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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
Q

serum beta hCG in ectopic pregnancy

A

serially track over 48 hour intervals

normal pregnancy will increase by 66%

26
Q

Serum progesterone in ectopic pregnancy

A

in viable IU pregnancy levels will be high >25ng/ml

27
Q

Management of ectopic pregnancy

A

methotrexate
laparascopic salpingectomy/salpingotomy
conservative

28
Q

Antepartum haemorrhage

A

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

29
Q

5 causes of APH

A
  1. placenta praevia
  2. placental abruption
  3. unknown
  4. vasa praevia
  5. local lesions of genital tract
30
Q

What is placenta praevia?

A

all or part of placenta implants in lower uterine segment

31
Q

How many pregnancies does placenta praevia occur?

A

1 in 200

32
Q

3 scenarios in which placenta praevia is more common

A

multiparous women
multiple pregnancies
previous caesarean

33
Q

Grade 1 placenta praevia

A

placenta enroaching on lower segment but not the internal cervical os

34
Q

Grade 2 placenta praevia

A

placenta reaches internal os

35
Q

Grade 3 placenta praevia

A

placenta eccentrically covers the os

36
Q

Grade 4 placenta praevia

A

central placenta praevia

37
Q

3 presentations of placenta praevia

A

painless PV bleeding
malpresentation of fetus
incidental

38
Q

Clinical features of placenta praevia

A

maternal condition correlates with PV bleeding

soft, non tender uterus +/- fetus malpresentation

39
Q

Diagnosis of placenta praevia

A

USS

40
Q

What examination should you not perform on women with placenta praevia

A

vaginal

41
Q

Managing placenta praevia

A

c-section, watch for PPH

42
Q

Medical management of PPH

A

oxytocin, ergometrine, carboprost, tranexamic acid

43
Q

Other management of PPH

A

balloon tamponade

B lynch suture, hysterectomy, ligation of uterine and iliac vessels

44
Q

Placental abruption

A

haemorrhage resulting from premature separation of placenta before birth of baby

45
Q

What % of pregnancies does placental abruption occur?

A

0.6

46
Q

Factors associated with placental abruption

A 
multiple pregnancies 
cocaine
increasing age
pre-eclampsia, chronic hypertension 
polyhydramnios
smoking
previous abruption
47
Q

3 types of placental abruption

A

revealed, concealed and mixed

48
Q

revealed placental abruption

A

major haemorrhage apparent externally as blood through internal os

49
Q

concealed placental abruption

A

occurs between the placenta and uterine wall

50
Q

Finding associated with concealed placental abruption

A

larger fundal height

51
Q

3 presentations of placental abruption

A

pain, PV bleeding and increased uterine activity

52
Q

What does the management of APH depend on?

A

amount of bleeding
general condition of mother and baby
gestation

53
Q

Complications of APH

A

maternal shock and collapse
fetal death
maternal DIC, renal failure
PPH

54
Q

premature labour

A

onset of labour before 37 completed weeks (259 days)

55
Q

Weeks cut off for mildly, very and extremely preterm

A

32-36
28-32
24-28

56
Q

Incidence of preterm labour

A

5-7% singletons, 30-40% multiple pregnancy

57
Q

Predisposing factors of preterm labour

A 
multiple pregnancy 
polyhydramnios 
APH 
pre-eclampsia 
infection - UTI
58
Q

Diagnosis of preterm labour

A

contractions with evidence of cervical changes on VE

59
Q

Managing preterm labour

A

consider tocolysis - time to transfer and give steroids

aim for vaginal birth

60
Q

Neonatal morbidity resulting from prematurity

A 
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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