[Music] all right guys so we are going to focus in on the female reproductive system diseases in this particular presentation we're going to look at the inflammation infection tumor cysts and even hormonal imbalances that might come into play as well as we're going to also look at issues with the breast and pregnancy okay so this video is going to kind of contain all that information so we're going to talk first about premenstrual syndrome and also known as pms this is symptoms obviously prior or before mensis symptoms begin mid-cycle so we're looking at around ovulation a little bit after and we see headache nausea back and joint pain edema and bloating weight gain breast tenderness sleep disturbances irritability mood swings and even depression that can occur the cause is uncertain but they do believe that it has to do with that fluctuation that's happening with a lot of times what we're talking about with those hormones we do see that the edema bloating and weight gain is normally going to be due to the water retention that occurs due to again hormone levels the big thing with treatment is it has to be individualized some dietary changes might come into play where the individual needs to avoid caffeine chocolate nicotine salt sugar and even alcohol during that time those could potentially exacerbate their symptoms during their pms issue we also see some medications could be given for like diuretics painkillers or even sometimes giving progesterone which is the whole pregnancy type of hormone the hormone that is normally telling the body that they're pregnant could help with some of these symptoms now this can't be prevented mostly because we don't know exactly what causes it but activities that could maybe reduce symptoms are quit smoking limit your caffeine intake taking dietary calcium and vitamin b6 may be helpful exercising eating a balanced diet and obviously reducing stress might help with even just the irritability mood swings and depression as well the next thing we have is what actually can happen or can be abnormal in the menstrual part in the actual menses where we are shedding that lining there are a couple of things listed here that we're going to talk about so the first one is amenorrhea amenorrhea is going to mean without menstruation so without immenses is the absence of menstrual periods primary amenorrhea is going to be defined as not having your menses or your period by age 18. so there is a primary amenorrhea this could be due to hormonal disorders it could be due to malfunction malformation or absence of female organs it could be pregnancy or anorexia we also see there could be secondary amenorrhea which is the absence of menses for six months or longer and this is coming from a woman who had normal or regular cycles prior to that okay so they had normal cycles that were happening but then it stopped and for six months or more there was no menstruation that's considered secondary amenorrhea now again it could be due to hormonal imbalances emotional upset can cause especially the secondary amenorrhea depression malnutrition excessive fitness training ovarian tumors and pregnancy now diagnosis is made based on of course physical examination but we're going to look at their hormone levels as well as some urine studies treatment depends on the cause okay now we can prevent potentially amenorrhea primary and secondary with adequate nutrition exercise and stress reduction the next one is dysmenorrhea dysmenorrhene means difficult menses okay this is going to be painful or difficult one of the most common gynecologic disorders that's out there a lot of women deal with having a lot of pain during their menstrual cycle now causes could be due to pelvic inflammation cervical stenosis so the cervix is going to be narrowed endometriosis and then there could be some unknown causes as well what happens is it normally starts out as dull cramping but it can become very severe pain and cramping in the pelvic area and even the low back we also see the pain could radiate to the upper back the thighs and even the genitalia now this can be a very painful thing but it can sometimes be relieved with birth control as well as potentially after having the birth of their first child sometimes having that first baby and the hormones kind of going and getting reset after that particular type of event could help with some of this treatment of course birth control oral compress contraceptives can be effective in reducing that pain that can come along with this it can also help with reducing the menstrual flow the amount of blood that they deal with non-steroidal anti-inflammatories could be used to reduce inflammation and pain and even application of like a hot pack might be helpful mineralia is an excessive or prolonged menstrual flow this is where it could be due to uterine tumors pelvic inflammatory disease that we call pid and hormone imbalances treatment is related to the cause but it could include surgical removal of any tumors present antibiotics to treat pid inflammation or infection and hormone therapy for the hormone imbalances another one here is the metroragia this one is where the uterus is actually bursting forth in a sense abnormal and excessive meaning abnormal bleeding between menstrual periods the cause is commonly due to hormonal imbalances this leads to abnormal thickening and shedding of that endometrial tissue treatment could be a dic when they go in they're going to take out some of the tissue removing some of that in order to return the andrometrium to its normal area like it's normal size