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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
Q

What is placental abruption?

A

Haemorrhage resulting from premature separation of the placenta before the birth of the baby

26
Q

Risk factors for placental abruption?

A
  • Pre-eclampsia/chronic hypertension
  • Multiple pregnancy
  • Polyhydraminos
  • Smoking, increasing age, parity
  • Previous abruption
  • Cocaine use
27
Q

Types of placental abruption?

A
  • Revealed (see blood)
  • Concealed (bleeding inside, cant see)
  • Mixed (concealed and revealed)
28
Q

Presentation of placental abruption?

A
  • Pain
  • Vaginal bleeding (may be minimal)
  • Increased uterine activity
29
Q

Complications of placental abruption?

A
  • Maternal shock, collapse
  • Fetal destress then death
  • Maternal DIC, renal failure
  • PPH
30
Q

What is gestational hypertension?

A

Pregnancy induced hypertension (develops after 20 weeks)

31
Q

What is preeclampsia?

A

Pregnancy induced hypertension in association with significant proteinuria

32
Q

What causes preeclampsia?

A
  • Secondary invasion of maternal spiral arterioles by trophoblasts impaired (reduced placental perfusion)
  • Imbalance between vasodilators/vasoconstrictors in pregnancy
33
Q

Risk factors for preeclampsia?

A
  • First pregnancy
  • Extremes of maternal age
  • Previous preeclampsia
  • Pregnancy interval >10yrs
  • BMI >35
  • Multiple pregnancy
  • Underlying medical disorders
34
Q

Complications to the mother caused by preeclampsia?

A
  • Seizures
  • Cerebral haemorrhage/stroke
  • HELLP (haemolysis, elevated liver enzymes, low platelets)
  • DIC
  • Renal failure
  • Pulm oedema, cardiac failure
35
Q

Complications to the fetus caused by preeclampsia?

A 
- Impaired placental infusion 
  > IUGR
  > Fetal distress 
  > Prematurity 
  > Increased PN mortality
36
Q

Signs/symptoms of severe preeclampsia?

A
  • Headache, blurring vision, epigastric pain, pain below ribs, vomiting, sudden swelling of hands/face/legs
  • Clonus/brisk reflexes
  • Reduced urine output
  • Convulsions
37
Q

Biochemical abnormalities in preeclampsia?

A
  • Raised liver enzymes (billirubin if HELLP)
  • Raised urea + creatinine
  • Raised urate
38
Q

Haematological abnormalities in preeclampsia?

A

Low platelets
Low haemoglobin, signs of haemolysis
Features of DIC

39
Q

Investigations in Preeclampsia (blood and fetal)?

A 
Blood 
- FBC, LFT, RFT (urea, creatinine), coagulation studies 
Fetal 
- scan for growth 
- ctg
40
Q

Management of preeclampsia?

A

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
Q

Prophylaxsis for preeclampsia in subsequent pregnancy?

A

Low dose aspirin

42
Q

What is gestational diabetes?

A
  • Carbohydrate intolerance with onset (or first recgonsied in pregnancy)
  • Abnormal OGTT that reverts to normal after delivery
43
Q

What does gestational diabetes increase the risk of?

A
  • Fetal congenital anomalities
  • Miscarriage
  • Fetal macrosomia, polyhydraminos
  • Operative delivery, shoulder dystocia
  • Stillbirth, increased perinatal mortality
44
Q

Management of geststional diabetes?

A
  • Better gylycaemic control
  • Folic acid 5mg
  • Dietary advice
  • Renal and retinal checks
45
Q

Risk factors for gestational diabetes?

A
  • 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
Q

How is gestational diabetes investigated?

A
  • If risk factor present, offer HbA1C, if this is abnormal offer a OGTT
47
Q

Prophylaxis for venous thromboembolism in pregnancy?

A
  • 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
Q

Symptoms of VTE in pregnancy?

A
  • Pain in calf
  • Increased girth of affected leg
  • Calf muscle tenderness
  • Breathlessness
  • Pain on breathing
  • Cough
  • Tachycardia
  • Hypoxic
  • Pleural rub
49
Q

Investigations for VTE?

A
  • ECG, blood gases, doppler, V/Q lung scan

- CTPA

Reproduction (20 decks)

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