Complications in Pregnancy 1 Flashcards by Shuen Lee

What is a miscarriage?

Spontaneous loss of pregnancy before 24 weeks gestation.

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

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What are the different kinds of miscarriage?

Threatened 
Inevitable 
Incomplete 
Septic 
Complete
Missed

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What is a threatened miscarriage?

Vaginal bleeding/pain
Viable pregnancy
Closed cervix

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How do you manage a threatened miscarriage?

Conservative treatment

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What is an inevitable miscarriage?

Viable pregnancy

* Open cervix with bleeding (+/- clots)

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How do you manage an inevitable miscarriage?

May need evacuation

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What is an incomplete miscarriage?

• Most of pregnancy expelled • Open cervix, vaginal bleeding

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How do you manage an incomplete miscarriage?

Evacuate RPOC

* Might progress to septic

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What is a septic miscarriage?

Infection of RPOC

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How do you manage a septic miscarriage?

Antibiotics and evacuate uterus

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What is a complete miscarriage?

Passed all POC

* Cervix closed and bleeding has stopped

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What is a missed miscarriage?

Foetus has died but uterus has not tried to expel

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How do you diagnose a missed miscarriage?

Gestational sac seen on scan
No clear foetus
No foetal heart

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How do you manage a missed miscarriage?

Prostaglandins e.g. misoprostol

* Surgical e.g. surgical management of miscarriage

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Causes of spontaneous miscarriage?

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

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How does an ectopic pregnancy present?

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

Abdo pain + woman of childbearing age

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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.