because obviously there's been this thickening process that's occurred so it's going to kind of take out some of that tissue so it starts over in a sense okay so these are some of the potential abnormal menstrual issues that we could see now the one not listed there with abnormal is menopause menopause guys is a natural thing it's a natural halting of menstruation it is not a disease it's a normal physical change that is related to aging however there are some things that do occur with this and a lot of women find that very uncomfortable so this usually takes place between the ages of 40 and 50 years of age it can be surgically induced at any age if we remove the ovaries because the ovaries of course are the ones who producing most of the hormones so if we remove those we would see that that could induce this now symptoms include hot flashes night sweats and vaginal dryness for some women there could be also some psychological symptoms like depression sleep disorders and a decreased libido now diagnosis is a blood test for presence of follicle stimulating hormone that's what we would be looking for there this is the one that's promoting the ovaries to release those hormones if that's not then the ovaries don't actually release this this causes those ovaries to start to atrophy because they're not being used like they are supposed to now treatment guys because this is not really a disorder it's not really a disease there's really no treatment that has to be done the big thing is maybe helping with the vaginal dryness the night sweats and the hot flashes but for the most part the rest of this is pretty natural some women don't like it though and because of that they do menopausal hormone therapy this is going to have to be done with consultation of your physician there are some pros to it there are some cons there is some some are better than others when we talk about the amount and what kind of hormones they're using synthetic versus more natural and so there's a lot of controversy about this especially when it's part of the normal process now if it's due to you having to have the ovaries removed at a younger age we may not want to have this stuff happen so early so i would say that hormone replacement might be more of an option if that was somebody who was potentially younger but again you'd have to do some research talking with your doctor and see what works best for you all right the next thing we want to look at is vaginitis vaginitis is going to be an inflammation of the vagina now there's multiple causes that could happen but the main ones are normally bacteria or yeast they're not really dangerous but it is an irritating uncomfortable issue and it could potentially though progress into a bladder infection and a uti symptoms include vaginal burning itching swelling of the vagina and external genitalia there could also be a discharge that's present the discharge could be white kind of cottage cheese like and that's going to be more with a fungal or yeast type of infection that we call can candidia in this case diagnosis is going to be testing the vaginal fluid ph we would do a culture and the culture is going to help us detect and decide if it is bacteria or yeast and what kind of treatment may need to be done identifying the cause helps us with the treatment because if it's bacterial we want to do antibiotics if it's going to be the yeast or the fungal we would want to use a type of anti-fungal now abstaining from sexual intercourse until this condition has healed is a big deal because it can end up spreading it can go further into the body deeper into the body and it can cause some issues for your sexual partner now there are different types types or a vaginitis the first one there is the candidia this is a fungus or yeast type when we look at this one it is going to be able to take over it's a normal flora that we have but when some of the other normal flora starts to decrease due to antibiotic use or something else we see that the fungus thing can kind of take over is an imbalance this could be due to the use of tampons as well diaphragms condoms spermicides vaginal what we call douching and deodorant sprays this can actually all these things could upset the normal flora which could increase the risk for this type of vaginitis treatment home remedies include douching with a one take a teaspoon of vinegar in one gallon of water and eating yogurt the yogurt could potentially add back to the normal flora and guys when we're talking about the whole idea of douching it's going to be putting fluid up into the vagina on purpose and cleaning that area out now we just talked about how that's a potential cause of this but if you're using certain things it's going to help decrease the growth of that particular yeast um there are some over-the-counter anti-fungal medications that could also be helpful the next one is the trichomonas type of vaginitis this is due to a parasite this parasite is going to be transmitted during sexual intercourse both sexual partners have to be treated for this using oral anti-parasitic medications in order to eradicate the infection because if the woman takes it okay the one who has the actual issues and the problems and the partner doesn't the partner could continue to reinfect over and over so we want to make sure that both individuals are taking the treatment there's also what we would call the atrophic or post-menopausal type of vaginitis this is due to the dryness that can happen in the vagina it's a decrease in secretion of estrogen which causes the vaginal lining to become