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Reproductive System > Complicated Pregnancy (APH, ectopic p. and miscarriage) > Flashcards

Complicated Pregnancy (APH, ectopic p. and miscarriage) Flashcards

1
Q

Define a spontaneous misscarriage/abortion?

A

Termination/loss of pregnancy <24wks gestation with no evidence of life

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2
Q

What type of spontaneous misccariage has occured if a patient presents <24wks with vaginal bleeding and the cervix is dilating?

A

Inevitable miscarriage

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3
Q

Whats the difference between a complete or incomplete abortion?

A

Complete: all the products of conception have been expelled, the cervix closed and bleeding stopped.

Incomplete: the POC are still partly inside, cervix open and bleeding ongoing

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4
Q

How do we confirm if a woman has had a complete abortion?

A

We need to either see the POC and confirm them to be that.

Or have a previous scan that confirms there was a viable pregnancy before

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5
Q

Define a septic miscarriage?

A

When infection ascends into the uterus and throughout the pelvis following a miscarriage. Its most common if it was an incomplete abortion.

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6
Q

Define a missed abortion?

A

When the foetus has died but the uterus hasn’t attempted to expel the POC. It can appear on US like a gestational sac lacking a foetus or a foetal pole without a developed heart.

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7
Q

List all the major causes of a miscarriage you can think of?

A
  • Abnormal conceptus (problems with the foetus, mainly chromosomal)
  • Uterine abnormality (problems with the uterus)
    • I.e. fibroids
  • Cervical Incompetence (problems with cervix)
  • Maternal conditions (problems with the mother)
    • Increase age, diabetes, hormone imbalance
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8
Q

What uterine abnormalities could cause a misscarriage?

A

A congenital abnormality

Fibroids (distortion of cavity)

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9
Q

What causes cervical incompetence?

A

Trauma including past surgical procedures

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10
Q

What maternal problems could cause a misscarriage?

A
  • Low progesterone
  • Diabetes
  • SLE
  • Thyroid disease
  • Acute infections e.g. appendicitis
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11
Q

How would we manage a threatened abortion?

A

Conservative management, best to try to get the foetus past 24wks so we can deliver and it will survive

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12
Q

How would we manage an inevitable abortion?

A

At this point there’s no point trying to save the foetus. If the bleeding is heavy they may need evacuation of the uterus.

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13
Q

How would we manage a missed misscarriage?

A

Several options:

  • Conservative in the hope the uterus will self-evacuate
  • Push the uterus with prostaglandins (MIsoprostol)
  • Surgical Management of Misscarriage (SMM)
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14
Q

How do we manage a septic misscarriage?

A

Antibiotics and evacuate the uterus of remaining POC

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15
Q

Define an Antepartum Haemorrhage?

A

Bleeding from genital tract >24wks but before delivery

Contrast to a miscarriage which is used for bleeds <24wks, this is because 24wks is when the foetus is considered viable.

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16
Q

List the major causes of an APH?

A
  • Placenta praevia - placenta attached to lower segment of uterus
  • Placental abruption - haemorrhage due to premature separation of placenta
  • Local lesion of genital tract
  • Idiopathic
  • Vasa praevia (very rare)
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17
Q

In what women is Placenta Praevia a risk?

A

Most common in multiparous women, multiple pregnancies and previous C section

18
Q

How are the different types of Placenta Praevia classified?

A

Graded 1-4:

  1. Placenta doesn’t touch internal cervical orifice
  2. Placenta reaches internal Os
  3. Placenta covers Os
  4. Central placenta praevia (directly over Os)
19
Q

How does a case of placenta praevia present?

A
  • Painless PV bleeding >24wks -
  • Malpresentation of uterus
  • Soft, non-tender uterus
  • Often they present because we spot malpresentation on exam, send for an US and discover placenta praevia as the source of the bad alignment
20
Q

How do we confirm a case of placenta praevia?

A

US! Don’t do vaginal exam till you’ve ruled it out with US as it could trigger a bigger bleed

21
Q

How do we manage a Placenta Praevia?

