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Year 3 Repro (JK) > Complications in pregnancy (1) > Flashcards

Complications in pregnancy (1) Flashcards

1
Q

Spontaneous miscarriage/abortion

A

termination/loss of pregnancy before 24 weeks gestation

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2
Q

% of spontaneous miscarriage

A

15

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3
Q

List the different categories of spontaneous miscarriage

A 
inevitable
incomplete
complete 
septic 
missed 
threatened
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4
Q

How is an early viable pregnancy determined?

A

fetal heartbeat on USS

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5
Q

Threatened miscarriage

A

vaginal bleeding +/- pain

viable pregnancy and cervix is closed

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6
Q

Inevitable miscarriage

A

viable pregnancy

open cervix with bleeding that could be heavy (+/- clots)

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7
Q

Other name for missed miscarriage

A

early fetal demise

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8
Q

Symptoms of missed miscarriage

A

no symptoms or could have bleeding/brown loss vaginally

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9
Q

What is seen on scan in missed miscarriage?

A

gestational sac - empty or fetal pole with no heartbeat in sac

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10
Q

Incomplete miscarriage

A

most of pregnancy expelled out but some POC remain

open cervix, PV bleeding

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11
Q

Complete miscarriage

A

passed all POC, cervix closed and bleeding stopped

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12
Q

What should ideally have been done before confirming a complete miscarriage?

A

confirmed POC

previous scan to confirm intrauterine pregnancy

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13
Q

What miscarriages are at particular risk of septic miscarriage?

A

incomplete

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14
Q

5 causes of spontaneous miscarriage and examples

A 
abnormal conceptus eg chromosomal 
uterine abnormality eg fibroids 
cervical incompetence eg primary or secondary 
maternal eg age, diabetes
unknown
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15
Q

Managing threatened miscarriage

A

conservative

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16
Q

Managing inevitable miscarriage

A

bleeding heavy - evacuation

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17
Q

Managing missed miscarriage

A

conservative
medical - prostaglandins (misoprostol)
surgical

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18
Q

Managing septic miscarriage

A

antibiotics and evacuate uterus

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19
Q

Ectopic pregnancy

A

pregnancy implanted outside uterine cavity

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20
Q

How many pregnancies are ectopic?

A

1 in 90

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21
Q

4 risk factors for ectopic pregnancy

A

PID
previous tubal surgery with adhesion
previous ectopic
assisted conception - IVF

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22
Q

4 presentations of ectopic pregnancy

A

period of amenorrhoea with positive pregnancy test
+/- vaginal bleeding
+/- pain in abdomen
+/- GI or urinary symptoms

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23
Q

3 investigations of ectopic pregnancy

A

scan
serum beta hCG
serum progesterone levels

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24
Q

Findings in scan for ectopic

A

no intrauterine gestational sac

may see adnexal mass, fluid in pouch of douglas

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25
serum beta hCG in ectopic pregnancy
serially track over 48 hour intervals | normal pregnancy will increase by 66%
26
Serum progesterone in ectopic pregnancy
in viable IU pregnancy levels will be high >25ng/ml
27
Management of ectopic pregnancy
methotrexate laparascopic salpingectomy/salpingotomy conservative
28
Antepartum haemorrhage
haemorrhage from genital tract after 24th week of pregnancy but before delivery of baby
29
5 causes of APH
1. placenta praevia 2. placental abruption 3. unknown 4. vasa praevia 5. local lesions of genital tract
30
What is placenta praevia?
all or part of placenta implants in lower uterine segment
31
How many pregnancies does placenta praevia occur?
1 in 200
32
3 scenarios in which placenta praevia is more common
multiparous women multiple pregnancies previous caesarean
33
Grade 1 placenta praevia
placenta enroaching on lower segment but not the internal cervical os
34
Grade 2 placenta praevia
placenta reaches internal os
35
Grade 3 placenta praevia
placenta eccentrically covers the os
36
Grade 4 placenta praevia
central placenta praevia
37
3 presentations of placenta praevia
painless PV bleeding malpresentation of fetus incidental
38
Clinical features of placenta praevia
maternal condition correlates with PV bleeding | soft, non tender uterus +/- fetus malpresentation
39
Diagnosis of placenta praevia
USS
40
What examination should you not perform on women with placenta praevia
vaginal
41
Managing placenta praevia
c-section, watch for PPH
42
Medical management of PPH
oxytocin, ergometrine, carboprost, tranexamic acid
43
Other management of PPH
balloon tamponade | B lynch suture, hysterectomy, ligation of uterine and iliac vessels
44
Placental abruption
haemorrhage resulting from premature separation of placenta before birth of baby
45
What % of pregnancies does placental abruption occur?
0.6
46
Factors associated with placental abruption
``` multiple pregnancies cocaine increasing age pre-eclampsia, chronic hypertension polyhydramnios smoking previous abruption ```
47
3 types of placental abruption
revealed, concealed and mixed
48
revealed placental abruption
major haemorrhage apparent externally as blood through internal os
49
concealed placental abruption
occurs between the placenta and uterine wall
50
Finding associated with concealed placental abruption
larger fundal height
51
3 presentations of placental abruption
pain, PV bleeding and increased uterine activity
52
What does the management of APH depend on?
amount of bleeding general condition of mother and baby gestation
53
Complications of APH
maternal shock and collapse fetal death maternal DIC, renal failure PPH
54
premature labour
onset of labour before 37 completed weeks (259 days)
55
Weeks cut off for mildly, very and extremely preterm
32-36 28-32 24-28
56
Incidence of preterm labour
5-7% singletons, 30-40% multiple pregnancy
57
Predisposing factors of preterm labour
``` multiple pregnancy polyhydramnios APH pre-eclampsia infection - UTI ```
58
Diagnosis of preterm labour
contractions with evidence of cervical changes on VE
59
Managing preterm labour
consider tocolysis - time to transfer and give steroids | aim for vaginal birth
60
Neonatal morbidity resulting from prematurity
``` hearing loss and visual problems infections jaundice ARDS intraventricular haemorrhage cerebral palsy temperature control nutrition ```

Year 3 Repro (JK) (33 decks)

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