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Reproductive - Y3* > Complications in Pregnancy 1 > Flashcards

Complications in Pregnancy 1 Flashcards

1
Q

What is a miscarriage?

A

Spontaneous loss of pregnancy before 24 weeks gestation.

To be any kind of miscarriage, should happen before 24 weeks.

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2
Q

What are the different kinds of miscarriage?

A 
Threatened 
Inevitable 
Incomplete 
Septic 
Complete
Missed
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3
Q

What is a threatened miscarriage?

A
  • Vaginal bleeding/pain
  • Viable pregnancy
  • Closed cervix
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4
Q

How do you manage a threatened miscarriage?

A

Conservative treatment

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5
Q

What is an inevitable miscarriage?

A
  • Viable pregnancy

* Open cervix with bleeding (+/- clots)

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6
Q

How do you manage an inevitable miscarriage?

A

May need evacuation

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7
Q

What is an incomplete miscarriage?

A

• Most of pregnancy expelled • Open cervix, vaginal bleeding

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8
Q

How do you manage an incomplete miscarriage?

A
  • Evacuate RPOC

* Might progress to septic

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9
Q

What is a septic miscarriage?

A

Infection of RPOC

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10
Q

How do you manage a septic miscarriage?

A

Antibiotics and evacuate uterus

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11
Q

What is a complete miscarriage?

A
  • Passed all POC

* Cervix closed and bleeding has stopped

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12
Q

What is a missed miscarriage?

A

Foetus has died but uterus has not tried to expel

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13
Q

How do you diagnose a missed miscarriage?

A
  • Gestational sac seen on scan
  • No clear foetus
  • No foetal heart
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14
Q

How do you manage a missed miscarriage?

A
  • Prostaglandins e.g. misoprostol

* Surgical e.g. surgical management of miscarriage

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15
Q

Causes of spontaneous miscarriage?

A
  • Maternal - age, DM
  • Abnormal conceptus - chromosomal, structural
  • Uterine abnormality - congenital, fibroids
  • Cervical weakness - trauma, hormonal condition
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16
Q

How does an ectopic pregnancy present?

A
  • Amenorrhoea
  • +ve pregnancy test
  • +/- vaginal bleeding
  • +/- abdo pain
  • +/- GI symptoms

Abdo pain + woman of childbearing age

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17
Q

Management of ectopic pregnancy?

A
  • Conservative for people with BhCG and haemodynamically stable
  • Methotrexate
  • Salpingectomy
18
Q

What are the causes of
antepartum haemorrhage?

A
  • Placenta praevia
  • Placental abruption
  • APH of unknown origin
  • Local lesions of genital tract
  • Vasa praevia (blood loss from foetal vessels)
19
Q

What is Placenta praevia?

A

When the placenta implants in lower uterine segment

20
Q

What are the risk factors for

Placenta praevia?

A
  • Multiparous women
  • Multiple pregnancies
  • Previous C section
21
Q

What are the different degrees of Placenta praevia?

A

1 – encroaching on lower segment but not internal cervical os
2 – placenta reaches internal os
3 – placenta eccentrically covers os
4 – central placenta praevia

22
Q

What is the presentation of

Placenta praevia?

A
  • Painless PV bleeding

* Malpresentation of foetus • Incidental

23
Q

What are the clinical features of Placenta praevia?

A
  • Maternal condition correlates with amount of PV bleeding

* Soft, non-tender uterus

24
Q

How do you diagnose Placenta praevia?

A

USS

25
Q

How do you manage Placenta praevia?

A
  • Depends on: Gestation, severity
  • CS 36-7 and watch for PPH
  • Medication: Oxytocin, ergometrine, carboprost, tranexamic acid
  • Surgical: Balloon tamponade, B-lynch suture, Ligation of uterine vessels, Hysterectomy
26
Q

If a patient has suspected placenta praevia, what examination can you NOT do?

A

DO NOT DO vaginal examination

27
Q

What is placental abruption?

A

Haemorrhage from premature separation of placenta before birth of baby

28
Q

What are the risk factors for placental abruption?

A 
Age
Smoking
Cocaine use
Previous abruption 
Pre eclampsia 
Multiple pregnancy
Polyhydramnios
29
Q

What are the three kinds of placental abruption?

A
  • Revealed
  • Concealed
  • Mixed
30
Q

How would revealed placental abruption present?

A

See blood. Obviously.

31
Q

How would concealed placental abruption present?

A

Bleeding but can’t see

32
Q

How would mixed placental abruption present?

A

Concealed and revealed.

Severe abdominal pain

33
Q

What are the complications of placental abruption?

A

Foetal: distress/death
Maternal: shock/collapse, DIC, Renal failure, PPH, Couvelaire uterus

34
Q

What is couvelaire uterus?

A

Haemorrhage from placental blood vessels penetrates into the uterine myometrium, forcing its way into the peritoneal cavity.

35
Q

What is pre-term labour?

A

Birth before 37 weeks gestation.

36
Q

What are the risk factors for pre-term labour?

A
  • Idiopathic
  • Infection e.g. UTI
  • Multiple pregnancy
  • Polyhydramnios
  • Pre-eclampsia
  • APH
  • Premature rupture of membranes (PROM)
37
Q

Is pre-term labour dangerous?

A

Major cause of perinatal mortality, but depends on gestational age.

38
Q

What are the investigations for pre-term labour?

A
  • Contractions. VE shows cervical change

* Test: foetal fibronectin

39
Q

What is the foetal fibronectin test for?

A

Foetal fibronectin is a protein produced by foetal cells.

For women with intact membranes, helps predict the likelihood of premature delivery within the next 7-14 days.

40
Q

Management for pre-term labour of <24-26 weeks?

A
  • Poor prognosis

* Decision with parents and neonatologists

41
Q

What are the principles of management for pre-term labour?

A
  • All cases are considered viable
  • Consider tocolysis to allow for steroids/transfer
  • Steroids unless contraindicated
  • Transfer to NICU
  • Aim for vaginal delivery
42
Q

Why do we give steroids to pre-term labour mothers?

A

Steroids e.g. corticosteroids help babies lungs to develop faster, gives them a much better survival rate.

Reproductive - Y3* (30 decks)

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