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Repro > Complications in Pregnancy 1 > Flashcards

Complications in Pregnancy 1 Flashcards

1
Q

How is miscarriage defined?

A

Spontaneous loss of pregnancy before 24 weeks gestation

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2
Q

What is a threatened miscarriage? What are some features of a threatened miscarriage?

A

Bleeding from the uterus before 24 weeks gestation when there is a viable fetus and no evidence of cervical dilatation

  • Vaginal bleeding +/- pain
  • Viable pregnancy
  • Closed cervix on speculum exam
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3
Q

What is an inevitable miscarriage? What are some features of an inevitable miscarriage?

A

Miscarriage once the cervix has begun to dilate

  • Viable pregnancy
  • Open cervix with bleeding that may be heavy (+/- clots)
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4
Q

What is an incomplete miscarriage? Complete?

A

Incomplete - only partial expulsion of the products of conception.

Complete - complete expulsion of the products of conception

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5
Q

What is a septic miscarriage?

A

After an incomplete abortion an ascending infection invades the uterus and may spread to the pelvis

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6
Q

What is a missed miscarriage? What are some features of a missed miscarriage?

A

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

  • No symptoms, or could have bleeding / brown expulsion vaginally
  • Gestational sac seen on scan
  • No clear fetus / fetal pole with no heartbeat on scan
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7
Q

What are some features of an incomplete miscarriage?

A
  • Open cervix
  • Vaginal bleeding that may be heavy
  • Expulsion of some of the products of conception
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8
Q

What are some features of a complete miscarriage?

A
  • Cervix closed and bleeding stopped
  • Complete expulsion of the products of conception
  • Should have previously had a scan that confirmed intrauterine pregnancy
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9
Q

What are some of the possible causes of spontaneous miscarriage?

A

Fetal abnormality - chromosomes / genetics

Uterine abnormality

Cervical weakness - cervix opens with minimal uterine activity and pregnancy is expelled

Hormonal abnormalities - corpus luteum dysfunction

Maternal disease

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10
Q

How is a threatened miscarriage managed?

A

Conservative, just wait for bleeding to stop

Most stop bleeding and require no further intervention

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11
Q

How is an inevitable miscarriage managed?

A

If bleeding is heavy may require surgical evacuation

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12
Q

How is a Missed miscarriage managed?

A

Either:
- Conservative

  • Prostaglandins (initiate labour)
  • Surgical: SMM, surgical management of miscarriage
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13
Q

Where do ectopic pregnancies tend to occur?

A

Ampullary - most common
Isthmus - second most common

Interstitial - 2-5%
Ovary - 0.5 - 1%
Cervical - 0.1%
Fimbrial - very rare

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14
Q

How common are ectopic pregnancies? What are some risk factors?

A

Incidence - 1:90 pregnancies

  • pelvic inflammatory disease
  • Previous tubal surgery
  • Previous ectopic
  • Assisted conception
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15
Q

How does an ectopic pregnancy tend to present?

A
  • Period of amenorhoea (with positive urine preg test)

+/- vaginal bleeding
+/- abdominal pain
+/- GI or urinary symptoms

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16
Q

Investigations for ectopic pregnancy?

A

USS - no intrauterine gestational sac, fluid in pouch of Douglas, possible adnexal mass

serum BHCG levels - increase slower than intrauterine pregnancy

17
Q

Management of ectopic pregnancy?

A

Methotrexate - blocks folate metabolism which stops pregnancy advancing

Surgery - laparoscopic salpingectomy / salpingotomy

Conservative

18
Q

What is an antepartum haemorrhage?

A

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

19
Q

What are some of the possible causes of antepartum haemorrhage?

A
  • Placenta praevia
  • Placental abruption
  • Uknown origin
  • Local lesions of the genital tract (eg. vaginal tear)
  • Vasa praevia
20
Q

What is placenta praevia? What are some risk factors?

A

all or part of the placenta presents in the lower uterus

  • Being multiparous
  • Multiple pregnancies
  • Previous caesarean section
21
Q

What is haemorrhage due to placenta praevia caused by? How does it present?

A

Caused by the detachment of the placenta from the uterine wall as it presents near the cervix

  • Soft, non-tender uterus
    +/- fetal malpresentation
22
Q

Diagnosis and management of placenta praevia?

A

Ultrasound scan
DO NOT do vaginal examination on suspected placenta praevia

management:

  • Blood transfusion + conservative management
  • Delivery by caesarean after conservative extension of gestation period
23
Q

What is a common complication associated with placenta praevia?

A

Post partum haemorrhage

24
Q

What is a placental abruption? Risk factors?

A

premature separation of the placenta before birth of the baby

  • Pre-eclampsia / chronic hypertension
  • Multiple pregnancy
  • Polyhydramnios
  • Smoking, old age, parity, cocaine
  • Previous abruption
25
Q

What are the types of placental abruption?

A

Revealed - haemorrhage is apparent externally

Concealed - bleeding confined to haematoma between placenta and uterine wall

Mixed - mixture of both

26
Q

How does a placental abruption tend to present?

A

Pain

vaginal bleeding (amount depends on type of abruption)

Increased uterine activity

27
Q

Management of placental abruption?

A

Depends on:
- amount of bleeding, condition of mother and baby, gestation

Options:

  • Vaginal delivery
  • |Immediate Caesarean
28
Q

What are some common complications of placental abruption?

A

Maternal shock / collapse

Fetal distress progressing to death

Maternal DIC / renal failure

Postpartum haemorrhage

Couvelaire uterus - bleeding penetrates the myometrium and then the peritoneal cavity

29
Q

What is preterm labour? How are preterm babies classified according to gestation period?

A

Onset of labour before 37 weeks gestation

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

30
Q

What are some predisposing factors for preterm labour?

A 
Multiple pregnancy (occurs in 30-40%)
Polyhydramnios
Antepartum haemorrhage 
pre-eclampsia 
- Infection
- Prelabour premature rupture of membranes
31
Q

Diagnosis of preterm labour?

A

Contractions with evidence of cervical change on vaginal exam

Fetal fibronectin - signals detachment of amniotic sac from uterus

32
Q

Management of preterm delivery?

A

Consider tocolysis to allow steroids / transfer (drugs preventing uterine contractions)

Steroids - increase baby’s lung function

Aim for vaginal delivery

33
Q

How dangerous is preterm delivery?

A

At 26 weeks only 48% survive, 26% of which are disabled

At 24 weeks only 26% survive, 38% of which are disabled

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