Complications in Pregnancy 1 Flashcards
What are some examples of complications in pregnancy?
- Miscarriage
- Ectopic pregnancy
- Antepartum haemorrhage
- Preterm labour
What is a miscarriage?
Miscarriage = spontaneous loss of pregnancy before 24 weeks gestation
What is an abortion?
Abortion = voluntary termination
What are the different classes of miscarriage and there presentation?
-
Threatened
- Bleeding from gravid uterus before 24 weeks gestation where there is viable foetus and no evidence of cervical dilation
- Vaginal bleeding with or without pain, viable pregnancy, closed cervix on speculum examination
-
Inevitable
- Becomes inevitable if cervix has already began to dilate
- Viable pregnancy, open cervix with bleeds that could become heavy
-
Incomplete
- Only partial expulsion of products of conception
- Vaginal bleeding, open cervix
-
Complete
- Expulsion of all products of conception
- Cervix closed and bleeding has stopped
-
Septic
- After incomplete miscarriage risk of ascending infection, known as septic abortion
-
Missed
- Foetus has died but uterus made no attempt to expel the products of conception
- No symptoms, or could have bleeding
What is a threatened miscarriage?
- Bleeding from gravid uterus before 24 weeks gestation where there is viable foetus and no evidence of cervical dilation
What is an inevitable miscarriage?
- Becomes inevitable if cervix has already began to dilate
What is an incomplete miscarriage?
- Only partial expulsion of products of conception
What is a complete miscarriage?
- Expulsion of all products of conception
What is a septic miscarriage?
- After incomplete miscarriage risk of ascending infection, known as septic abortion
What is a missed miscarriage?
- Foetus has died but uterus made no attempt to expel the products of conception
What is the aetiology of miscarriage?
- Abnormal conceptus
- Chromosomal, genetic, structural
- Uterine abnormality
- Congenital, fibroids
- Cervical weakness
- Primary, secondary
- Maternal
- Increasing age, diabetes
- Idiopathic
What is the prevalence of miscarriage?
15% in lifetime
What is the management of miscarriage?
- Threatened
- Conservative, just wait
- Inevitable
- If bleeding heavy may need evacuation
- Missed
- Conservative
- Medical – prostaglandins (misoprostol)
- Surgical – SMM (surgical management of miscarriage)
- Septic
- Antibiotics and evacuate uterus
What is an ectopic pregnancy?
Pregnancy implanted outside uterine cavity, usually in ampulla of fallopian tubes
Where does an ectopic pregnancy usually occur?
Ampulla of fallopian tubes
What is the incidence of ectopic pregnancy?
1:90 pregnancies
What are risk factors for ectopic pregnancy?
- Pelvic inflammatory disease
- Previous tubal surgery
- Previous ectopic
- Assisted conception
What is the presentation of ectopic pregnancy?
- Period of ammenorhoea (with positive urine pregnancy test)
- Maybe vaginal bleeding
- Maybe abdominal pain
- Maybe GI or urinary symptoms
What investigations are done for ectopic pregnancy?
- USS
- No intrauterine gestational sac, may see adnexal mass, fluid in pouch of douglas
- Serum BHCG levels
- May need to track over 48 hour intervals