456 XXI. Diseases of the Female Genital System Foetus in Uterine Foetus:  Is that of 5-month duration Uterus:  Is enlarged  Size is that corresponding to 5 months gestation.  Wall is rather thinned out  Cavity contains a 5-month-foetus.  Shows the placental attachment

N.B.1:  Pregnancy  May end normally (by delivery of a living child after 275 days from last reproductive coitus or 282 days from last menstruation) or, it  May be interrupted and ends by abortion (expulsion of the fertilized ovum before the 16th. Week),  Miscarriage (expulsion between the 16th and 28th. Weeks),  Premature foetus (from the 6th, to 8th. Month) or by  Still-birth (full-term child who is born-dead)

Days Weeks Months normally 275 days from last reproductive coitus or 40 +- 2 9.33 282 days from last menstruation abortion 112 16 4 Miscarriage 112 - 196 16 - 28 4-7 Premature foetus 168- 224 24 - 32 6 - 8 Still-birth full-term child who is born-dead

Features and physiological changes during pregnancy:  Amenorrhea;  Indigestion  (morning-sickness,  constipation and  appetite-changes);   Slight hypertrophy of heart and  Very slight elevation of blood pressure;   Skin-changes (pigmentation, linea nigra and striae gravidarum);   Breast-changes (enlargement and secondary areola); Montgomery's follicles   Mucous membrane changes (dark-bluish vagina which is moist & warm);  Enlargement of uterus; Softening of cervix;  Distended veins;   Urine: Polyuria, Frequency of micturition & Changes in urine-content of estrin & prolans;   Persistence of corpus luteum in ovary;  Increased thyroid action;  Foetal parts; Foetal heart;  Placental bruit;  Positive pregnancy-tests  X-ray diagnostic picture.

D.D. of pregnancy: 1. Full bladder; hydronephrosis; pyonephrosis. 2. Hydrosalpinx and pyosalpinx. 3. Ovarian cysts; mesenteric cysts. 4. Fibroids of uterus; other tumours. 5. Ascites. 6. Pseudocyesis. 7. Subinvolution. 8. . 9. Gynaecological or general diseases associated with amenorrhea.

N.B.2 Diseases of pregnancy (or associated with it): 1. Toxaemia of pregnancy (): (a) Vomiting of pregnancy (neurotic, reflex or toxic).  If severe  hyperemesis gravidarum.  Dehydration,  Acidosis,  High ammonia-coefficient,  Diminution of liver-glycogen and  Liability to renal damage.

(b) Pre-eclampsia (A symptom-complex which only arises in the pregnant woman and consists of  Elevation of blood pressure,  Albuminuria and  Oedema as well as some  Gastro-intestinal and  Nervous symptoms). It may be called albuminuria of pregnancy or vomiting of pregnancy).

(c) Eclampsia:  A severer condition than pre-eclampsia where there are also attacks of convulsions or and coma.  It may be due to o Sensitization, o Shock, o thrombosis of vessels, o Toxaemia, o Water-poisoning, o Endocrine disorders etc... 

 Gross picture in eclampsia:  Placenta: o Premature ageing; o Areas of infarction; o More atrophy of more villi.  Brain and heart: o Minute haemorrhages; o Thrombosis of small vessels; o Oedema.  Anterior pituitary: o Small haemorrhages; o Thrombosis; o Infarcts  post-partum pituitary necrosis (Sheehan's).  Kidneys : o Cloudy swelling; fatty change; minute infarcts in cortex  renal cortical necrosis.  Liver: o Irregular subcapsular and focal intra-parenchymal haemorrhages; o Hepatic necrosis (focal).