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Reproductive System > Complications in Pregnancy > Flashcards

Complications in Pregnancy Flashcards

1
Q

What is a miscarriage?

A

Spontaneous loss of pregnancy before 24 weeks gestation

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2
Q

What is abortion?

A

Voluntary termination

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3
Q

What are spontaneous miscarriage classified into?

A

Threatened, inevitable, incomplete, complete, septic and missed

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4
Q

Describe a threatened miscarriage

A

Vaginal bleeding with possible pain
Viable pregnancy
Closed cervix on speculum examination

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5
Q

Describe an inevitable miscarriage

A

Viable pregnancy seen in uterus
Open cervix with bleeding that could be heavy and have clots

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6
Q

When is a missed miscarriage diagnosed?

A

No symptoms or could have bleeding/ brown loss vaginally
Gestational sac seen on screen
No clear foetus or foetal pole with no foetal heart seen

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7
Q

Describe an incomplete miscarriage

A

Most of pregnancy expelled out and some product of pregnancy remain in uterus
Open cervix and vaginal bleeding which may be heavy

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8
Q

Describe a complete miscarriage

A

Passed all products of conception, cervix closed and bleeding has stopped (ideally confirm POC or should have had scan previously)

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9
Q

What miscarriage can cause septic miscarriage?

A

Incomplete miscarriage

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10
Q

What is the aetiology of spontaneous miscarriage?

A

Abnormal foetal development - chromosome, genetic and structural
Uterine abnormality - congenital and fibroids
Cervical weakness
Maternal - increasing age and diabetes
Unknown

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11
Q

What is the management for threatened miscarriage?

A

Conservative
Most stop bleeding and are okay

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12
Q

What is the management for inevitable miscarriage?

A

If bleeding heavy may need evacuation

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13
Q

What is the management of missed miscarriage?

A

Conservative
Medical - prostaglandins (misoprostol)
Surgical - SMM (surgical management of miscarriage)

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14
Q

What is the management of septic miscarriage?

A

Antibiotics and evacuate uterus

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15
Q

What is an ectopic pregnancy?

A

Pregnancy implanted outside the uterine cavity
Mainly in ampulla of fallopian tubes

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16
Q

What are the risk factors for ectopic pregnancy?

A

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

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17
Q

What is the presentation of ectopic pregnancy?

A

Period of amenorrhoea with positive urine pregnancy test
Possible vaginal bleeding, pain in abdomen and GI/ urinary symptoms

18
Q

What are the investigations used for ectopic pregnancy?

A

Scan - no intrauterine gestational sac, may see adnexal mass and fluid in pouch of Douglas
Serum BHCG - tracked over 48hr intervals - if normal early intrauterine pregnancy then HCG levels will increase

19
Q

What is the management for ectopic pregnancy?

A

Methotrexate
Surgical - mostly laparoscopy - salpingectomy and salpingotomy
Conservative

20
Q

What is antepartum haemorrhage (APH)?

A

Haemorrhage from genital tract after the 24th weeks of pregnancy but before delivery of baby
Medical emergency

21
Q

What are the causes of antepartum haemorrhage?

A

Placenta praevia
Placental abruption
Unknown
Local lesion in genital tract
Vasa praevia (very rare)

22
Q

Describe placenta praevia

A

All or part of the placenta implants in lower uterine segment
1 in 200 pregnancies

23
Q

Who is placenta praevia common in?

A

Multiparous women
Multiple pregnancies
Previous caesarean scan

24
Q

Describe the RCOG classification

A

Low lying - placenta is less than 20mm from internal os
Placenta praevia - covering the os

25
Q

What is the presentation of placenta praevia?

A

Painless PV bleeding
Malpresentation of foetus
Incidental

26
Q

What investigation is used for placenta praevia?

A

US
Vaginal examination must not be done with suspected placenta praevia

27
Q

What is the management for placenta praevia?

A

Blood transfusion depends on maternal condition
Mother stays in hospital
Conservative to prolong pregnancy then caesarean
Watch for PPH

28
Q

What is post partum haemorrhage (PPH)?

A

Any bleeding after delivery which is more than 500mls

29
Q

What is the medical management for PPH?

A

Oxytocin, ergometrine, carboprost and tranexamic acid
Balloon tamponade
Surgical - B lynch cutre, ligation of uterine, iliac vessels and hysterectomy

30
Q

What is placental abruption?

A

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

31
Q

What are the factors associated with placental abruption?

A

Pre-eclampsia/ chronic hypertension, multiple pregnancy, polyhydramnios, smoking, increased age, parity, previous abruption and cocaine use

32
Q

What are the 3 types of placental abruption?

A

Revealed - see the blood
Concealed - bleeding but inside cant see
Mixed

33
Q

What is the presentation for placental abruption?

A

Pain
Vaginal bleeding - may be minimal
Increased uterine activity - uterine tone increased and patient may have contractions

34
Q

What is the management of APH?

A

Ranges from attempting vaginal delivery to immediate CS depends on - amount of bleeding, condition of mother and baby and gestation

35
Q

What are the complications of placental abruption?

A

Maternal shock and collapse
Foetal distress then death
Maternal DIC and renal failure
Postpartum haemorrhage - couvelaire uterus

36
Q

How is preterm labour defined?

A

Onset of labour before 37 weeks gestation
32-36 weeks is mild
28-32 is very preterm
24-38 is extremely

37
Q

What is preterm labour characterised into?

A

Spontaneous or induced (iatrogenic)

38
Q

What are the predisposing factors of preterm labour?

A

Multiple pregnancy, polyhydramnios, APH, pre-eclampsia, infection (UTI) and prelabour premature rupture of membranes
Also unknown

39
Q

How is preterm delivery diagnosed?

A

Contraction with evidence of cervical change on VE
Test - foetal fibronectin
Consider the possible cause

40
Q

When is poor prognosis for preterm delivery?

A

Under 24 to 26 weeks
Decisions made with parents and neonatologists

41
Q

What is done for preterm delivery for all cases?

A

Consider tocolysis to allow steroid/ transfer
Steroid unless contraindications
Transfer to unit with NICU
Aim for vaginal delivery

42
Q

What are neonatal morbidity resulting from prematurity?

A

Respiratory distress syndrome, intraventricular haemorrhage, cerebral palsy, nutrition, tempreture control, jaundice, infections, visual impairment and hearing loss

Reproductive System (18 decks)

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