irritated it's not maintained as well and so because of that it can cause vaginitis treatment often often includes estrogen type therapies the use of adequate lubrication during sexual intercourse to prevent injury to the vaginal wall can also be helpful the next thing we want to look at is endometriosis endometriosis is an abnormal growth of the endometrial tissue outside of the uterus so there's endometrial tissue that's going to be that inner lining of the uterus but this means that that gets out of that area it's an abnormal type of growth common implantation sites are going to be the ovaries fallopian tubes abdominal wall and even the intestines and guys this is because in that shedding we see in the menses some of those endometrial cells could potentially migrate backwards up through the fallopian tubes and remember they're just sitting there over the ovaries so what this means is an opening this means it can collect in the fallopian tube out in the abdominal area the intestines are even on the ovary implanted intermedial tissue continues to act under the influences those of the of the hormones so when we see that the hormones increase and we would see that menses would take place and there should be a shedding and some bleeding that's going to also happen with this tissue as well and so it causes something that they call chocolate cysts these chocolate cysts though can also cause scar tissue and adhesions so what are some symptoms that we see with endometriosis well a lot of times there's a type of dysmenorrhea so again we have a difficulty during the menstrual cycle low back vaginal and pelvic cramping heavy menses where there's going to be a lot more of a discharge and bleeding we also see dysperunia this is going to be uncomfortable and um this is going to be painful sexual intercourse and then also primary complication is infertility and so a lot of times because of all these issues that are forming in adhesions and scar tissues infertility is going to be a big complication of this now treatment guys hormones can help treat this remissions with it can be go into remission with pregnancy nursing or even during menopause but that doesn't mean it gets fixed it what's happened there is during nursing during pregnancy during menopause the hormone levels change and they're a little more stable and so then because of that we see that it's not going to have as many of the symptoms the main way to actually prevent a lot of this is what we call a pan hysterectomy which means they're going to remove everything okay ovaries fallopian tubes the uterus all of that and they would also look in the abdominal cavity to see if they could find any of these kind of chocolate cysts and help remove that tissue as well all right so the next thing we're going to look at is the pelvic inflammatory disease known as pid this is inflammation of some or all pelvic reproductive organs this could include what we would call cervicitis so the cervix is going to be inflamed endometritis the inner layer of the uterus okay and we see that it could then continue on up through the structures like spalpinigitis which is going to be the fallopian tubes and oophoritis which are the ovaries now the most common cause of pelvic inflammatory disease is a sexually in disease or infection now what this does is it causes an abnormal inflammation in those pelvic organs and so it causes the patient to have fever chills pelvic pain and also leucorrhea which is a kind of white discharge that is very foul smelling so it's a vaginal discharge that has a very foul smell to it treatment are going to be antibiotics analgesics and rest okay so the big thing is we need to treat the the std in order to help get that under control painkillers may be helpful and then resting will help cause that inflammation to start to decrease now prevention how do we prevent pid well practicing safe sex is a big deal with this with proper use of condoms to help prevent potentially stds from occurring contracting stds the primary cause of this disease could be helped be deterred by having a monogamous sexual relationship only one other individual because then you're not necessarily seeing that that other end of that that you are bringing in things from other parties into that as well as if they are not either and also just the abstaining from sex altogether helps prevent transmission of stds and of course pid the next is ovarian cysts ovarian cysts are commonly benign fluid filled sacs so comp these are actually pretty common because when an egg is being formed it does create a cyst that has to burst okay but sometimes these get relatively large okay when they are there near the ovary and they can become pretty painful when we see them attaching to some other pelvic type structures especially like muscles or bone in that particular area so physiological cysts are going to be caused by the normal functioning of the ovary but they can actually become very large they can become the size of a grapefruit and that's when they start to actually produce a lot more of their symptoms neoplastic are going to obviously be cancerous a type of cancerous type of growth that's present so symptoms low back pain pelvic pain we also see again the difficulty and painful sex nausea and even vomiting treatment depends on the type and the size may be resolved by itself a lot of times they'll just resolve on their own and we don't need to really do much except for maybe help with some of the symptoms other times we may need to go in laparoscopically and be able to remove part of this or even drain