Antenatal Obstetric Complications Flashcards
GIT, Pelvic Organs, UTI,VTE (Thrombophilia, DVT,PE), Substance Abuse, Oligo/Polyhydraminos
Minor Complications
1.Backache
2.Symphsis Pubis Dysfunction
3.Carpel Tunnel Syndrome
GIT complications
1.Constipation
2.Hyperemesis Gravidarum
3.Gastroesophageal Reflux
4.Haemorrhoids
5.Varicose Veins
Antenatal Constipation
Increased by Iron tablets and slow gut motility
hyperemesis gravidarum leads to….
1.Imbalance of fluid and electrolytes
2. Nutritional disturbances such as vitamin deficiences (may cause Wernicke’s encephalopathy)
3. Psychological and Physical Toll
4.(May cause mallory weiss tears)
5. Adverse Preg Outcomes
Possible cause of Hyperemesis gravidarum
Increase in HCG, T4, Estrogen
Treatment of Hyperemesis Gravidarum
Fluids, Thiamine and Antiemetic (Phenothiazine)
Treatment of GER
Smoking cessation
frequent light meals
head propped up when lying down
Drugs used for GER
Antacids/ Histamine 2 receptor antagonists/ Protein pump inhibitor
Why are Haemorrhoids more common in pregnancy?
Increase in pressure on superior rectal veins, increase in circulating volume, increase in progesterone
Treatment of Haemorrhoids
Anti irritant cream
Local Anesthetic
If tenesmus/ bloody stool accompanies haemorrhoids, what should be done?
Rectal Digital Exam to check for Rectal Carcinoma
Varicose Veins cause and treatment
Cause: progestrone effect on vascular smooth muscle
Rx: Support stockings + avoid standing long periods
Common outcome of large varicose veins post delivery
Thrombophlebitis
Generalized oedema is a feature of
Pre-eclampsia
Leiomyomata
mass of smooth muscle in uterus cavity, uterine muscle or outside surface
Large Fibroid may cause
Obstruction in vaginal delivery
Complication of Fibroid may cause…
Red Degeneration
Explain Red Degeneration
Fibroid becomes ischaemic causes pain, tenderness, vomiting.
Severe symptoms of Red Degeneration may cause
Uterine Contractions leading to miscarriage or preterm labour
Retroversion of Uterus may cause
Long term bladder issues due to stretch of base of bladder and urethra
Complications of Bicornuate Uterus
Miscarriage
Preterm Labour
Preterm Prelabour Rupture of Membrane
Most common types of Ovarian Cysts
Serous and Benign Teratomas
Predisposing factors of UTI
History of recurrent cystitis
Renal Abnormalities
DM
Bladder emptying issues
Symptoms of UTI
low back pain
flu-like symptoms
tachycardia
pyrexia
dehydration
(rarely, haematuria, dysuria)
Investigations done for sus UTI
CBC
Mid-stream specimen of urine (MSU) +10^5 to confirm
Treatment for UTI/ sus UTI
Start antibiotic (Amoxicillin/ oral cephalosporin
Fluids
Paracetamol
Patient has Hx of recurrent UTI
Test MSU @ every visit + give prophylactic
Common causes of UTI
E.coli (most common)
Proteus
Pseudomonas
Kleibsella
Symptoms of Pyelonephritis
Dehydration
High Temp (>38.5)
Shock
Treatment for Pyelonephritis
Admission
IV fluids
Opiate Analgesics
IV antibiotic (Cephalosporin/ Gentamicin)
Renal tests done
Monitor baby via CTG
Most common cause of maternal death
Venous Thromboembolism (VTE)
Why is the risk of VTE higher in pregnant women
- Due to occurence of hypercoagulable state in pregnancy (Increase in Factors 7,8,9,10,12 and Fibrinogen)
- Venous Stasis due to pressure of gravid uterus on IVC
Thrombophilia
Increased tendency to form blood clots
Hereditary Thrombophilia is due to
Anticoagulant Defieciences
Abnormal procoagulant factors
Mutated prothrombin
Acquired Thrombophilia is due to
Anti-phosphlipid syndrome
Systemic Lupus Erythematous
Risk factors for Thromboembolism (Pre-existing before pregnancy)
- Age
2.Obesity - Thrombophilia
- Prev Hx of Thromboembolism
- Severe Varicose Veins
- Smoking
- Malignancy
Pregnancy Specific Risk Factors for Thromboembolism
- Multiple Pregnancy
- Multiparous
3.Pre-eclampsia
4.Caesarean Section
5.Sepsis
6.Pelvic vein damage
7.Prolonged bed rest
Symptoms of Deep Vain Thrombosis
Calf tenderness, pain
Swelling (esp if unilateral)
How to diagnose DVT
Compression U/S scan
Venography
Symptoms of Pulmonary Embolus
Breathlessness
Inspiratory pain
Mild Pyrexia
Slight tachycardia
What to do if Pulmonary Embolus is suspected?
ECG
CHest Xray
ABG
^ to eliminate other resp. diagnoses.
if still sus, do:
ventilation perfusion scan
or
Computed tomography pulmonary angiogram
Treatment for Venous Thromboembolism
Low Molecular Weight Heparin
Why is Warfarin rarely used as treatment for VTE
passes placenta can cause fetal defects and intracranial hemorrhage (can be given post-partum, safe during breastfeeding)
Tobacco use during pregnancy can cause
FGR
Alcohol Abuse causes
FGR
Fetal Alcohol Syndrome
Opiates (Heroin etc) abuse
Preterm Labour
Neonatal withdrawal
Cocaine Abuse
FGR
Placental Abruption
Preterm Labour
Oligohydraminos is
reduced amount of amniotic fluid
Maximum Vertical pool and Amniotic fluid index in Oligohydraminos
Maximum Vertical Pool= Less than 2cm
AFI= Less than 5cm
Oligohydraminos in abdomen exam appearance
Fetal poles very obvious and hard
Small for date uterus
Oligohydraminos is caused by
FGR
Cystic Kidney
Renal Agenisis
Polyhydraminos is
Increase in Amniotic Fluid
MVP and AFI in Polyhydraminos
MVP= +8cm
AFI= +25cm
Causes of Polyhydraminos
Maternal:
1. DM
Placental:
1.Chorioanginoma, 2.Arterio-venus fistula
Fetal:
1.Multi preg,
2.Eso/Dud Atresia
3.Anencephaly
4.Neuromuscular condition
