Chapter 8. The surgery of pregnancy

Table of Contents
Surgical problems in pregnancy
Evacuating an abortion
Fetal death, missed abortion, and intrauterine death
Suturing an incompetent cervix for recurrent second- trimester abortions
''Acute' ectopic pregnancy
''Chronic' ectopic pregnancy [s8](ectopic pregnancy without massive abdominal bleeding)
Angular and cervical ectopic pregnancies
Abdominal pregnancies
APH[md]bleeding after the 28th week
Placenta praevia
Placental abruption

Surgical problems in pregnancy

The staff in your clinics should be able to manage most of the minor complications of pregnancy. In early pregnancy they will need to refer incomplete abortions, especially septic ones (6.6a). McDonald's suture (16.5) will prevent some second- trimester abortions. They will also need to refer acute ectopic pregnancies (16.6), and, if they are well-trained, an occasional chronic one (16.7). Rarely, you may have to treat an abdominal pregnancy (16.9), a missed abortion (16.4), or a hydatidiform mole (32.38).

Late in pregnancy, after the 28th week, your main concerns will be antepartum haemorrhage, from placenta praevia (16.12) or placental abruption (16.13). Both of these need differentiation from incidental bleeding from lower in the birth canal. Another problem will be the dead baby, whose management before 18 weeks differs from that later on (16.4).