the cyst if at all possible the next one is the fibroid tumors this is also known as a lyle myoma this is a type of benign tumor of the smooth muscle of the uterine wall okay so it's the smooth muscle of that uterine area most common tumor of the female reproductive system that we see now this is going to see that these tumors could grow because they're stimulated by estrogen thus they tend to occur during reproductive years and then they tend to regress and become smaller during menopause now symptoms are abnormal uterine bleeding excessive menstrual bleeding and pain now treatment guys is going to depend on the woman's age and their desire of whether or not they want to have children so surgical removal of any of them that are super painful and they can be removed without compromising the reproductive organs may be done but a lot of times if they have a lot of these and they're done having children or they do not have the desire to have any children a hysterectomy may be done these type of tumors cannot be prevented the next thing we want to look at is toxic shock syndrome this is a severe life-threatening illness that can occur it is found mostly exclusively in menstruating females and those using tampons however some research has shown that it does extend into potentially any form of insert that you use to collect that menstrual fluid so it could be a diaphragm it could be a type of cup that kind of thing it all increases the risk the most common cause of this toxic shock syndrome is an organism called staphylococcus aureus this is a bacteria that is found on your skin it's found on you all the time it's some of your normal flora the problem is is that when it gets trapped inside and it is able to react with that synthetic fiber from the tampon or from the other structures that are in there it does produce a type of toxin this toxin if it becomes an issue in higher levels it can cause a sudden onset of a high fever vomiting diarrhea and decreases in the blood pressure if not treated properly we do see that it can cause death it can be fatal our treatment is going to be iv fluids this is going to help with the dehydration that happens with vomiting and diarrhea and then also antibiotics to treat the staphylococcus auroras infection that is present there is some prevention that could be done here one is to do proper type of teaching for um young ladies on how to use these products and when to use them and how they need to be changed out properly wearing them for too long and also using like super absorbent type of tampons just so you don't have to change them as often increases the risk okay and so because of this we want to kind of educate these individuals these women these young ladies on how to use these products the next one is uterine prolapse this is where the uterus protrudes into the vagina okay so it's going to be moving down symptoms of this includes heaviness in the pelvis urinary stress dysuria because it obviously causes issues with urination and low back pain now the cause it is an aging thing that happens and a lot of times it's because there's muscles and structures in that pelvic floor that are supposed to help hold all those organs up when they get weakened due to maybe multiple pregnancies or even age over time we see that they start to drop and a lot of these different organs we see that the bladder has issues as well it's not just the uterus but this is part of that now there's different kind of levels of this these pictures show you we have a normal uterus in the first picture then we have a first degree prolapse where it's starting to move down a second degree and then a third it's actually sticking out of the vagina and it can be seen okay this isn't really considered a medical emergency unless the individual has lots of br bleeding but a hysterectomy is what's going to help correct this but again that is going to depend on the woman's age and whether or not they want to try to bear children the next one we have is the cystocele cystocele is a urinary bladder type of herniation this is where the bladder is going to be herniating or protruding into the anterior vaginal wall so it's going to be pushing through that anterior vaginal wall this is going to be a weakening to those particular muscles or tissues either due to a trauma or pelvic floor issues that occur from aging and childbirth we see that it's going to cause pelvic pressure urinary urgency frequency and incontinence which we talked about back in the urinary chapter now diagnosis is through a pelvic examination and we do see some of the treatments include certain exercises that we call kegel exercises and it's a tightening of those pelvic floor muscles as well as relaxing them in order to help strengthen those muscles as well as potential surgery to help that weakened area kind of like when we have a hernia with our intestines through the abdominal wall we could go in and reinforce the area since there's a weakening of that tissue now prevention there can be some preventative measures for women for this avoiding having lifting maintaining a healthy weight controlling constipation performing kegel exercises even before we have children after we have children those are all things that could potentially help now on the other side we also could have what we call a rectal cell this is going to be a herniation of the rectum through the posterior vaginal wall symptoms here are going to be discomfort constipation and fecal incontinence the main treatment here is going to be surgical repair okay so this is going to be where the rectum