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Reproductive > Complications in pregnancy 1 > Flashcards

Complications in pregnancy 1 Flashcards

1
Q

Abortion

A

* Voluntary termination of foetus

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2
Q

Miscarriage

A

Spontaneous loss of pregnancy before 24 weeks gestation

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3
Q

Categories of spontaneous miscarriage

A

* Threatened
* Inevitable
* Incomplete
* Complete
* Septic
* Missed

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4
Q

Aetiology of spontaneous miscarriage

A

* Abnormal conceptus: chromosomal, genetic, structure
* Uterine abnormality: congenital, fibroids
* Cervical weakness: primary or secondary
* Maternal factors: increasing age, diabetes, SLE
* Unknown

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5
Q

Threatened miscarriage

A

* Vaginal bleeding +/- pain
* Viable pregnancy Closed cervix on speculum examination
*

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6
Q

Inevitable miscarriage

A

* Viable pregnancy
* Open cervix with heavy bleeding (+/- clots)

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7
Q

Missed miscarriage (early fatal demise)

A

* Asymptomatic
* Sometimes bleeding/ brown loss from vagina
* Gestational sac on scan
* No clear foetus/ foetal pole without foetal heartbeat

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8
Q

Incomplete miscarriage

A

* Majority of products of conception (POC) expelled, some retained
* Open cervix, vaginal bleeding (maybe heavy)

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9
Q

Complete miscarriage

A

* All products of conception passed
* Cervix is closed
* Bleeding has stopped

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10
Q

Septic miscarriage

A

* Incomplete miscarriage caused by ascending infection

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11
Q

Management of spontaneous miscarriage

A

* 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

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12
Q

Definition of pre-term labour

A

Onset of labour before 37 weeks gestation (259 days)
* Can be spontaneous or induced 3 categories
* Mildly preterm
* Very preterm
* Extremely preterm

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13
Q

Aetiological factors in pre-term labour

A

Idiopathic (majority)
* Multigravidity
* Polyhydramnios
* APH
* Pre-eclampsia Infection (UTI)
* Prelabour premature rupture of membranes (PPRM)

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14
Q

Diagnosis for pre-term labour

A

* Vaginal examination → contractions with evidence of cervical changes Test → fetal fibrinoectin Consider possible cause

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15
Q

Management of preterm labour

A

* Tocolytics (allows steroids and transfer to NICU)
* Steroids unless contraindicated
* Transfer to NICU
* An aim for vaginal delivery

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16
Q

Complications of prematurity

A

* Respiratory distress syndrome
* Intraventricular haemorrhage
* Cerebral palsy
* Nutrition needs
* Temperature control requirements
* Jaundice
* Infection
* Visual impairment
* Hearing loss

17
Q

Tocolysis

A

* Medications used to inhibit uterine contractions
* Used in pre-term labour

18
Q

Definition of ectopic pregnancy

A

* Pregnancy implanted outside the uterine cavity
* Commonly found Fallopian tube, fimbriae, cervix

19
Q

Risk factors for ectopic pregnancy

A

* Pelvic inflammatory disease
* Previous tubal surgery
* Previous ectopic
* Assisted conception (IVF)

20
Q

Management of antepartum haemorrhage

A
  • Maternal shock, collapse
  • Fetal distress → death
  • Maternal DIC (disseminated intravascular coagulation) → renal failure
  • Post-partum haemorrhage → ‘couvelaires sign’
21
Q

Presentation of placental abruption

A

Pain
* Vaginal bleeding (minimal)
* Increasing uterine tone

22
Q

Definition of Placental abruption

A

* Haemorrhage due to early separation of the placenta before birth of baby
* Very rare

23
Q

Classification of Placental abruption

A

* Revealed (visibility of a lot of blood)
* Concealed (bleeding inside but can’t see)
* Mixed (concealed and revealed)

24
Q

Couvelaire’s uterus

A
  • Placental abruption causing bleeding to penetrate deep into myometrium and eventually peritoneal cavity
25
Q

Factors associated with Placental abruption

A

* Pre-eclampsia/ chronic hypertension
* Multigravidity
* Polyhydramnios
* Smoking, increasing age parity
* Previous abruption
* Cocaine use

26
Q

Definition of placenta praevia

A

* All or part of the placenta implants into the lower segment of uterus (near internal os)

27
Q

Presentation of placenta praevia

A
  • Painless PV (per vaginum) bleeding
  • Malpresentation of foetus
  • Soft, no-tender uterus
  • Incidental finding
28
Q

Risk factors for placenta praevia

A
  • Multiparous women
  • Multiple pregnancies
  • Previous Caesarean section
29
Q

Classification of placenta praevia

A
  • Low lying → less than 20mm from internal loss
  • Placenta praevia → covering os entirely
30
Q

Investigation for placenta praevia

A

* Ultrasound (gold standard)More difficulty to locate posterior placenta praevia

31
Q

Management of placenta praevia

A
  • Depends on severity and gestational age
  • Conservative → reach gestational maturity
  • Elective Caesarean section
  • Watch for postpartum haemorrhage
32
Q

Definition of antepartum haemorrhage

A

Haemorrhage from the genital tract after 24 weeks gestation but before delivery of baby

33
Q

Aetiology of antepartum haemorrhage

A

* Placenta praaevia
* Placental abruption
* APH of unknown origin
* Local lesion of genital tract
* Vasa praevia (rare)

34
Q

Definition of postpartum haemorrhage

A

* Bleeding after delivery more than 500mls

35
Q

Management of postpartum haemorrhage

A
  • Medical: oxytocin, ergometrine, carboprost, tranexemic acid
  • Ballon tamponade
  • Surgical: B Lynch suture, ligaton of uterine. iliac arteries, hysterectomy
36
Q

Presentation of ectopic pregnancy

A

Period of amenorrhea (+/- urine pregnancy test)
* Vaginal bleeding
* Abdominal pain
* GI/ urinary symptoms

37
Q

Investigations for ectopic pregnancy

A

* Ultrasound scan → no intrauterine gestational sac, adnexal mass, fluid in pouch of Douglas
* Serum b-hCG levels → high

38
Q

Management of ectopic pregnancy

A

* Medical → IV methotrexate
* Surgical → laparoscopy salpingectomy, salpingostomy
* Conservative → to those haemodynamically stable + low serum b-hCG

Reproductive (25 decks)

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