Complications in Pregnancy 1 Flashcards
1
Q
What are some examples of complications in pregnancy?
A
- Miscarriage
- Ectopic pregnancy
- Antepartum haemorrhage
- Preterm labour
2
Q
What is a miscarriage?
A
Miscarriage = spontaneous loss of pregnancy before 24 weeks gestation
3
Q
What is an abortion?
A
Abortion = voluntary termination
4
Q
What are the different classes of miscarriage and there presentation?
A
-
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
5
Q
What is a threatened miscarriage?
A
- Bleeding from gravid uterus before 24 weeks gestation where there is viable foetus and no evidence of cervical dilation
6
Q
What is an inevitable miscarriage?
A
- Becomes inevitable if cervix has already began to dilate
7
Q
What is an incomplete miscarriage?
A
- Only partial expulsion of products of conception
8
Q
What is a complete miscarriage?
A
- Expulsion of all products of conception
9
Q
What is a septic miscarriage?
A
- After incomplete miscarriage risk of ascending infection, known as septic abortion
10
Q
What is a missed miscarriage?
A
- Foetus has died but uterus made no attempt to expel the products of conception
11
Q
What is the aetiology of miscarriage?
A
- Abnormal conceptus
- Chromosomal, genetic, structural
- Uterine abnormality
- Congenital, fibroids
- Cervical weakness
- Primary, secondary
- Maternal
- Increasing age, diabetes
- Idiopathic
12
Q
What is the prevalence of miscarriage?
A
15% in lifetime
13
Q
What is the management of miscarriage?
A
- 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
14
Q
What is an ectopic pregnancy?
A
Pregnancy implanted outside uterine cavity, usually in ampulla of fallopian tubes
15
Q
Where does an ectopic pregnancy usually occur?
A
Ampulla of fallopian tubes
16
Q
What is the incidence of ectopic pregnancy?
A
1:90 pregnancies
17
Q
What are risk factors for ectopic pregnancy?
A
- Pelvic inflammatory disease
- Previous tubal surgery
- Previous ectopic
- Assisted conception
18
Q
What is the presentation of ectopic pregnancy?
A
- Period of ammenorhoea (with positive urine pregnancy test)
- Maybe vaginal bleeding
- Maybe abdominal pain
- Maybe GI or urinary symptoms
19
Q
What investigations are done for ectopic pregnancy?
A
- 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
20
Q
What is the mangement of ectopic pregnancy?
A
- Medical
- Methotrexate
- Surgical
- Laparoscopy
- Or maybe salopingectomy (remove the tube) or salpingotomy (leave a damaged tube, remove embryo)
- Conservative
21
Q
What does APH stand for?
A
Antepartum haemorrhage
22
Q
What is an antepartum haemorrhage?
A
Haemorrhage from the genital tract after 24th week of pregnancy but before delivery of baby
23
Q
What is the aetiology of APH?
A
- 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
24
Q
What is a placenta praevia?
A
Placenta partially or completely covers mothers cervix
25
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
26
What are the different classes of placenta praevia, new system?
* Low lying placenta
* Less than 20mm from internal OS
* Placental previa
* Covering os
27
What is the incidence of placenta praevia?
1/200 pregnancies
28
What are the risk factors for placental praevia?
* Multiparous woman
* Multiple pregnancies
* Previous caesarean section
29
What is the presentation of placenta praevia?
* **Painless PV bleeding**
* Malpresentation of foetus
* Incidental
30
What investigations are done for placental praevia?
* USS
* **Vaginal examination must not be done with suspected placental praevia**
31
What should NEVER be done in suspected case of placental praevia?
Vaginal examination
32
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
33
What is a possible complication of placental praevia?
* Post-partum haemorrhage
34
What is a placental abruption?
Haemorrhage resulting from premature separation of placenta before the birth of the baby
35
What is the prevalence of placental abruption?
0.6% of pregnancies
36
What are risk factors for placental abruption?
* Pre-eclampsia/chronic hypertension
* Multiple pregnancy
* Polyhydramnios
* Smoking, increasing age, parity
* Previous abruption
* Cocaine use
37
What are the different clinical categories of placental abruption?
* Revealed (see the blood)
* Concealed (bleeding but inside so cannot see)
* Mixed (concealed and revealed)
38
What is the presentation of placental abruption?
* **Pain**
* Vaginal bleeding
* Increased uterine activity
39
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
40
What are possible complications of placental abruption?
* Maternal shock, collapse
* Foetal distress then death
* Maternal DIC (disseminated intravascular coagulation), renal failure
* Postpartum haemorrhage
41
What is preterm labour?
Onset of labour before 37 weeks completed gestation (259 days)
42
What are the different categories of preterm labour?
* Mildly preterm
* 32-36 weeks
* Very preterm
* 28-32 weeks
* Extremely preterm
* 24-28 weeks
43
When is labour considered to be preterm?
Before 37 weeks completed gestation (259 days)
44
Describe the epidemiology of preterm labour (incidence)?
* 5-7% in single pregnancy
* 30-40% in multiple pregnancy
45
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
46
How is preterm labour diagnosed?
* Contractions with evidence of cervical change on VE
* Foetal fibronectin test
47
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
48
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