starts to push through the back side of this area of the vaginal wall now what can happen though is it could happen from both sides so if we look here you have the bladder and then you have the rectum and if it's coming from both sides then of course surgery is the only thing that can be done and that's actually going to be an anterior and posterior repair and so sometimes they call that the a and p repair all right now we have cervical cancer cervical cancer is most commonly caused by human papilloma virus or hpv this is a type of wart type virus it is going to be what we consider genital warts the problem is is that there are a ton of different strands or subtypes of this particular type of virus now symptoms are going to be abnormal cervical bleeding treatment is going to be surgical removal of the tumor so we want to take the tumor out if at all possible if if it has already metastasized however radiation may also need to occur now risk factors what could put you at a higher risk of developing cervical cancer while beginning sex at an early age having multiple sex partners smoking sex with males who smoke sex with males who have a spouse diagnosed with cervical cancer obesity and excessive alcohol consumption those are all things that could increase the risk now what about preventing the risk or reducing the risks okay have early pap smear tests follow up on the results get the hpv vaccine now with this guys there are two vaccines that the fda has approved they are approved for individuals between the ages of 9 to 26. there was a big push here in the state of new mexico of making this particular vaccine required in order to go to school the only problem with that is that this is only passed on through sexual activity when we look at the hpv virus and so it's kind of hard to justify parents forcing or forcing parents or children to get this vaccine when it's due to sexual activity not something that should be happening in school like breathing i mean it's different if it's something that is caused by you breathing like with measles chickenpox mumps that kind of thing um now neither vaccine has been proven to provide complete protection against all strands of hpv so there still is a chance okay the biggest thing that's actually helped is the pap smears looking for that early detection looking for abnormal cells and being able to have that screening early that has actually reduced the risk over the last 35 years of h or of cervical cancer by about 50 percent okay so that's one of the biggest things is taking our children our kids our girls in for pap smears earlier on giving them the idea of showing how it works not being scared of doing that and granted now with pap smears because of the genetic testing and being able to look at the dna and looking for mutations a lot of this can be done just every five years instead of every year like it was before now the next one is uterine cancer this develops in the endometrium and spreads to the uterine wall and sometimes this is known as endometriosis when we look at this the symptoms are abnormal bleeding in post-menopausal females so it's abnormal because after menopause we shouldn't see all this bleeding take place treatment is surgical removal of the uterus and ovaries and radiation therapy may need to also be done especially if it has potentially metastasized the next type of cancer ovarian cancer and it is quite common and a lot of times it's fatal and the reason it's fatal is because it's not diagnosed early on symptoms include pressure on the bladder abdominal or pelvic pain and generally feeling ill not feeling good now treatment is a complete hysterectomy radiation and chemotherapy the problem is again if we can detect it early prognosis is good the problem though is it's not normally detected early until you start feeling just plain ill and they start looking for the issue a lot of times it is already metastasized and cause major issues now activities that can lower the risk of developing this type of cancer ovarian cancer is a history of taking oral contraceptives like birth controls bearing at least one child could be helpful and breastfeeding for at least one year all right switching gears a little bit let's talk about diseases of the breast okay so when we look at the breast tissue guys one of the best ways to detect if there's any issues going on is doing the self-breast examinations these examinations are important because you're not going to get a mammogram normally until you're a little bit and so doing those self-tests are important again though we need to educate women on how to do those so when we look at some of these issues we see the first one is hybrocystic dis fibrocystic disease this is the most common breast disorder of premenopausal females so between the ages of normally 30 to 55 we do see that it's cause of cysts forming and it is linked a lot of times to estrogen levels okay so estrogen levels being higher because of being premenopausal these cysts can develop within the breast tissue now symptoms a lot of times the woman may feel an irregular lumpy feeling in their breast it's usually on the upper outer quadrant of the breast tissue they may have some breast discomfort that is persistent and occurs on and off typically peaking around their menstrual cycle though because of the higher levels of estrogen the breast also may feel heavy full and even tender and they may have this may have a tendency of running in families now an increased risk of cancer is shown with this and so it's important that this be addressed this be looked