Complicated pregnancy Flashcards
Typical week of presentation for ectopic pregnancy
6-8 weeks
Most common sites of ectopic pregnancies
fallopian tube (97%) Ovary (3.2%) Abdomen (1.3%)
Signs and symptoms of ectopic pregnancy
Lower abdominal pain (usually unilateral)
Vaginal bleeding,
Amennorhea
Symptoms of shock, including lightheadedness, may indicate severe haemorrhage and tubal rupture
Risk factors for ectopic pregnancies
Prior ectopic Prior tubular steralisation surgery Mum was exposed to diethylstilbestrol in utero (use to be used for pregnancy until shown to cause clear cell vaginal cancer) Multiple sex partners PID or STDs Salpingitis IUD use Subfertility Smoking
Key test to confirm ectopic
HcG to confirm pregnant
high-resolution TVUS examination is used to determine the location of the pregnancy
Management of ectopic pregnancy
Low risk HcG<200 and declining ectopic mass diameter <3cm-Expectant. Monitor and wait for miscarraige
Moderate risk. (Stable HcG<5000 mass<3.5-4cm and no embryonic cardiac activity) or failed expectant
Methotrexate: 50 mg/square metre of body surface area intramuscularly as a single dose
Ruptured ectopic or failed medical management
Surgery: laparoscopy with either salpingostomy or salpingectomy
Post surgery methotrexate
Anti D immunoglobulin
Placental abruption
The premature separation of a normally located placenta from the uterine wall that occurs before delivery of the fetus.
Risk factors for placental abruption
Cocaine use Chronic hypertension Pre-Eclampsia Trauma Hx of placental abruption Uterine malformation Smoking Oligohydramnios
Signs and symptoms of placental abruption
Abdominal pain with/without vaginal bleeding Uterine contraction (thrombin is a utero-tonic agent) Uterine tenderness (may be palpable, consistency of wood)
Investigations for placental abruption
late decelerations, loss of variability, variable decelerations, a sinusoidal fetal heart rate tracing, and fetal bradycardia (<110 bpm)
Hb, Hct and coagulation studies if there is bleeding
Ultrasound. May not pick up the abruption
Treatment of placental abruption
Stabilise mother
If fetus>34 wks: vaginal delivery or oxytocin induction. If fetus unstable then caesarean section
<34 wks and stable. Monitore closely with regular sonograms, fetal heart rate monitoring, and biophysical profiles. Following this corticosteroids for lung maturation between 24-34 weeks
Pregnancy induced hypertension
Defined as hypertension (>/=140/90) in the second half of pregnancy in the absence of proteinuria or other markers of pre-eclampsia
Gestational diabetes risk factors
Previous GDM.
• Family history of diabetes (first-degree relative with diabetes). • Previous macrosomic baby.
• Previous unexplained stillbirth.
• Obesity (BMI>30).
• Glycosuria on more than one occasion.
• Polyhydramnios.
• Large for gestational age fetus in current pregnancy.
Tx of gestational diabetes
Multidisciplinary team
Diet first line treatment avoid ketosis
Start insulin if:
Premeal glucose >6 mmol
1 hr Post-prandial glucose >7.5mmol
AC >95th centile despite apparent good control
Post partum:
Stop glucose and insulin infusions
OGTT to exclude undiagnosed Diabetic II
50% risk of developing diabetes in next 25 years
Abortion act 5 categories for abortion
A: continuance of the pregnancy would involve risk to life of
pregnant woman greater than if pregnancy were terminated.
• B: termination is necessary to prevent grave permanent injury to
physical or mental health of pregnant woman.
• C: pregnancy has not exceeded 24th week and continuance of
the pregnancy would involve risk, greater than if pregnancy were terminated, of injury to physical or mental health of pregnant woman.
• D: pregnancy has not exceeded 24th week and continuance of pregnancy would involve risk, greater than if pregnancy were terminated, of injury to physical or mental health of any existing child(ren) of family of pregnant woman.
• E: there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
