Complications in pregnancy (1) Flashcards
Spontaneous miscarriage/abortion
termination/loss of pregnancy before 24 weeks gestation
% of spontaneous miscarriage
15
List the different categories of spontaneous miscarriage
inevitable incomplete complete septic missed threatened
How is an early viable pregnancy determined?
fetal heartbeat on USS
Threatened miscarriage
vaginal bleeding +/- pain
viable pregnancy and cervix is closed
Inevitable miscarriage
viable pregnancy
open cervix with bleeding that could be heavy (+/- clots)
Other name for missed miscarriage
early fetal demise
Symptoms of missed miscarriage
no symptoms or could have bleeding/brown loss vaginally
What is seen on scan in missed miscarriage?
gestational sac - empty or fetal pole with no heartbeat in sac
Incomplete miscarriage
most of pregnancy expelled out but some POC remain
open cervix, PV bleeding
Complete miscarriage
passed all POC, cervix closed and bleeding stopped
What should ideally have been done before confirming a complete miscarriage?
confirmed POC
previous scan to confirm intrauterine pregnancy
What miscarriages are at particular risk of septic miscarriage?
incomplete
5 causes of spontaneous miscarriage and examples
abnormal conceptus eg chromosomal uterine abnormality eg fibroids cervical incompetence eg primary or secondary maternal eg age, diabetes unknown
Managing threatened miscarriage
conservative
Managing inevitable miscarriage
bleeding heavy - evacuation
Managing missed miscarriage
conservative
medical - prostaglandins (misoprostol)
surgical
Managing septic miscarriage
antibiotics and evacuate uterus
Ectopic pregnancy
pregnancy implanted outside uterine cavity
How many pregnancies are ectopic?
1 in 90
4 risk factors for ectopic pregnancy
PID
previous tubal surgery with adhesion
previous ectopic
assisted conception - IVF
4 presentations of ectopic pregnancy
period of amenorrhoea with positive pregnancy test
+/- vaginal bleeding
+/- pain in abdomen
+/- GI or urinary symptoms
3 investigations of ectopic pregnancy
scan
serum beta hCG
serum progesterone levels
Findings in scan for ectopic
no intrauterine gestational sac
may see adnexal mass, fluid in pouch of douglas
serum beta hCG in ectopic pregnancy
serially track over 48 hour intervals
normal pregnancy will increase by 66%
Serum progesterone in ectopic pregnancy
in viable IU pregnancy levels will be high >25ng/ml
Management of ectopic pregnancy
methotrexate
laparascopic salpingectomy/salpingotomy
conservative
Antepartum haemorrhage
haemorrhage from genital tract after 24th week of pregnancy but before delivery of baby
5 causes of APH
- placenta praevia
- placental abruption
- unknown
- vasa praevia
- local lesions of genital tract
What is placenta praevia?
all or part of placenta implants in lower uterine segment
How many pregnancies does placenta praevia occur?
1 in 200
3 scenarios in which placenta praevia is more common
multiparous women
multiple pregnancies
previous caesarean
Grade 1 placenta praevia
placenta enroaching on lower segment but not the internal cervical os
Grade 2 placenta praevia
placenta reaches internal os
Grade 3 placenta praevia
placenta eccentrically covers the os
Grade 4 placenta praevia
central placenta praevia
3 presentations of placenta praevia
painless PV bleeding
malpresentation of fetus
incidental
Clinical features of placenta praevia
maternal condition correlates with PV bleeding
soft, non tender uterus +/- fetus malpresentation
Diagnosis of placenta praevia
USS
What examination should you not perform on women with placenta praevia
vaginal
Managing placenta praevia
c-section, watch for PPH
Medical management of PPH
oxytocin, ergometrine, carboprost, tranexamic acid
Other management of PPH
balloon tamponade
B lynch suture, hysterectomy, ligation of uterine and iliac vessels
Placental abruption
haemorrhage resulting from premature separation of placenta before birth of baby
What % of pregnancies does placental abruption occur?
0.6
Factors associated with placental abruption
multiple pregnancies cocaine increasing age pre-eclampsia, chronic hypertension polyhydramnios smoking previous abruption
3 types of placental abruption
revealed, concealed and mixed
revealed placental abruption
major haemorrhage apparent externally as blood through internal os
concealed placental abruption
occurs between the placenta and uterine wall
Finding associated with concealed placental abruption
larger fundal height
3 presentations of placental abruption
pain, PV bleeding and increased uterine activity
What does the management of APH depend on?
amount of bleeding
general condition of mother and baby
gestation
Complications of APH
maternal shock and collapse
fetal death
maternal DIC, renal failure
PPH
premature labour
onset of labour before 37 completed weeks (259 days)
Weeks cut off for mildly, very and extremely preterm
32-36
28-32
24-28
Incidence of preterm labour
5-7% singletons, 30-40% multiple pregnancy
Predisposing factors of preterm labour
multiple pregnancy polyhydramnios APH pre-eclampsia infection - UTI
Diagnosis of preterm labour
contractions with evidence of cervical changes on VE
Managing preterm labour
consider tocolysis - time to transfer and give steroids
aim for vaginal birth
Neonatal morbidity resulting from prematurity
hearing loss and visual problems infections jaundice ARDS intraventricular haemorrhage cerebral palsy temperature control nutrition