at because if you develop these cysts you are at a potential higher risk of developing cancer some women if they develop these very often they may actually do a preventative or prophylactic type of mastectomy where they'll remove the breast tissue because cysts are present and then that helps prevent them from developing potential breast cancer later on now treatment well we want to decrease the breast the breast pain okay and that's the main thing with this um they're not really a big issue for the most part except for watching them because they could be pre-cancerous but reduce caffeine and salt intake using mild diuretics and using also mild analgesics the week before menstruation may be helpful in a lot of times the pain that can come along with these fibrocystic cysts mastitis mastitis is inflammation of breast tissue this is going to be caused normally from bacteria of the baby from the baby's mouth that goes into the breast during breast feeding especially if it's not emptying the breast during that feeding time it's really important to empty one whole breast before switching the baby to the other because leaving some of that milk in there and potentially some of the child's saliva with bacteria increases this risk symptoms redness heat swelling that's the inflammation part pain bloody nipple discharge can also be present now diagnosis is normally relatively easy because you can tell and see it's very painful antibiotics are going to be the main form of treatment because it is normally due to bacterial infection applying heat may help some painkillers and also firm supportive bra can also be helpful to help decrease the discomfort that comes along with it it's kind of like when you have inflammation in your ankle and wrapping it and having that compression is helpful the same thing can be helpful here having that compression for that edema all right this brings us to breast cancer breast cancer guys is an adenocarcinoma and it's going to have an issue in the ducts of the breast itself it's the second leading cause of death in women monthly breast examinations and routine mammograms are going to help with early detection which then is going to increase the prognosis for a woman this is the most common breast type of neoplasm out there type of cancer risk factors are going to be age 40 and over family member affected with breast cancer early onset menses or late menopause we also see nullipia which is none or no birth so they have no children if their first child came after the age of 30 obesity chronic breast disease and if they wear their bras braziers is what they have here but bras um too often okay when we look at this like wearing them not enough wearing it too much this is a wear time that's kind of where there's a lot of controversy about this um some studies show that the less they wear the bra the better the more they wear the bra the better it just depends on what study you're looking at right now but wear time can potentially maybe affect some of this symptoms symptoms include non-tender lumps that can happen in varying sizes they can occur most often though in the upper outer quadrant of the breast that's where they're normally seen the lump may also cause a dimpling in the skin or the nipple might start to retract um but a lot of times guys there's no visual indication it's going to be where you're going to have to feel it okay so it's not going to have a visual indication diagnosis is looking for the lump a mammogram and then potentially a biopsy treatment is usually surgical removal of the mast or the breast as a whole and there's different types that you can see here the lumpectomy is removal of the lump only a simple or total mastectomy involving removal of the breast and nipple may be done we also see there could be a modified radical mastectomy this involves removal of the breast nipple and the lymph nodes in the area you can see that there's the incision under the armpit and then a radical mastectomy is the removal of the breast nipple lymph nodes and the underlining pectoral chest muscles and so that's a radical form and a lot of times guys with this with this type of treatment psychological issues can happen with the female because of losing that breast tissue it's almost sometimes that they feel like they're losing their womanhood in a sense and so reconstructive surgery is normally a big deal with some of this so they may end up having them removed but sometimes they'll actually put in like spacers and skin grafts and things like that to help be able to replace with a implant later on and this can help with the psychological effects that could occur another thing we may need to look at treatment wise is what's called what caused the growth of it if it's a hormone issue we would want to do some hormone potential medications to help prevent potential growth if any of those cells were to escape even with the mastectomy if it was present all right last but not least let's talk about the disorders of pregnancy so we have here the issue with when pregnancies are not happening like they should something is going to be abnormal here okay something is improper and this could happen due to stress it could be improper prenatal care it could just be something that is spontaneous meaning that it could happen to anybody and so the first one that we look at is the atopic pregnancies this is where the fertilized egg attaches to tissues outside of the uterus and they don't make it actually into the uterus for that connection to occur now usually this is going to happen in the fallopian tubes we