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Repro > Complications in Pregnancy 1 > Flashcards

Complications in Pregnancy 1 Flashcards

Miscarriage Ectopic Pregnancy Antepartum Haemorrhage Preterm Labour

1
Q

Define Abortion and Spontaneous Miscarriage

A

Termination/loss of pregnancy before 24 weeks gestation with no evidence of life

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2
Q

What is the incidence of spontaneous miscarriage?

A

15%

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3
Q

What are the 6 categories of spontaneous miscarriage?

A
  1. Threatened
  2. Inevitable
  3. Incomplete
  4. Complete
  5. Septic
  6. Missed
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4
Q

What constitutes a ‘threatened’ miscarriage?

A

Bleeding from gravid uterus before 24 weeks gestation +/- pain
Foetus viable
No evidence of cervical dilatation

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5
Q

What constitutes an ‘inevitable’ miscarriage?

A

Cervix has already begun to dilate

Open cervix with bleeding (may be heavy) +/- clots

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6
Q

What constitutes an ‘incomplete’ miscarriage?

A

Only partial expulsion of products of conception
Open cervix
Vaginal bleeding

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7
Q

What constitutes a ‘septic’ miscarriage?

A

Risk of ascending infection into uterus and spread through pelvis

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8
Q

What constitutes a ‘missed’ miscarriage?

A

Fetus has died
No attempt by uterus to expel products

Could have bleeding/brown loss vaginally

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9
Q

Describe findings on ultrasound in missed miscarriage

A

Gestational sac visible

No fetus - empty sac or foetal pole with no foetal heartbeat

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10
Q

What constitutes a ‘complete’ miscarriage?

A

All products expelled
Cervix closed
Bleeding stopped

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11
Q

What investigations are helpful in confirming complete miscarriage?

A

Confirmed products of conception expelled

Witnessed scan of intrauterine pregnancy

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12
Q

What cases of miscarriage are at higher risk of sepsis occuring?

A

Incomplete

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13
Q

8 factors that could lead to Spontaneous miscarriage

A 
Abnormal conceptus
Uterine abnormality
Cervical incompetence
Maternal factors - age, diabetes
Hormonal imbalances
SLE, Thyroid Disease
Acute maternal infection
UNKNOWN - general risk is quite high
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14
Q

3 elements of Abnormal conceptus

A

Chromosomal
Genetic
Structural

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15
Q

Why are causes of structural issues in conceptus difficult to identify?

A

Changes in fetal tissue after death changes chromosomal analysis

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16
Q

Name 2 uterine abnormalities that could contribute to spontaneous miscarriage occurring

A

Congenital - double uterus

Fibroids - distorts uterine cavity (submucus)

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17
Q

How do congenital abnormalities occur in the uterus?

A

Failure of normal fusion of mullerian ducts

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18
Q

At which stage of pregnancy is cervical incompetence prevalent?

A

2nd trimester

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19
Q

3 ways in which cervical incompetence may occur

A

Premature opening of cervix without uterine activity - pregnancy expelled
Primary or secondary weakness (disease, surgery, smears)
Trauma - dilatation, biopsy

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20
Q

Which hormone is found to be at lower levels in women who experience threatened miscarriages and inevitable abortions compared to those who continue with healthy pregnancy?

A

Progesterone

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21
Q

What is essential during the first 8 weeks of pregnancy and if removed will induce abortion within 7 days?

A

Corpus luteum

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22
Q

Why is corpus luteum essential in early pregnancy?

A

Pumps out progesterone - thickens uterine lining, decidualization and maintenance of endometrium keeps pregnancy viable

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23
Q

Name examples of maternal infection that can lead to loss of pregnancy

A

Appendicitis

Pyelitis

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24
Q

How can acute infection lead to the loss of a pregnancy?

A

Mother will experience general toxic illness, high temperature
This can stimulate uterine activity and loss

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25
Q

How is a threatened miscarriage managed?

A

Conservatively

Bleeding will settle

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26
Q

How is an inevitable miscarriage managed?

A

Evacuation if heavy bleeding

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27
Q

How is a missed miscarriage managed?

A

Conservative management

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28
Q

Describe medical and surgical management in miscarriage

A

Medical - prostaglandins

Surgical - Surgical Management of Miscarriage (SMM) - Short GA, dilate cervix, evacuate uterus

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29
Q

How is a septic miscarriage managed?

A

Antibiotics
Evacuation of uterus
Prevent spread to tubes

30
Q

Define an ectopic pregnancy

A

Implantation outwith the uterine cavity

31
Q

Most common site of ectopic pregnancy

A

Ampullary
Second- isthmus
Tubal 95-97%

32
Q

Rate of ectopic pregnancies

A

1 in 90

33
Q

Risk factors for ectopic pregnancy

A

Pelvic inflammatory disease
Previous ectopic
Previous tubal surgery - sterilisation; ask for reverse
Assisted conception -IVF

34
Q

Why might IVF treatment increase the risk of ectopic pregnancy?

A

How the embryo is implanted

Underlying fertility issues that are present in IVF patients

35
Q

Presentation of Ectopic Pregnancy

A

Period of amenorrhea with positive urine pregnancy test

Vaginal bleeding
Pain in abdomen
GI or urinary symptoms

36
Q

What GI or urinary symptoms may present in ectopic pregnancy?

