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Reproductive block - Y3 > Complications in pregnancy 1 > Flashcards

Complications in pregnancy 1 Flashcards

1
Q

miscarriage

A

spontaneous loss of pregnancy before 24 weeks gestation

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2
Q

abortion

A

voluntary termination

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3
Q

threatened miscarriage signs

A

Vaginal bleeding+/- pain
Viable pregnancy
Closed cervix on speculum examination

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4
Q

inevitable miscarriage signs

A

Viable pregnancy
Open cervix with bleeding
that could be heavy (+/-clots)

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5
Q

missed miscarriage (early foetal demise) signs

A

No symptoms, or could have bleeding/ brown loss vaginally
Gestational sac seen on scan
No clear fetus (empty gestational sac) or a fetal pole with no fetal heart seen in the gestational sac

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6
Q

incomplete miscarriage signs

A

No symptoms, or could have bleeding/ brown loss vaginally
Gestational sac seen on scan
No clear fetus (empty gestational sac) or a fetal pole with no fetal heart seen in the gestational sac

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7
Q

complete miscarriage signs

A

– passed all products of conception (POC), cervix closed and bleeding has stopped (should ideally have confirmed the POC or should have had a scan previously that confirmed an intrauterine pregnancy)

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8
Q

when are septic miscarriages most commonly seen

A

especially in cases of an incomplete miscarriage

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9
Q

aetiology of a spontaneous miscarriage

A

Abnormal conceptus
chromosomal, genetic, structural

Uterine abnormality
congenital, fibroids

Cervical weakness
Primary, secondary

Maternal
increasing age, diabetes

Unknown

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10
Q

management of a threatened miscarriage

A

conservative, “just wait” – most stop bleeding and are okay

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11
Q

management of inevitable miscarriage

A

If bleeding heavy may need evacuation

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12
Q

missed miscarriage management

A

conservative
- medical – prostaglandins (misoprostol)
- surgical – SMM (surgical management of miscarriage)

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13
Q

management of septic miscarriage

A

antibiotics and evacuate uterus

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14
Q

ectopic pregnancy

A

pregnancy outside the uterus cavity

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15
Q

incidence ectopic pregnancy

A

around 1:90 pregnancies

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16
Q

risk factors ectopic pregnancy

A

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

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17
Q

presentation ectopic pregnancy

A

Period of ammenorhoea (with +ve urine pregnancy test)
+/_ Vaginal bleeding
+/_ Pain abdomen
+/_ GI or urinary symptoms

18
Q

what investigations are done for an ectopic pregnancy

A

Scan – no intrauterine gestational sac, may see adnexal mass, fluid in Pouch of Douglas

Serum BHCG levels – may need to serially track levels over 48 hour intervals- if a normal early intrauterine pregnancy HCG levels will increase by at least 66%ish

19
Q

management for ectopic pregnancy

A

Medical – Methotrexate

Surgical –
(mostly laparoscopy– Salpingectomy, Salpingotomy for few indications)

Conservative

20
Q

what is an antepartum haemorrhage

A

haemorrhage from the genital tract after the 24th week of pregnancy but before delivery of the baby.

21
Q

what are causes of antepartum haemorrhage

A

Placenta praevia

Placental abruption

APH of unknown origin

Local lesions of the genital tract

Vasa praevia (very rare)

22
Q

what is Placenta praevia

A

All or part of the placenta implants in the lower uterine segment

Incidence
1/200 pregnancies

More common in
Multiparous women
multiple pregnancies
previous caesaren section

23
Q

old classification of Placenta praevia

A

Grade I Placenta encroaching on the lower segment but not the internal cervical os

Grade II Placenta reaches the internal os

Grade III Placenta eccentrically covers the os

Grade IV Central placenta praevia

24
Q

RCOG classification
Placenta Praevia

A

Low lying- placenta is less than 20 mm from internal os

Placenta previa – covering the os

25
Q

presentation placenta Praevia

A

Painless PV bleeding
Malpresentation of the fetus
Incidental

26
Q

clinical features placenta Praevia

A

Maternal condition correlates with amount of bleeding PV

Soft, non tender uterus +/- fetal malpresentation

27
Q

diagnosis placenta Praevia

A

Ultrasound scan to locate placental site

VAGINAL EXAMINATION MUST NOT BE DONE WITH SUSPECED PLACENTA PRAEVIA

28
Q

management placenta Praevia

A

Gestation
Severity
Caesarean section, watch for PPH

29
Q

management PHH

A

Medical management – oxytocin, ergometrine, carboprost, tranexemic acid

Balloon tamponade Surgical – B Lynch cutre, ligation of
uterine, iliac vessels, hystrectomy

30
Q

Placental abruption

A

Haemorrhage resulting from premature separation of the placenta before the birth of the baby

Incidence 0.6% of all pregnancies

31
Q

Factors associated with Placental Abruption

A

Pre-eclampsia/ chronic hypertension
Multiple pregnancy
Polyhydramnios
Smoking, increasing age, parity
Previous abruption
Cocaine use

32
Q

clinical types Placental abruption

A

Revealed (see the blood)
Concealed (bleeding but inside so can’t see!)
Mixed (concealed and revealed)

33
Q

presentation placental abruption

A

Pain
Vaginal bleeding (may be minimal bleeding)
Increased uterine activity

34
Q

General management of APH

A

Management will vary from expectant treatment to attempting a vaginal delivery to immediate Caesarean section depending on

Amount of bleeding
General condition of mother and baby
Gestation

35
Q

Complications of placental abruption

A

Maternal shock, collapse (may be disproportionate to the amount of bleeding seen)

Fetal distress then death
Maternal DIC, renal failure
Postpartum haemorrhage
‘couvelaire uterus’

36
Q

what is preterm labour

A

Onset of labour before 37 completed weeks gestation (259 days)

32-36 wks mildly preterm
28-32 wks very preterm
24-28 wks extremely preterm

Spontaneous or induced (iatrogenic)

37
Q

what is the incidence of preterm labour

A

Around 5- 7% in singletons
30 - 40% multiple pregnancy

38
Q

what are predisposing factors to preterm labour

A

Multiple pregnancy
Polyhydramnios
APH
Pre-eclampsia
Infection eg UTI
Prelabour premature rupture of membranes
Majority no cause (idiopathic)

39
Q

how is preterm delivery managed

A

Contractions with evidence of cervical change on VE
Test- Fetal fibronectin

Consider possible cause
abruption, infection

40
Q

management preterm delivery

A

<24-26 weeks
Generally regarded as very poor prognosis
decisions made in discussion with parents and neonatologists

All cases considered viable
Consider tocolysis to allow steroids/ transfer
Steroids unless contraindicated
Transfer to unit with NICU facilities
Aim for vaginal delivery

41
Q

Neonatal Morbidity resulting from Prematurity

A

respiratory distress syndrome
intraventricular haemorrhage
cerebral palsy
nutrition
temperature control
jaundice
infections
visual impairment
hearing loss

Reproductive block - Y3 (22 decks)

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