Complications in Pregnancy 1 Flashcards
define a miscarriage
spontaneous loss of pregnancy before 24 weeks gestation
what does a threatened miscarriage refer to?
A threatened miscarriage refers to bleeding from the gravid uterus before 24 weeks gestation when there is a viable fetus and no evidence of cervical dilatation.
miscarriage becomes inevitable if?
the cervic has already begun to dilate
what does a missed miscarriage refer to?
a pregnancy in which the fetus has died but the uterus has made no attempt to expel the products of conception
clinical features of a threatened miscarriage
- vaginal bleeding +/- pain
- viable pregnancy
- closed cervix on speculum exam
clinical features of inevitable miscarriage
- viable pregnancy
- open cervix with bleeding that could be heavy (+/- clots)
clinical features of missed miscarriage (early fetal demise)
- no symptoms, or could have bleeding/brown loss vaginally
- gestational sac seen on scan
- no clear fetus (empty gestational sac) or fetal pole with no fetal heart seen in the gestational sac
define a complete miscarriage
- passed all products of conception (POC), cervix closed and bleeding has stopped (should ideally have confirmed the POC or should have had a scan previouslt rhat confirmed and intrauterine pregnancy
List some causes of spontaneous miscarriage
- abnormal conceptus: chromosomal, genetic, structural
- uterine abnormality: congenital, fibroids
- cervical weakness: primary, secondary
- materanl: increasing age, diabetes
- unknown
outline the management of different types of miscarriage
threatened, inevitable, missed, septic
Threatened - conservative, ‘just wait’, most stop bleeding and are okay
Inevitable - if bleeding heavy may need evacutation
Missed - conservative, medical: prostaglandins (misoprostol), surgical: SMM
Septic: antibiotics and evacuate uterus
what are the most common sites of ectopic pregnancy?
ectopic pregnancy incidence
1:90 pregnancies
ectopic pregnancy risk factors
- pelvic inflammatory disease
- previous tubal surgery
- previous ectopic
- assisted conception
ectopic pregnancy clinical presentation
- period of ammenorrhoea (with +ve urine pregnancy test)
- +/- vaginal bleeding
- +/- abdomen pain
- +/- GI or urinary symptoms
ectopic pregnancy investigations
- scan - no uterine gestational sac, may see adnexal mass, fluid in Pouch of Douglas
- serum BHCG levels - may need to serially track levels over 48hr intervals, if a normal intrauterine pregnancy HCG levels will increase by at least 66%
ectopic pregnancy management
- medical: methotrexate
- surgical: mostly laparoscopy - Salpingectomy (remove the tube), Salpingotomy (leave a damaged tube, remove the embryo) for few indications
- conservative
define antepartum haemorrhage (APH)
- haemorrhage from the genital tract after the 24th week of pregnancy but before the delivery of the baby
list some caused of antepartum haemorrhage (APH)
- placental praevia - where the placenta is attached to lower segment of uterus
- placental abruption
- APH of unknown origin
- local lesion of the genital tract
- Vasa praevia (very rare) - rupture of fetal vessel, can be catastrophic for fetus
what is placenta praevia
- all or part of the placenta implants in the lower uterine segment
- a cause of APH
- incidence 1/200 pregnancies
- more common in multiparous women, multiple pregnancies, previous c-section
RCOG classification placenta previa
- low-lying - placenta is less than 20mm from internal os
- placenta previa - covering the os
placenta praevia presentation
- painless PV bleeding
- soft, non-tender uterus +/- malpresentation of fetus on US
- incidental
placenta praevia diagnossi
Ultrasound scan to locate placental site
VAGINAL EXAMINATION MUST NOT BE DONE WITH SUSPECED PLACENTA PRAEVIA
placenta praevia management
- gestation
- severity
- c-section, watch for post-partum haemorrhage
management of post-partum haemorrhage (PPH)
- medical: oxytocin, ergometrine, carboprost
- balloon tamponade
- surgical: B lynch suture, ligation of uterine, iliac vessels, hysterectomy.