A

Increased micturition

Increased bowel movement

37
Q

Investigations for ectopic pregnancy

A

Ultrasound Scan - no gestational sac, adnexal mass, fluid in pouch of douglas
Serum bHCG
Serum progesterone - should be high, over 25 ng/ml

38
Q

Management of ectopic pregnancy

A

Medical - Methotrexate - shrink tissue
Surgical - Laprascopical salpingectomy, salpingotomy (tube spared)
Conservative - if asymptomatic

39
Q

Define Antepartum Haemorrhage

A

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

40
Q

5 Causes of Antepartum Haemorrhage

A 
Placenta Praevia
Placental abruption
APH of unknown origin
Local lesions of genital tract
Vasa praevia - rare
41
Q

Examples of local lesions in genital tract

A

Cervical erosions or polyps
Cervical cancers
Trichomonas or thrush - bleeding, blood-stained discharge

42
Q

Vasa praevia is the rupture of which vessels?

A

Rupture of foetal vessels in membranes

Blood loss is foetal, not maternal blood loss

43
Q

Where in the uterus does all or part of the placenta implant to cause placenta praevia?

A

Lower uterine segment

44
Q

What 3 factors can increase likelihood of placenta praevia?

A

Multiparous women
Multiple pregnancies
Previous Caesarean Section

45
Q

Describe Grades I to IV in the classification of Placenta Praevia

A

Grade I - Placenta encroaching on lower segment not the internal cervical os
Grade II - Placenta reaches internal os
Grade III- Placenta eccentrically covers internal os
Grade IV - Central placenta praevia

46
Q

Presentation of placenta praevia

A

Painless bleeding per vaginam
Malpresentation of foetus - oblique/transverse
Incidental

47
Q

Why does bleeding occur with placenta praevia?

A

Placenta separates as lower segment is formed and cervix effaces
Blood loss from venous sinuses in lower segment

48
Q

Clinical features of placenta praevia

A

Maternal condition will correlate with amount of PV bleeding (unlike abruption)
Soft, non-tender uterus
Fetal malpresentation

49
Q

Diagnosis of Placenta Praevia

A

Ultrasound

50
Q

Which type of placenta praevia is harder to identify on ultrasound?

A

Posterior

51
Q

What organ is a landmark for the anterior part of the lower uterine segment?

A

Bladder

52
Q

Management of placenta praevia

A

Confirm diagnosis by US
Cross match blood and transfuse if necessary
Conservative approach to prolong pregnancy to foetal maturity
Caesarean - risk of Post Partum Haemorrhage
Medical
Balloon Tamponade
Surgical

53
Q

Describe medical management of placenta praevia

A

Oxytocin
Ergometrin
Carbaprost
Tranexamic acid

54
Q

Describe surgical management of placenta praevia

A

B lynch suture
Ligation of uterine and iliac vessels
Hysterectomy
Post partum bleed severe, placenta adherent

55
Q

What is placental abruption?

A

Haemorrhage due to premature separation of placenta before birth of baby

Associated with large retroplacental clot

56
Q

What is associated with placental abruption?

A

Large retroplacental clot

57
Q

What factors may predispose a mother to placental abruption?

A 
Pre-eclampsia/Chronic hypertension
Multiple pregnancies
Polyhydramnios
Smoking
Increasing age
Parity
Previous abruption
Cocaine use
58
Q

Three Clinical Types of Placental Abruption

A

Revealed - apparent, bood through cervical os
Concealed- haemorrhage between placental and uterine wall
Mixed

59
Q

2 Clinical signs of a concealed placental abruption

A

Increased pain - tender/irritable on examination

Fundal height greater than consistent for gestation

60
Q

Signs and symptoms of placental abruption

A

Severe abdominal pain and APH
Longitudinal lie with presenting part fixed in pelvis
Uterine tone increased - may be contracting

61
Q

Management of Placental Abruption

A

Expectant Treatment
Vaginal delivery
Immediate Caesarean Section

62
Q

What determines the management of placental abruption

A

Amount of bleeding
Condition of mother and baby
Gestation

63
Q

Complications of placental abruption

A 
Maternal shock
Fetal death
Maternal DIC - will bleed when line inserted
Renal failure
PPH
Couvelaire Uterus
64
Q

What is Couvelaire uterus?

A

Uterus appears bruised

Blood penetrates the uterine wall and seeps into myometrium

65
Q

Define preterm labour

A

Onset of labour prior to 37 weeks gestation

32-36 mildly preterm
28-32 very preterm
24-28 extremely preterm

66
Q

Predisposing factors to preterm labour

A 
Multiple pregnancies
Polyhydramnios
APH
Pre-eclampsia
Infection eg UTI
Pre-labour premature rupture of membranes
67
Q

Diagnosis of Preterm labour

A

Contractions

Evidence of cervical change on vaginal exam

68
Q

Vaginal exam must not be carried out in which condition?

A

Suspected placenta praevia

69
Q

Management of preterm labour

A

Tocolysis - slows contractions to allow steroid admin/transfer of mother
Steroids
Transfer to NICU
Aim for vaginal delivery

70
Q

In which cases are steroids contraindicated in management of preterm labour?

A

Fetal immaturity

If help needed with breathing
2 doses maximum

71
Q

Examples of neonatal morbidity resulting from prematurity

A 
Respiratory Distress Syndrome
Intraventricular Haemorrhage
Cerebral palsy
Nutrition
Temperature control
Jaundice
Infections
Visual impairments
Hearing loss

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