A

If possible be conservative e.g. blood transfusions etc to get the baby to term then deliver by C-section (but watch for PPH). Either way you can’t deliver vaginally.

22
Q

Define placental Abruption?

A

The placenta seperates from the wall early, usually with a retroplacental clot forming

23
Q

What are the types of placental abruption?

A
  • Revealed - blood can escape through Os
  • Concealed - blood trapped between placenta/uterine wall
    • Blood can penetrate uterine wall and uterus appears bruised –> Couvelaire uterus)
  • Mixed
24
Q

How does a Placental Abruption present?

A

Severe abdo pain

Vaginal bleeding

May increase uterine tone andhave contractions

25
Q

How extra can a Concealed placental abruption present?

A

Blood can’t escape through os so builds up –> Uterine volume increases –> Fundal height excessive Couvelaire Uterus

26
Q

What are the risk factors for a placenta abruption?

A
  • Pre-eclampsia/ chronic hypertension
  • Multiple pregnancy
  • Polyhydramnios (XS amniotic fluid)
  • Smoking, increasing age, parity
  • Previous abruption
  • Cocaine use
27
Q

Placenta Abruption can be very dangerous, especially if the bleed is concealed. What complications can it trigger? (Think big bleed and clot)

A
  • Maternal shock, collapse (may be disproportionate to the amount of bleeding seen)
  • Fetal death
  • Maternal Disseminated Intravascular Coagulation (DIC), renal failure
  • Postpartum haemorrhage - ‘couvelaire uterus’
28
Q

List some local genital tract lesions that could be the source of APH?

A
  • Cervical polyps
  • Cervical cancer
  • Vaginal thrush
29
Q

So how do we manage an APH?

A

It varies based on:

  • Amount of bleeding
  • Maternal/foetal condition
  • Gestation
  • Expectant treatment
  • Conservative e.g. blood transfusions
  • Attempt a vaginal delivery
  • Emergency C-sections
30
Q

What is placenta praaevia?

A

Placenta is attached to the lower segment of the uterine segment

31
Q

What is Couvelaire Uterus?

A

Bruising in myometrium

32
Q

What is vasa Praevia?

A

Small rupture to fetal vessels

33
Q

What are the different categories of spontaneous miscarriage?

A
  • Threatened
  • Inevitable
  • Incomplete
  • Complete
  • Septic
  • Missed
34
Q

Defined a threated miscarriage?

A

Bleeding from gravid uterus before 24 weeks gestation when there is a viable fetus and no evidence of cervical dilatation

  • Vaginal bleeding +/- pain
  • Viable pregnancy
  • Closed cervix
35
Q

What is an ectopic pregnancy?

A

A pregnancy which is implanted outside of the uterine cavity.

36
Q

What are the risk factors for ectopic pregnancy?

A
  • Pelvic inflammatory disease
  • Previous tubal surgery
  • Previous ectopic
  • Assisted conception
37
Q

Describe the presentation of an ectopic pregnancy

A

Period of ammenorhoea (with +ve urine pregnancy test)

+/_ Vaginal bleeding

+/_ Pain abdomen

+/_ GI or urinary symptoms

38
Q

How are ectopic pregnancies diagnosed?

A
  • USS – no intrauterine gestational sac, may see adnexal mass, fluid in Pouch of Douglas
  • Serum BHCG levels – may need to serially track levels over 48hr intervals - if a normal early intrauterine pregnancy HCG levels will increase by at least 66%ish
  • Serum Progesterone levels – with viable IU pregnancy high levels > 25ng/ml
39
Q

How are ectopic pregnancies managed?

A
  • Medical – Methotrexate
  • Surgical – mostly laparosciopical: Salpingectomy, Salpingotomy for few indications
  • Conservative
40
Q

How are Post-Partum Haemorrhages (PPH) managed?

A
  • Medical management – oxytocin, ergometrine, carbaprost, tranexemic acid
  • Balloon tamponade
  • Surgical – B Lynch suture, ligation of uterine, iliac vessels, hysterectomy

Reproductive System (26 decks)

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