call this also a tubal pregnancy this is about 95 of the time however it could also take place in the ovaries in the pelvic cavity itself it could be on the outside of the uterus on the pelvic wall there have even been cases where it could develop on other types of organs in that abdominal cavity but when this happens though as the baby starts to form and starts its development we see that the individual have acute pelvic pain they'll have vaginal bleeding they will show a positive pregnancy test a lot of times because it is releasing the hormone still allowing this pregnancy to start but the problem is that those structures are not made for this to occur and so damage to those structures may also happen it could cause the individual to go into shock now treatment prompt surgery to terminate the pregnancy we need to remove that and every effort is taken to try to preserve the ovary or the tube if future pregnancies are desired if we don't take care of this early enough guys that pregnancy especially in the tubal pregnancy can expand so much that the tube ruptures if the fallopian tube ruptures now that ovary and that particular fallopian tube is useless so taking down the the chance of pregnancy is going to occur with that and so we want to try to help maintain the integrity as much as possible for that woman especially if they would potentially want some future pregnancies the next one we want to look at is spontaneous abortion spontaneous abortion is also known as miscarriage it's a natural termination of the pregnancy before the fetus is viable this normally most cases are going to happen before the second trimester so before week 12. now there the reason of an abortion a spontaneous abortion or miscarriage is kind of unknown but it could be due to infection drug use by the pregnant mother abnormal fetal development like there could be a chromosomal issue and development just could not occur or an incompetent cervix so this is where the cervix dilates prematurely and it causes the pregnancy to be lost now guys this is actually pretty common one in every six pregnancies are going to end in a spontaneous abortion or a miscarriage and 75 of those do occur before the week 12 mark now the risk is higher during the woman's first pregnancy now symptoms include vaginal bleeding they will have cramping and pelvic pain that comes along with it it's usually again in the first trimester and if bleeding is severe though the patient could go into shock treatment is bed rest bed rest is the treatment for the chronic bleeding as long as it's not severe once spontaneous abortion begins it's a difficult to stop and normally it cannot be stopped and so then a dic may need to be done and the dic is to surgically clean out all of the debris and tissue in order to again help prepare the endometrium the uterus for the next pregnancy if it is desired now again there's no way of preventing this because it is spontaneous however doing things if you were going to or you're trying to get pregnant of like not drinking not doing drugs having a healthy diet that kind of stuff can all potentially help prevent but again it is a spontaneous thing the next thing we want to look at is morning sickness morning sickness is normally associated with the first trimester of pregnancy but it could be any time during the pregnancy and it doesn't have to just be in the morning it gets the name in the morning and a lot of times they feel like it's because of the lack of food after you wake up but it could be any time of the day symptoms are nausea and vomiting it can be very severe which we'll talk about more in a minute and the main treatment it's not necessarily going to need a lot of treatment unless you are vomiting excessively but eating light meals several times a day could be helpful dry foods before you drink something avoidance of fatty foods resting after meals sometimes there's some natural things like using ginger like ginger or peppermints might be helpful with the nausea and so there's a lot of different things out there but it doesn't normally need medication in the sense of a prescription unless again it becomes severe with the vomiting now if it is severe and you have a lot of vomiting during the morning sickness we call this hyperemencia gravidarum now this is hyper meaning lots and immense minces is vomiting so excessive vomiting during the pregnancy now with this is it could be due to the hormones released by the fetus it could be due to the hormones the woman's dealing with but no matter what it is causing issues and now this is a big deal especially when women are carrying multiples and that's why they think it's due to the hormones released by the baby now symptoms are excessive vomiting which leads to dehydration weight loss and possible electrolyte imbalance which can be detrimental to the mother but also the developing child so treatment is iv fluids withholding all food and oral fluids may be needing to be done here in order to make sure that they don't have that vomiting that keeps being triggered and that sort of thing but iv fluids are going to be very beneficial making sure that they are going to be hydrated as well as have nutrients that they need a lot of times this does subside by the second trimester but other medications may need to be given the problem is a lot of the medications that are out there to help with excessive vomiting potentially could cause birth defects and so we need to be careful about how we treat that if they but again it could be life threatening to the mother and the baby if this is not put under