Complicated Pregnancy 2 Flashcards
This deck will cover:
Ectopic Pregnancies
Early Labour
How common is an ectopic?
1 in 90 pregnancies so pretty common
What are the most common locations for an ectopic?
97% tubal:
- Mainly Ampullary
- Some Isthmus
- Rarely Intramural
1% Ovarian
0.1% Cervical
Rarely Fimbrial
In what women would we be particularly wary of ectopics?
Risk factors include:
- PID
- Tubal surgery
- H/o
- Assisted conception e.g. IVF
How would you tell an ectopic pregnancy?
They'll initially appear pregnant in that they have a period of amenorrhoea with a +ve pregnancy test. Ectopic signs include: - Vaginal bleeding - Abdo Pain - GI/Urinary pressure symptoms
How do we test to confirm an ectopic?
First do an US, you should see:
- No intrauterine sac
- Possibly an adnexal mass and/or blood in the pouch of douglas
Also do serum BHCG & Progesterone
What does Serum BHCG tell us about an ectopic
Serially tracked over 48 hours it increase by atleast 66%
However an ectopic will rise sub-optimally
How can you treat an ectopic pregnancy?
1) Conservative (if she’s stable it may shrink on its own)
2) Medical - MTX
3) Surgical - Laparoscopic salpingectomy if there’s a risk of rupture and/or very unstable
Define preterm labour and its grades?
Preterm means onset <37wks/259days
Mildly preterm = 32-36wks
Very Preterm = 28-32 wks
Extremely Preterm = 24-28wks
Preterm labour can be both spontaneous or Induced
Is preterm labour more common in single or multiple pregnancies?
Multiple duh, seriouslly could you stay being that close to your roomate for 9 months?
(6% in singles and 35% in multiples)
Most Preterm Labours are Idiopathic!!!
But what are the common causes?
- Multiple pregnancy
- Polyhydramnios
- APH
- Pre-eclampsia
- Infection e.g. UTI
- Premature membrane rupture
How do we spot if someone’s in pre-term labour?
Just like normal labour:
1) Are they contracting?
2) Is there cervical change on VE?
Important to then consider why, look for signs of infection, hypertension or enlarged uterine volume
How do we go about managing a pre-term labour?
Firstly involve the family and neonatologist in decisions as there’s a high risk of failure and disability
- Tocolysis
- Steroids
- NICU
- Vaginal Delivery
What is Tocolysis and when do we use it?
Tocolysis encompasses labour suppressant meds.
You can use it for up to 24hrs in order to transfer the patient to a facility with a NICU & to give steroids
Why give steroids in pre-term labour?
Speeds up surfactant development allowing the baby to survive outside the womb (i.e. to fuckin breathe)
