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Gepubliceerd in:
hoofdstuk lezen eerste hoofdstuk lezen

2024 | OriginalPaper | Hoofdstuk

24. Early pregnancy disorders

Auteurs : Prof. dr. Rebecca C. Painter, Dr. Norah M. van Mello, Prof. dr. Mariëtte Goddijn, Dr. Merel M. J. van den Berg, Dr. Christianne Lok, Dr. Nienke van Trommel, Prof. dr. Joris A. M. van der Post

Gepubliceerd in: Textbook of Obstetrics and Gynaecology

Uitgeverij: Bohn Stafleu van Loghum

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Summary

Early pregnancy, starting at conception and ending with the completion of embryogenesis, is a period of rapid growth and development of both embryo and placental tissues. Early disruption of embryonic development has major consequences, which are discussed in this chapter. Gestational trophoblast disease is rare and occurs when the embryo’s genetic material is polyploid or of monoparental origin and can result in gestational trophoblast neoplasm. Miscarriage is common and reflects early embryonic developmental arrest and demise, e.g. due to chromosomal abnormalities. Ectopic pregnancy occurs when implantation takes place at any site other than the uterine cavity, usually the fallopian tube, in some cases leading to intra-abdominal bleeding. Each of the disorders frequently present with bleeding in early pregnancy. Finally, and in contrast to the previous three disorders, hyperemesis gravidarum, or excessive vomiting in pregnancy, is likely a result of the surge in placental hormones in early pregnancy that marks a healthy placental development.
vorige hoofdstuk Maternal adaptations
volgende hoofdstuk Gestational disorders
Bijlagen
Alleen toegankelijk voor geautoriseerde gebruikers
Woordenlijst
Antiphospholipid syndrome
An autoimmune, hypercoagulable state associated with antiphospholipid antibodies.
Asherman’s syndrome
A condition characterised by adhesions of the endometrium. Patients experience secondary menstrual irregularities and have problems getting pregnant in the future.
Biochemical pregnancy
Spontaneous pregnancy demise based on decreasing serum or urinary HCG levels, without an ultrasound evaluation.
Complete hydatidiform moles (CHM)
Usually diploid and androgenetic in origin.
Crown-rump length (CRL)
The measurement of the length of human embryos and foetuses from the top of the head (crown) to the bottom of the buttocks (rump).
Ectopic pregnancy
Occurs when the fertilised egg implants outside the uterine cavity. The most common site for an ectopic pregnancy is the fallopian tube.
Foetal pole
When a small embryo can be discerned within the gestational sac on transvaginal ultrasound imaging.
Free fluid
On transvaginal ultrasound imaging fluid, ascites or blood is visible as echolucent (black). Free fluid usually collects in the cul-de-sac (rectouterine space, or Douglas’ pouch).
Gestational age
A measure of the age of a pregnancy timed from the first day of the last normal menstrual period, usually given in weeks and days.
Gestational trophoblastic disease (GTD)
Includes all conditions of gestational trophoblastic neoplasia, as well as two benign entities: complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM).
Gestational trophoblastic neoplasia (GTN)
Includes persistent trophoblastic disease (PTD), choriocarcinoma (CC), and placental site trophoblastic tumour (PTT) and epithelioid trophoblastic tumour (ETT).
Human chorionic gonadotropin (hCG)
A glycoprotein hormone produced by trophoblastic cells and therefore a key marker in pregnancy and GTD.
Hyperemesis gravidarum (HG)
Severe or protracted nausea and vomiting, it and complicates 1–3 % of pregnancies.
In vitro fertilization (IVF)
Involves the fertilization of an egg outside the body.
Misoprostol
A synthetic prostaglandin analogue C22H38O5 used to prevent stomach ulcers, but is also used to induce miscarriage, without official registration.
Monosomy X
A type of aneuploidy in which a female is missing an X chromosome, instead of the normal two X chromosomes.
Nausea and vomiting (NVP)
Common in pregnancy; 70 % of women experience nausea and 40 % experience occasional vomiting.
Partial hydatidiform moles (PHM)
Triploid conceptions.
Polyploidy
The presence of more than two complete sets of chromosomes.
Pregnancy of unknown location (PUL)
Positive pregnancy test but no pregnancy visualized at transvaginal ultrasonography.
Ruptured ectopic pregnancy
Acute or subacute intra-abdominal bleeding after the fallopian tube, in which the ectopic pregnancy had implanted, has split open.
Septate uterus
A common type of congenital uterine anomaly. It results from partial or complete failure of resorption of the uterovaginal septum after fusion of the paramesonephric ducts.
Structural chromosome abnormalities
Occur when the structure of one of the chromosomes is altered, while the number of chromosomes is normal.
Trisomy
A type of aneuploidy in which there are three instances of a particular chromosome instead of the normal two.
Uterine perforation
Occurs when an intrauterine instrument inadvertently passes through the uterine wall, potentially damaging the intestines, bladder, or blood vessels. It can complicate any intrauterine procedure, including dilatation and curettage, hysteroscopy, or placement of a contraceptive coil (intrauterine device, IUD).
Literatuur
1.
Coomarasamy A, Gallos ID, Papadopoulou A, Dhillon-Smith RK, Al-Memar M, Christiansen OB, Stephenson MR, Oladapo OT, Wijeyaratne CN, Small R, Bennett PR, Regan R, Goddijn M, Devall AJ, Bourne T, Brosens JJ, Quenby S. Sporadic miscarriage: evidence to provide effective care. Lancet. 2021;397:1668–74.CrossRefPubMed
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ESHRE Guideline Group on RPL. Atik RB, Christianses OB, Elson J, Kolte AM, Lewis S, Middeldorp S, Nelen W, Peramo B, Quenby S, Vermeulen N, Goddijn M. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open. 2018(2).
3.
4.
Kolte AM, Bernardi LA, Christiansen OB, Quenby S, Farquharson RG, Goddijn M, Stephenson MD. Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. Hum Reprod. 2015;30(3):495–8.CrossRefPubMed
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6.
RCOG. The management of nausea and vomiting of pregnancy and hyperemesis gravidarum. RCOG Green Top Guideline 2016;69.
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Roseboom T, De Rooij S, Painter R. The Dutch famine and its long-term consequences for adult health. Early HumDev. 2006;82:485–91.CrossRef
8.
Seckl MJ, Sebire NJ, Fisher RA, et al. Gestational trophoblastic disease: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi39–50.
9.
Metagegevens
Titel
Early pregnancy disorders
Auteurs
Prof. dr. Rebecca C. Painter
Dr. Norah M. van Mello
Prof. dr. Mariëtte Goddijn
Dr. Merel M. J. van den Berg
Dr. Christianne Lok
Dr. Nienke van Trommel
Prof. dr. Joris A. M. van der Post
Copyright
2024
Uitgeverij
Bohn Stafleu van Loghum
Boek
Textbook of Obstetrics and Gynaecology

Print ISBN: 978-90-368-2993-9

Elektronisch ISBN: 978-90-368-2994-6

Copyright: 2024

DOI
https://doi.org/10.1007/978-90-368-2994-6_24