control and so yes it usually subsides by the second trimester not pregnancy here i mean that would be terrible all right the next one is toxemia toxiemia usually appears during the third trimester and this is a misleading name because it's not actually due to a toxin they thought it was due to a toxin that the baby would start to release during the third trimester but that's not true what happens here in toxemia this is also known as pre-eclampsia and then potentially eclampsia this is going to be seen a lot of times in women who have poor prenatal care it could be due to them being younger than 20 years of age or older than 30 individuals with poor nutritional status those with hypertensive issues prior to a pregnancy also if it's a multiple pregnancy like with twins or triplets that kind of thing but it can occur with pretty much anybody symptoms are going to be things like hypertension sudden weight gain and a lot of times that's due to swelling and water retention and protein in their urine those are kind of the three factors they're watching this is one reason why you give a urine sample when you're pregnant you get your wet weight checked all the time and they take your blood pressure because they're looking for this stuff okay it also can cause a lot of swelling in the face hands and feet now this is preeclampsia this is before there's the big issue eclampsia though is when you have all these issues plus convulsions and this is when it gets to be life-threatening now treatment is frequent monitoring of the blood pressure weight and uterine protein but also delivery may need to be done delivering the child can help with these issues it normally goes down after the child is born allowing then the mother to go back to normal in most cases all right so the next thing we want to talk about are going to be issues with the placenta okay so if we look at the picture here you can see in a that this is going to be a normal uterine pregnancy no issues there with the placenta but you can at least see it there attached to the uterine wall then with the baby the umbilical cord to the baby in b guys this one is showing you um abrupto placentae the brepto placenta is when the placenta abruptly or suddenly pulls away from the uterine lining we'll talk about that one first and then the last picture down here is going to be placenta previa and this is where the placenta is actually covering the opening of the cervix okay and so we're going to talk about each of those so the first one is the abrupto placentae this is a separation of the placenta from the uterus itself the symptoms are determined by the degree of separation if it's a partial separation it may be asymptomatic you may not even know at all that there is a problem but complete separation could cause severe abdominal pain and vaginal bleeding for the mother it could cause the mother to have hemorrhage the mother mother to go into shock but it also could cause the baby to to die if we don't take it care take care of it quickly it's a decrease in fetal heart tones because they are not getting the nutrients they need anymore oxygen is not being supplied nutrients is not being supplied and waste products are not being taken away so treatment is a prop delivery now this delivery could happen vaginally or by c-section and then blood replacement for the mother if necessary if hemorrhaging is taking place the next one is placenta previa this is an abnormal positioning of the placenta and it's going to be on the lower part of the uterus often near or over the cervical opening okay so it's the opening the outer opening there now the symptoms are normally painless but there can be bright red vaginal bleeding a lot of times though not until the third trimester because the baby is starting to put pressure on it and it's starting to also drop into the birth canal which then puts pressure on that placenta now there are some potential risk factors that can make a woman be more prone to having placenta previa things like maternal age the fact that they're older than 35 multiple births like they've had lots of babies before and then previous uterine surgeries but this could happen if even with it being the first pregnancy and the woman is just even a younger woman in her low in her early 20s but with this guy's treatment is going to be vaginal delivery if asymptomatic or bleeding is not severe so we're going to try to do this and then emergency c-section if maternal bleeding or fetal anoxia takes place now anoxia is where the baby's not getting oxygen like it's supposed to it's not getting the blood supply like it's supposed to now guys with this as well being up and gravity pushing the baby and all down could cause more symptoms and more issues to be present and so sometimes women who have placenta previa are put on bed rest this is to help sustain the pregnancy and also to reduce the potential complications that can occur with the bleeding and then also the baby not getting the blood supply that it needs all right so this covers the female side if you have any questions please do not be afraid to ask okay there's going to be a place down here where you can make comments that if you've got questions right off the bat while you're watching this i can address them there but i can also address them in class as well all right this is not going to take the place of like if you really have questions about any of these please let me know right we will continue on with these reproductive notes next week in class again if you got any questions please do not be afraid to ask [Music]