‫‪Normal Pregnancy and Ectopic‬‬

‫‪Pregnancy in Woman‬‬

‫ا لدكتور‬
‫طال لانور عبد ا لكريم‬
‫ف سلجة ا لتناسل وا لتلقيح ا الصطناعي‬
‫ق سم ا لثروة ا لحيوانية‬
‫ك لية ا لزراعة – جامع ة ب غ داد‬
 ‫الرحيم‬
‫الرحمن َ‬
‫ِبسم هللا َ‬

‫ت َثالث‬
‫طون أمها ِت ُكم َخلقا ً مِن َبع ِد َخلق في ُظلما ٍ‬
‫ِ‬ ‫ب‬‫ُ‬ ‫في‬ ‫م‬ ‫ُ‬
‫ك‬ ‫ُ‬ ‫” َيخلُق‬
‫صرفون“‬ ‫ذلِ ُكم هللا َر ُب ُكم لَ ُه ال ُملك ال اله إال هوفأنى ُت َ‬

‫ص َد َق هللا َ‬
‫العظيم‬ ‫َ‬

‫( االنعام ‪ ,‬االية ‪)6‬‬

Normal Pregnancy
in woman
 ?How to detect the pregnancy
Two types of tests ( in Serum or Urine):

• Qualitative human chorionic

gonadotropin (hCG) : gives yes or No
results.

• Quantitative or beta human chorionic

gonadotropin: Gives exact level of hCG
 Maternal Physiology
• Basal metabolic rate increases 15 %
• Cardiac output increases 30 – 40 %
• Blood volume increases 30 %
• O2 utilization increases 20 %
• Renal tubule reabsorption increases
50%
• Glomerulus filtration rate increases
50%
 Weight gain and pregnancy
• Average: 10.9 kg, may reach 34 kg
• Fetus: 3.2 kg
• Extraembryonic fluids / tissues: 1.8 kg
• Uterus: 0.9 kg
• Breasts: 0.9 kg
• Body fluids: 2.7 kg
• Fat accumulation : 1.3 kg
 Hormonal changes during
pregnancy
hCG
- detected within few days of
implantation (7 – 10 days)

- increase rapidly during early

pregnancy to a peak occurring 60 days
post- conception.

- Decreased gradually to reach

minimum level at term.
Human Placental Lactogen (hPL)

- Increased Progressively during pregnancy

- Biologically, Similar to growth hormone
- Affect carbohydrate and lipid metabolism.

Estrogens

- Biosynthesis by mother, fetus, placenta

- Affect uterus and other reproductive organs.
- influence carbohydrate, lipid, and bone metabolism
Progesterone

- rise progressively throughout pregnancy.

- Progesterone relaxes smooth muscle, which
causes atony of the gastrointestinal and
urinary tracts.
 Hematological changes during
pregnancy

• Plasma volume increases by about 50%

• RBC volume increases by about 30%
• WBC count increases during pregnancy by
about 20%
• Platelet count decreases, but stays within
normal limits
 Gastrointestinal System during
pregnancy

• Decreased motility due to influence of

progesterone.

• Reduced gastric acid secretion.

 Daily dietary requirements of
pregnant woman
• Calories: increased 15% kcal/day, or you need about
2200 cal/day
• Protein: an additional 10 to 30 gm /day (about 75
gm/day total)
• Iron: supplement 30 to 60 mg of elemental iron per
day
• Calcium: 1200 mg needed per day
• Foliate: supplement 200 to 400 g per day
 Nausea and Vomiting during
pregnancy

• Peaks during first Trimester.

• Positive correlation with birth weight
• Nausea – 50-70% of pregnant women
• Vomiting- 40-50% of pregnant women
• Less than 2% is solely in the morning.
 Possible causes of Nausea and
vomiting
• Elevated hCG level
• Elevated estrogen / progesterone level
• Bacterial ( Heliocobacter pylori)
• Serotonin levels
Definition of Ectopic pregnancy

Ectopic means "out of place." In an ectopic

pregnancy, a fertilized egg has implanted outside the
uterus. The egg settles in the fallopian tubes in more
than 95% of ectopic pregnancies (Tubal
pregnancies).

The egg can also implant in the ovary, abdomen, or

the cervix (ovarian, cervical or abdominal
pregnancies )
 Signs and Symptoms of ectopic
pregnancy
• Ectopic pregnancy can be difficult to diagnose
• Pain (sharp and stabbing ) in pelvis.
• Vaginal bleeding.
• Pain in shoulder and neck ( irritates certain nerves)
• dizziness or fainting (caused by blood loss)
• low blood pressure (also caused by blood loss)
• lower back pain
 Causes of Ectopic Pregnancy
• Inability of fertilized eggs to work its way quickly
enough down the Fallopian tube into the uterus.

• Pelvic inflammatory disease (PID) caused by

gonorrhea that cause blockage of Fallopian tube.

• Endometriosis (cells from the lining of the uterus

implant and grow elsewhere in the body and cause
blockages

• Rarely, birth defect or abnormal growth can alter

shape of tube and disrupt the egg’s process.
Diagnosis of Ectopic pregnancy
• If woman know she is pregnant
• serum quantitative hCG level

• Normally, Its levels double every 2 days for

the first several weeks of pregnancy, so if
hCG levels are lower than expected for your
stage of pregnancy, one possible explanation
might be an ectopic pregnancy.
Diagnosis of Ectopic pregnancy
• ultrasound examination, whether the uterus
contains a developing fetus or if masses are
present elsewhere in the abdominal area.

• The doctor may also give pelvic exam to

locate the areas causing pain, to check for an
enlarged, pregnant uterus, or to find any
masses.
• All above together.
 Options for Treatment

Treatment varies depending on:

- Medically stable the woman is.

- Size and location of the pregnancy
 Options for Treatment
• An early ectopic pregnancy can sometimes
be treated with an injection of methotrexate,
which stops the growth of the embryo.

• If the pregnancy is further along, she will

likely need surgery to remove the abnormal
pregnancy using laparoscopy provided with
camera.
?What About Future Pregnancies
• Some women with ectopic pregnancy will
have difficulty becoming pregnant again
especially those had fertility problems
before.

• Future pregnancy depends on fertility before

ectopic and size of damage.
 Who's at Risk for an Ectopic
? Pregnancy

• women who are over 35 age.

• PID.
• a previous ectopic pregnancy.
• surgery on a fallopian tube.
• infertility problems or medication to
stimulate ovulation.
• Women used Intrauterine device (IUD).
Thank you for your listening