ectopic pregnancies occur in the Fallopian tube (so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. An ectopic pregnancy is a potential medical emergency, and, if not treated properly, can lead to death.In a normal pregnancy, the fertilized egg enters the uterus and settles into the uterine lining where it has plenty of room to divide and grow. About 1% of pregnancies are in an ectopic location with implantation not occurring inside of the womb, and of these 98% occur in the Fallopian tubes.Detection of ectopic pregnancy in early gestation has been achieved mainly due to enhanced diagnostic capability. Despite all these notable successes in diagnostics and detection techniques ectopic pregnancy remains a source of serious maternal morbidity and mortality worldwide, especially in countries with poor prenatal care. In a typical ectopic pregnancy, the embryo adheres to the lining of the fallopian tube and burrows into the tubal lining. Most commonly this invades vessels and will cause bleeding. This intratubal bleeding hematosalpinx expels the implantation out of the tubal end as a tubal abortion. Tubal abortion is a common type of miscarriage. There is no inflammation of the tube in ectopic pregnancy. The pain is caused by prostaglandins released at the implantation site, and by free blood in the peritoneal cavity, which is a local irritant. Sometimes the bleeding might be heavy enough to threaten the health or life of the woman. Usually this degree of bleeding is due to delay in diagnosis, but sometimes, especially if the implantation is in the proximal tube (just before it enters the uterus), it may invade into the nearby Sampson artery, causing heavy bleeding earlier than usual.If left untreated, about half of ectopic pregnancies will resolve without treatment. These are the tubal abortions. The advent of methotrexate treatment for ectopic pregnancy has reduced the need for surgery; however, surgical intervention is still required in cases where the Fallopian tube has ruptured or is in danger of doing so. This intervention may be laparoscopic or through a larger incision, known as a laparotomy.There are a number of risk factors for ectopic pregnancies. However, in as many as one third to one half of ectopic pregnancies, no risk factors can be identified. Risk factors include: pelvic inflammatory disease, infertility, use of an intrauterine device (IUD), previous exposure to DES, tubal surgery, intrauterine surgery (e.g. D&C), smoking, previous ectopic pregnancy, and tubal ligation.
[13]

Although older texts suggests an

association between endometriosis and ectopic pregnancy this is not evidence based and current research suggests no association between endometriosis and ectopic pregnancy

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy (1). The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy. Women with GDM are at increased risk for the development of diabetes, usually type 2, after pregnancy. Obesity and other factors that promote insulin resistance appear to enhance the risk of type 2 diabetes after GDM, while markers of islet cell-directed autoimmunity are associated with an increase in the risk of type 1 diabetes. Offspring of women with GDM are at increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood. Uterine subinvolution is a slowing of the process of involution or shrinking of the uterus. a. Causes. Endometritis, retained placental fragments, pelvic infection, and uterine fibroids may cause uterine subinvolution. b. Signs and Symptoms. (1) Prolonged lochial flow. (2) Profuse vaginal bleeding. (3) Large, flabby uterus. c. Medical Treatment. (1) Administration of oxytocic medication to improve uterine muscle tone. Oxytocic medication includes (a) Methergine-a drug of choice since it can be given by mouth. (b) Pitocin. (c) Ergotrate. (2) Dilation and curettage (D&C) to remove any placental fragments. (3) Antimicrobial therapy for endometritis. d. Nursing Interventions. (1) Early ambulation postpartum. (2) Daily evaluation of fundal height to document involution.

Total abdominal hysterectomy is utilized for benign and malignant disease where removal of the internal genitalia is indicated. The operation can be performed with the preservation or removal of the ovaries on one or both sides. In benign disease, the possibility of bilateral and unilateral oophorectomy should be thoroughly discussed with the patient. Frequently, in malignant disease, no choice exists but to remove the tubes and ovaries, since they are frequent sites of micrometastases. In general, the modified Richardson technique of intrafascial hysterectomy is used. The purpose of the operation is to remove the uterus through the abdomen, with or without removing the tube and ovaries. Physiologic Changes. The predominant physiologic change from removal of the uterus is the elimination of the uterine disease and the menstrual flow. If the ovaries are removed with the specimen, the predominant physiologic change noted is loss of the ovarian steroid sex hormone production. Points of Caution. The predominant point of caution in performing abdominal hysterectomy is to ensure that there is no damage to the bladder, ureters, or rectosigmoid colon. Mobilization of the bladder with a combination of sharp and blunt dissection frees the bladder from the lower uterine segment and upper vagina. This reduces the incidence of damage to the bladder. By exercising extreme care in management of the uterine artery pedicle, the surgeon may minimize the risk of injury to the ureter. The same is true of the management of the cardinal and uetrosacral ligament pedicles. If the vaginal cuff is left open with the edges sutured, the incidence of postoperative pelvic abscess is dramatically reduced.