Complications in Pregnancy 1 Flashcards
What is a miscarriage?
Spontaneous loss of pregnancy before 24 weeks gestation.
To be any kind of miscarriage, should happen before 24 weeks.
What are the different kinds of miscarriage?
Threatened Inevitable Incomplete Septic Complete Missed
What is a threatened miscarriage?
- Vaginal bleeding/pain
- Viable pregnancy
- Closed cervix
How do you manage a threatened miscarriage?
Conservative treatment
What is an inevitable miscarriage?
- Viable pregnancy
* Open cervix with bleeding (+/- clots)
How do you manage an inevitable miscarriage?
May need evacuation
What is an incomplete miscarriage?
• Most of pregnancy expelled • Open cervix, vaginal bleeding
How do you manage an incomplete miscarriage?
- Evacuate RPOC
* Might progress to septic
What is a septic miscarriage?
Infection of RPOC
How do you manage a septic miscarriage?
Antibiotics and evacuate uterus
What is a complete miscarriage?
- Passed all POC
* Cervix closed and bleeding has stopped
What is a missed miscarriage?
Foetus has died but uterus has not tried to expel
How do you diagnose a missed miscarriage?
- Gestational sac seen on scan
- No clear foetus
- No foetal heart
How do you manage a missed miscarriage?
- Prostaglandins e.g. misoprostol
* Surgical e.g. surgical management of miscarriage
Causes of spontaneous miscarriage?
- Maternal - age, DM
- Abnormal conceptus - chromosomal, structural
- Uterine abnormality - congenital, fibroids
- Cervical weakness - trauma, hormonal condition
How does an ectopic pregnancy present?
- Amenorrhoea
- +ve pregnancy test
- +/- vaginal bleeding
- +/- abdo pain
- +/- GI symptoms
Abdo pain + woman of childbearing age
Management of ectopic pregnancy?
- Conservative for people with BhCG and haemodynamically stable
- Methotrexate
- Salpingectomy
What are the causes of
antepartum haemorrhage?
- Placenta praevia
- Placental abruption
- APH of unknown origin
- Local lesions of genital tract
- Vasa praevia (blood loss from foetal vessels)
What is Placenta praevia?
When the placenta implants in lower uterine segment
What are the risk factors for
Placenta praevia?
- Multiparous women
- Multiple pregnancies
- Previous C section
What are the different degrees of Placenta praevia?
1 – encroaching on lower segment but not internal cervical os
2 – placenta reaches internal os
3 – placenta eccentrically covers os
4 – central placenta praevia
What is the presentation of
Placenta praevia?
- Painless PV bleeding
* Malpresentation of foetus • Incidental
What are the clinical features of Placenta praevia?
- Maternal condition correlates with amount of PV bleeding
* Soft, non-tender uterus
How do you diagnose Placenta praevia?
USS
How do you manage Placenta praevia?
- 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
If a patient has suspected placenta praevia, what examination can you NOT do?
DO NOT DO vaginal examination
What is placental abruption?
Haemorrhage from premature separation of placenta before birth of baby
What are the risk factors for placental abruption?
Age Smoking Cocaine use Previous abruption Pre eclampsia Multiple pregnancy Polyhydramnios
What are the three kinds of placental abruption?
- Revealed
- Concealed
- Mixed
How would revealed placental abruption present?
See blood. Obviously.
How would concealed placental abruption present?
Bleeding but can’t see
How would mixed placental abruption present?
Concealed and revealed.
Severe abdominal pain
What are the complications of placental abruption?
Foetal: distress/death
Maternal: shock/collapse, DIC, Renal failure, PPH, Couvelaire uterus
What is couvelaire uterus?
Haemorrhage from placental blood vessels penetrates into the uterine myometrium, forcing its way into the peritoneal cavity.
What is pre-term labour?
Birth before 37 weeks gestation.
What are the risk factors for pre-term labour?
- Idiopathic
- Infection e.g. UTI
- Multiple pregnancy
- Polyhydramnios
- Pre-eclampsia
- APH
- Premature rupture of membranes (PROM)
Is pre-term labour dangerous?
Major cause of perinatal mortality, but depends on gestational age.
What are the investigations for pre-term labour?
- Contractions. VE shows cervical change
* Test: foetal fibronectin
What is the foetal fibronectin test for?
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.
Management for pre-term labour of <24-26 weeks?
- Poor prognosis
* Decision with parents and neonatologists
What are the principles of management for pre-term labour?
- All cases are considered viable
- Consider tocolysis to allow for steroids/transfer
- Steroids unless contraindicated
- Transfer to NICU
- Aim for vaginal delivery
Why do we give steroids to pre-term labour mothers?
Steroids e.g. corticosteroids help babies lungs to develop faster, gives them a much better survival rate.
