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Complications in Pregnancy Flashcards

1
Q

Miscarriage?

A

Spontaneous loss of pregnancy before 24weeks gestation?

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2
Q

What is threatened miscarriage?

A

Vaginal bleeding but cervical os is closed and US shows an intrauterine pregnancy

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3
Q

What is inevitable miscarriage?

A

Vaginal bleeding with an open cervical os, wither +/- abdominal pain. Pregnancy loss WILL occur.

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4
Q

What is an incomplete miscarriage?

A

Vaginal bleeding, an open cervical os and products of contraception are seen on examination

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5
Q

What is a complete miscarriage?

A

Products of conception have passed, cervical os is closed and ultrasound shows an empty uterine cavity

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6
Q

What is a missed miscarriage?

A

A nonviable intrauterine pregnancy that hasn’t yet resulted in symptoms or passage of products of conception

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7
Q

What is recurrent miscarriage?

A

3 or more miscarriages

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8
Q

What is septic miscarriage?

A

Miscarriage and infection (often associated with incomplete)

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9
Q

What causes miscarriages?

A
  • Abnormal conceptus (chromosomal, genetic, structural)
  • Uterine abnormality (fibroids)
  • Cervical weakness
  • Maternal (increasing age, diabetes)
  • Unknown
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10
Q

Treatment for threatened miscarriage?

A

Conservative (just wait), most stop bleeding and are okay

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11
Q

Treatment for inevitable miscarriage?

A

If heavy bleeding may need evacuation

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12
Q

Treatment for missed miscarriage?

A
  • Conservative
  • Prostaglandins
  • Surgical management
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13
Q

Treatment for septic miscarriage?

A
  • Antibiotics and evacuate uterus
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14
Q

What are the risk factors for an ectopic pregnancy?

A
  • Pelvic inflammatory disease
  • Previous tubal surgery
  • Previous ectopic
  • Assisted conception
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15
Q

Presentation of ectopic pregnancy?

A

Period of ammenorhoea (with +ve pregnancy test)
+/- vaginal bleeding
+/- pain abdomen
+/- GI/urinary symptoms

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16
Q

Investigations for ectopic pregnancy?

A

Scan

Serum BHCG levels

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17
Q

Ectopic pregnancy management?

A

Methotrexate

Surgery

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18
Q

What is antepartum haemorrhage (APH)?

A

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

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19
Q

Causes of APH?

A
  • Placenta praevia
  • Placental abruption
  • APH of unknown origin
  • Local lesions of genital tract
  • Vasa praevia (very rare)
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20
Q

What is placenta praevia?

A

All or part of the placenta implants in the lower uterine segment

21
Q

Who is more likely to get placenta praevia?

A
  • multiparous women
  • multiple pregnancies
  • previous cesarian section
22
Q

How does placenta praevia present?

A
  • Painless PV bleeding

- Malposition of fetus

23
Q

How is placenta praevia diagnosed?

A
  • US scan to locate placenta

- vaginal examination must NOT be done

24
Q

What is the management of placenta praevia?

A
  • Gestation
  • Severity
  • Cesarian section, watch for PPH
25
What is placental abruption?
Haemorrhage resulting from premature separation of the placenta before the birth of the baby
26
Risk factors for placental abruption?
- Pre-eclampsia/chronic hypertension - Multiple pregnancy - Polyhydraminos - Smoking, increasing age, parity - Previous abruption - Cocaine use
27
Types of placental abruption?
- Revealed (see blood) - Concealed (bleeding inside, cant see) - Mixed (concealed and revealed)
28
Presentation of placental abruption?
- Pain - Vaginal bleeding (may be minimal) - Increased uterine activity
29
Complications of placental abruption?
- Maternal shock, collapse - Fetal destress then death - Maternal DIC, renal failure - PPH
30
What is gestational hypertension?
Pregnancy induced hypertension (develops after 20 weeks)
31
What is preeclampsia?
Pregnancy induced hypertension in association with significant proteinuria
32
What causes preeclampsia?
- Secondary invasion of maternal spiral arterioles by trophoblasts impaired (reduced placental perfusion) - Imbalance between vasodilators/vasoconstrictors in pregnancy
33
Risk factors for preeclampsia?
- First pregnancy - Extremes of maternal age - Previous preeclampsia - Pregnancy interval >10yrs - BMI >35 - Multiple pregnancy - Underlying medical disorders
34
Complications to the mother caused by preeclampsia?
- Seizures - Cerebral haemorrhage/stroke - HELLP (haemolysis, elevated liver enzymes, low platelets) - DIC - Renal failure - Pulm oedema, cardiac failure
35
Complications to the fetus caused by preeclampsia?
``` - Impaired placental infusion > IUGR > Fetal distress > Prematurity > Increased PN mortality ```
36
Signs/symptoms of severe preeclampsia?
- Headache, blurring vision, epigastric pain, pain below ribs, vomiting, sudden swelling of hands/face/legs - Clonus/brisk reflexes - Reduced urine output - Convulsions
37
Biochemical abnormalities in preeclampsia?
- Raised liver enzymes (billirubin if HELLP) - Raised urea + creatinine - Raised urate
38
Haematological abnormalities in preeclampsia?
Low platelets Low haemoglobin, signs of haemolysis Features of DIC
39
Investigations in Preeclampsia (blood and fetal)?
``` Blood - FBC, LFT, RFT (urea, creatinine), coagulation studies Fetal - scan for growth - ctg ```
40
Management of preeclampsia?
Only 'cure' is delivery of baby and placenta but cant do this if fetus is not mature enough so: - Close observation - Anti-hypertensives - Steroids for fetal lung maturity if gestation <36weeks
41
Prophylaxsis for preeclampsia in subsequent pregnancy?
Low dose aspirin
42
What is gestational diabetes?
- Carbohydrate intolerance with onset (or first recgonsied in pregnancy) - Abnormal OGTT that reverts to normal after delivery
43
What does gestational diabetes increase the risk of?
- Fetal congenital anomalities - Miscarriage - Fetal macrosomia, polyhydraminos - Operative delivery, shoulder dystocia - Stillbirth, increased perinatal mortality
44
Management of geststional diabetes?
- Better gylycaemic control - Folic acid 5mg - Dietary advice - Renal and retinal checks
45
Risk factors for gestational diabetes?
- Increased BMI - Previous macrosomic baby - Previous GD - Family hx of diabetes - Women from high risk groups of developing diabetes - Polyhydraminos or big baby in current pregnancy - Recurrent glycosuria in current pregnancy
46
How is gestational diabetes investigated?
- If risk factor present, offer HbA1C, if this is abnormal offer a OGTT
47
Prophylaxis for venous thromboembolism in pregnancy?
- TED stockings - Advice increased mobility, hydration - Prophylactic anti-coagulation with 3 or more risk factors (may be indicated even with one risk factor if significant risk)
48
Symptoms of VTE in pregnancy?
- Pain in calf - Increased girth of affected leg - Calf muscle tenderness - Breathlessness - Pain on breathing - Cough - Tachycardia - Hypoxic - Pleural rub
49
Investigations for VTE?
- ECG, blood gases, doppler, V/Q lung scan | - CTPA

Reproduction (20 decks)

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