456 XXI. Diseases of the Female Genital System Foetus in Uterine Pregnancy 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. Ectopic pregnancy. 9. Gynaecological or general diseases associated with amenorrhea.
N.B.2 Diseases of pregnancy (or associated with it): 1. Toxaemia of pregnancy (eclampsia): (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).