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
What is the mangement of ectopic pregnancy?
- Medical
- Methotrexate
- Surgical
- Laparoscopy
- Or maybe salopingectomy (remove the tube) or salpingotomy (leave a damaged tube, remove embryo)
- Conservative
What does APH stand for?
Antepartum haemorrhage
What is an antepartum haemorrhage?
Haemorrhage from the genital tract after 24th week of pregnancy but before delivery of baby
What is the aetiology of APH?
- Placenta praevia
- Placenta partially or totally covers the mothers cervix
- Placental abruption
- Local lesions of genital tract
- Vasa praevia
- Foetal blood vessels cross or run near the internal opening of uterus
- Idiopathic
What is a placenta praevia?
Placenta partially or completely covers mothers cervix
What are the different classes of placenta praevia (old classification system)?
- Grade 1
- Placenta encroaching on the lower segment but not he internal cervix os
- Grade 2
- Placenta reaches internal os (orifice of cervix)
- Grade 3
- Placenta eccentrically covers the os
- Grade 4
- Central placental praevia
What are the different classes of placenta praevia, new system?
- Low lying placenta
- Less than 20mm from internal OS
- Placental previa
- Covering os
What is the incidence of placenta praevia?
1/200 pregnancies
What are the risk factors for placental praevia?
- Multiparous woman
- Multiple pregnancies
- Previous caesarean section
What is the presentation of placenta praevia?
- Painless PV bleeding
- Malpresentation of foetus
- Incidental
What investigations are done for placental praevia?
- USS
- Vaginal examination must not be done with suspected placental praevia
What should NEVER be done in suspected case of placental praevia?
Vaginal examination
Describe the management of placental praevia?
- Depends on
- Gestation
- Severity
- Caesarean section
- Medical management
- Oxytocin, ergometrine, carboprost, tranexamic acid
- Surgical management
- Balloon tamponade
- B lynch cutre, ligation of uterine, iliac vessels, hysterectomy
What is a possible complication of placental praevia?
- Post-partum haemorrhage
What is a placental abruption?
Haemorrhage resulting from premature separation of placenta before the birth of the baby
What is the prevalence of placental abruption?
0.6% of pregnancies
What are risk factors for placental abruption?
- Pre-eclampsia/chronic hypertension
- Multiple pregnancy
- Polyhydramnios
- Smoking, increasing age, parity
- Previous abruption
- Cocaine use
What are the different clinical categories of placental abruption?
- Revealed (see the blood)
- Concealed (bleeding but inside so cannot see)
- Mixed (concealed and revealed)
What is the presentation of placental abruption?
- Pain
- Vaginal bleeding
- Increased uterine activity
What is the mangement of placental abruption?
- Varies from expectant treatment, attempting delivery or caesarean section depending on
- Amount of bleeding
- General condition of mother and baby
- Gestation
What are possible complications of placental abruption?
- Maternal shock, collapse
- Foetal distress then death
- Maternal DIC (disseminated intravascular coagulation), renal failure
- Postpartum haemorrhage
What is preterm labour?
Onset of labour before 37 weeks completed gestation (259 days)
What are the different categories of preterm labour?
- Mildly preterm
- 32-36 weeks
- Very preterm
- 28-32 weeks
- Extremely preterm
- 24-28 weeks
When is labour considered to be preterm?
Before 37 weeks completed gestation (259 days)
Describe the epidemiology of preterm labour (incidence)?
- 5-7% in single pregnancy
- 30-40% in multiple pregnancy
What are risk factors for preterm labour?
- Idiopathic (most common)
- Multiple pregnancy
- Polyhydramnios
- APH
- Pre-eclampsia
- Infection such as UTI
- Prelabour premature rupture of membranes
How is preterm labour diagnosed?
- Contractions with evidence of cervical change on VE
- Foetal fibronectin test
Describe the management of preterm labour?
- <24-26 weeks
- Poor prognosis
- All cases considered viable
- Consider tocolysis to allow steroids/transfer
- These are drugs that prevent uterine contractions
- Steroids unless contraindicated
- Transfer to unit with NICU facilities
- Aim for vaginal delivery
- Consider tocolysis to allow steroids/transfer
Describe the prognosis of preterm labour?
- Possible neonatal morbidity from prematurity
- Respiratory distress syndrome
- Intraventricular haemorrhage
- Cerebral palsy
- Nutrition
- Temperature control
- Jaundice
- Infections
- Visual impairment
- Hearing loss
