Complications in pregnancy 1 Flashcards
Abortion
* Voluntary termination of foetus
Miscarriage
Spontaneous loss of pregnancy before 24 weeks gestation
Categories of spontaneous miscarriage
* Threatened
* Inevitable
* Incomplete
* Complete
* Septic
* Missed
Aetiology of spontaneous miscarriage
* Abnormal conceptus: chromosomal, genetic, structure
* Uterine abnormality: congenital, fibroids
* Cervical weakness: primary or secondary
* Maternal factors: increasing age, diabetes, SLE
* Unknown
Threatened miscarriage
* Vaginal bleeding +/- pain
* Viable pregnancy Closed cervix on speculum examination
*
Inevitable miscarriage
* Viable pregnancy
* Open cervix with heavy bleeding (+/- clots)
Missed miscarriage (early fatal demise)
* Asymptomatic
* Sometimes bleeding/ brown loss from vagina
* Gestational sac on scan
* No clear foetus/ foetal pole without foetal heartbeat
Incomplete miscarriage
* Majority of products of conception (POC) expelled, some retained
* Open cervix, vaginal bleeding (maybe heavy)
Complete miscarriage
* All products of conception passed
* Cervix is closed
* Bleeding has stopped
Septic miscarriage
* Incomplete miscarriage caused by ascending infection
Management of spontaneous miscarriage
* Threatened → conservative, ‘wait and see’
* Inevitable → heavy bleeding may require evacuationMissed
* Conservative
* Medical → prostaglandins (misoprostol)
* Surgical → surgical management of miscarriage
* Septic → antibiotics and uterine evacuation
Definition of pre-term labour
Onset of labour before 37 weeks gestation (259 days)
* Can be spontaneous or induced 3 categories
* Mildly preterm
* Very preterm
* Extremely preterm
Aetiological factors in pre-term labour
Idiopathic (majority)
* Multigravidity
* Polyhydramnios
* APH
* Pre-eclampsia Infection (UTI)
* Prelabour premature rupture of membranes (PPRM)
Diagnosis for pre-term labour
* Vaginal examination → contractions with evidence of cervical changes Test → fetal fibrinoectin Consider possible cause
Management of preterm labour
* Tocolytics (allows steroids and transfer to NICU)
* Steroids unless contraindicated
* Transfer to NICU
* An aim for vaginal delivery
Complications of prematurity
* Respiratory distress syndrome
* Intraventricular haemorrhage
* Cerebral palsy
* Nutrition needs
* Temperature control requirements
* Jaundice
* Infection
* Visual impairment
* Hearing loss
Tocolysis
* Medications used to inhibit uterine contractions
* Used in pre-term labour
Definition of ectopic pregnancy
* Pregnancy implanted outside the uterine cavity
* Commonly found Fallopian tube, fimbriae, cervix
Risk factors for ectopic pregnancy
* Pelvic inflammatory disease
* Previous tubal surgery
* Previous ectopic
* Assisted conception (IVF)
Management of antepartum haemorrhage
- Maternal shock, collapse
- Fetal distress → death
- Maternal DIC (disseminated intravascular coagulation) → renal failure
- Post-partum haemorrhage → ‘couvelaires sign’
Presentation of placental abruption
Pain
* Vaginal bleeding (minimal)
* Increasing uterine tone
Definition of Placental abruption
* Haemorrhage due to early separation of the placenta before birth of baby
* Very rare
Classification of Placental abruption
* Revealed (visibility of a lot of blood)
* Concealed (bleeding inside but can’t see)
* Mixed (concealed and revealed)
Couvelaire’s uterus
- Placental abruption causing bleeding to penetrate deep into myometrium and eventually peritoneal cavity
Factors associated with Placental abruption
* Pre-eclampsia/ chronic hypertension
* Multigravidity
* Polyhydramnios
* Smoking, increasing age parity
* Previous abruption
* Cocaine use
Definition of placenta praevia
* All or part of the placenta implants into the lower segment of uterus (near internal os)
Presentation of placenta praevia
- Painless PV (per vaginum) bleeding
- Malpresentation of foetus
- Soft, no-tender uterus
- Incidental finding
Risk factors for placenta praevia
- Multiparous women
- Multiple pregnancies
- Previous Caesarean section
Classification of placenta praevia
- Low lying → less than 20mm from internal loss
- Placenta praevia → covering os entirely
Investigation for placenta praevia
* Ultrasound (gold standard)More difficulty to locate posterior placenta praevia
Management of placenta praevia
- Depends on severity and gestational age
- Conservative → reach gestational maturity
- Elective Caesarean section
- Watch for postpartum haemorrhage
Definition of antepartum haemorrhage
Haemorrhage from the genital tract after 24 weeks gestation but before delivery of baby
Aetiology of antepartum haemorrhage
* Placenta praaevia
* Placental abruption
* APH of unknown origin
* Local lesion of genital tract
* Vasa praevia (rare)
Definition of postpartum haemorrhage
* Bleeding after delivery more than 500mls
Management of postpartum haemorrhage
- Medical: oxytocin, ergometrine, carboprost, tranexemic acid
- Ballon tamponade
- Surgical: B Lynch suture, ligaton of uterine. iliac arteries, hysterectomy
Presentation of ectopic pregnancy
Period of amenorrhea (+/- urine pregnancy test)
* Vaginal bleeding
* Abdominal pain
* GI/ urinary symptoms
Investigations for ectopic pregnancy
* Ultrasound scan → no intrauterine gestational sac, adnexal mass, fluid in pouch of Douglas
* Serum b-hCG levels → high
Management of ectopic pregnancy
* Medical → IV methotrexate
* Surgical → laparoscopy salpingectomy, salpingostomy
* Conservative → to those haemodynamically stable + low serum b-hCG
