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Reproductive Systems > Complications in Pregnancy 1 > Flashcards

Complications in Pregnancy 1 Flashcards

1
Q

define a miscarriage

A

spontaneous loss of pregnancy before 24 weeks gestation

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2
Q

what does a threatened miscarriage refer to?

A

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.

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3
Q

miscarriage becomes inevitable if?

A

the cervic has already begun to dilate

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4
Q

what does a missed miscarriage refer to?

A

a pregnancy in which the fetus has died but the uterus has made no attempt to expel the products of conception

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5
Q

clinical features of a threatened miscarriage

A
  • vaginal bleeding +/- pain
  • viable pregnancy
  • closed cervix on speculum exam
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6
Q

clinical features of inevitable miscarriage

A
  • viable pregnancy
  • open cervix with bleeding that could be heavy (+/- clots)
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7
Q

clinical features of missed miscarriage (early fetal demise)

A
  • 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
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8
Q

define a complete miscarriage

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 previouslt rhat confirmed and intrauterine pregnancy
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9
Q

List some causes of spontaneous miscarriage

A
  • abnormal conceptus: chromosomal, genetic, structural
  • uterine abnormality: congenital, fibroids
  • cervical weakness: primary, secondary
  • materanl: increasing age, diabetes
  • unknown
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10
Q

outline the management of different types of miscarriage

threatened, inevitable, missed, septic

A

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

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11
Q

what are the most common sites of ectopic pregnancy?

A
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12
Q

ectopic pregnancy incidence

A

1:90 pregnancies

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13
Q

ectopic pregnancy risk factors

A
  • pelvic inflammatory disease
  • previous tubal surgery
  • previous ectopic
  • assisted conception
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14
Q

ectopic pregnancy clinical presentation

A
  • period of ammenorrhoea (with +ve urine pregnancy test)
  • +/- vaginal bleeding
  • +/- abdomen pain
  • +/- GI or urinary symptoms
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15
Q

ectopic pregnancy investigations

A
  • 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%
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16
Q

ectopic pregnancy management

A
  • medical: methotexate
  • surgical: mostly laparoscopy - Salpingectomy (remove the tube), Salpingotomy (leave a damaged tube, remove the embryo) for few indications
  • conservative
17
Q

define antepartum haemorrhage (APH)

A
  • haemorrhage from the genital tract after the 24th week of pregnancy but before the delivery of the baby
18
Q

list some caused of antepartum haemorrhage (APH)

A
  • 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
19
Q

what is placenta praevia

A
  • 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
20
Q

RCOG classification placenta previa

A
  • low-lying - placenta is less than 20mm from internal os
  • placenta previa - covering the os
21
Q

placenta praevia presentation

A
  • painless PV bleeding
  • soft, non-tender uterus +/- malpresentation of fetus on US
  • incidental
22
Q

placenta praevia diagnossi

A

Ultrasound scan to locate placental site

VAGINAL EXAMINATION MUST NOT BE DONE WITH SUSPECED PLACENTA PRAEVIA

23
Q

placenta praevia management

A
  • gestation
  • severity
  • c-section, watch for post-partum haemorrhage
24
Q

management of post-partum haemorrhage (PPH)

A
  • medical: oxytocin, ergometrine, carboprost
  • balloon tamponade
  • surgical: B lynch suture, ligation of uterine, iliac vessels, hysterectomy.
25
Q

what is placental abruption?

A
  • Placental abruption causes haemorrhage from premature separation of the placenta before the birth of the baby and is associated with a retroplacental clot.
  • The incidence of placental abrution will depend on maternal age, parity and social status but it is estimated to occur in approx 0.6% of all pregnancies
26
Q

which risk factors are associated with placental abruption?

A
  • pre-eclampsia/chronic hypertension
  • multiple pregnancy
  • polyhydramnios
  • smoking, increasing age, parity
  • previous abruption
  • cocaine use
27
Q

what are the clinical types of placental abruption?

A
  • revealed (see the blood)
  • concealed (bleeding but inside so can’t see)
  • mix of above
28
Q

placental abruption presentation

A
  • pain
  • vaginal bleeding (may be minimal)
  • increased uterine activity
29
Q

placental abruption complications

A
  • maternal shock, collapse
  • fetal distress then death
  • maternal DIC, renal failure
  • postpartum haemorrhage ‘couvelaire uterus’
30
Q

define preterm labour

A
  • onset of labour before 37 completed weeks gestation (259 days)
  • 32-36 wks mildy preterm
  • 28-32 wks very preterm
  • 24-28 wks extremely preterm
  • spontaneous or induced (iatrogenic)
31
Q

preterm labour risk factors

A
  • multiple pregnancy
  • polyhydramnios
  • APH
  • pre-eclampsia
  • infection e.g. UTI
  • prelabour premature rupture of membranes
  • majority idiopathic
32
Q

preterm labour diagnosis

A
  • contractions with evidence of cervical change on VE
  • test fetal fibronectin
33
Q

Preterm delivery management

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

34
Q

neonatal morbidities resulting from prematurity

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

Reproductive Systems (36 decks)

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