Complications in Pregnancy Flashcards
What is a miscarriage?
Spontaneous loss of pregnancy before 24 weeks gestation
What is abortion?
Voluntary termination
What are spontaneous miscarriage classified into?
Threatened, inevitable, incomplete, complete, septic and missed
Describe a threatened miscarriage
Vaginal bleeding with possible pain
Viable pregnancy
Closed cervix on speculum examination
Describe an inevitable miscarriage
Viable pregnancy seen in uterus
Open cervix with bleeding that could be heavy and have clots
When is a missed miscarriage diagnosed?
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
Describe an incomplete miscarriage
Most of pregnancy expelled out and some product of pregnancy remain in uterus
Open cervix and vaginal bleeding which may be heavy
Describe a complete miscarriage
Passed all products of conception, cervix closed and bleeding has stopped (ideally confirm POC or should have had scan previously)
What miscarriage can cause septic miscarriage?
Incomplete miscarriage
What is the aetiology of spontaneous miscarriage?
Abnormal foetal development - chromosome, genetic and structural
Uterine abnormality - congenital and fibroids
Cervical weakness
Maternal - increasing age and diabetes
Unknown
What is the management for threatened miscarriage?
Conservative
Most stop bleeding and are okay
What is the management for inevitable miscarriage?
If bleeding heavy may need evacuation
What is the management of missed miscarriage?
Conservative
Medical - prostaglandins (misoprostol)
Surgical - SMM (surgical management of miscarriage)
What is the management of septic miscarriage?
Antibiotics and evacuate uterus
What is an ectopic pregnancy?
Pregnancy implanted outside the uterine cavity
Mainly in ampulla of fallopian tubes
What are the risk factors for ectopic pregnancy?
Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception
What is the presentation of ectopic pregnancy?
Period of amenorrhoea with positive urine pregnancy test
Possible vaginal bleeding, pain in abdomen and GI/ urinary symptoms
What are the investigations used for ectopic pregnancy?
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
What is the management for ectopic pregnancy?
Methotrexate
Surgical - mostly laparoscopy - salpingectomy and salpingotomy
Conservative
What is antepartum haemorrhage (APH)?
Haemorrhage from genital tract after the 24th weeks of pregnancy but before delivery of baby
Medical emergency
What are the causes of antepartum haemorrhage?
Placenta praevia
Placental abruption
Unknown
Local lesion in genital tract
Vasa praevia (very rare)
Describe placenta praevia
All or part of the placenta implants in lower uterine segment
1 in 200 pregnancies
Who is placenta praevia common in?
Multiparous women
Multiple pregnancies
Previous caesarean scan
Describe the RCOG classification
Low lying - placenta is less than 20mm from internal os
Placenta praevia - covering the os
What is the presentation of placenta praevia?
Painless PV bleeding
Malpresentation of foetus
Incidental
What investigation is used for placenta praevia?
US
Vaginal examination must not be done with suspected placenta praevia
What is the management for placenta praevia?
Blood transfusion depends on maternal condition
Mother stays in hospital
Conservative to prolong pregnancy then caesarean
Watch for PPH
What is post partum haemorrhage (PPH)?
Any bleeding after delivery which is more than 500mls
What is the medical management for PPH?
Oxytocin, ergometrine, carboprost and tranexamic acid
Balloon tamponade
Surgical - B lynch cutre, ligation of uterine, iliac vessels and hysterectomy
What is placental abruption?
Haemorrhage resulting from premature separation of the placenta before the birth of the baby
What are the factors associated with placental abruption?
Pre-eclampsia/ chronic hypertension, multiple pregnancy, polyhydramnios, smoking, increased age, parity, previous abruption and cocaine use
What are the 3 types of placental abruption?
Revealed - see the blood
Concealed - bleeding but inside cant see
Mixed
What is the presentation for placental abruption?
Pain
Vaginal bleeding - may be minimal
Increased uterine activity - uterine tone increased and patient may have contractions
What is the management of APH?
Ranges from attempting vaginal delivery to immediate CS depends on - amount of bleeding, condition of mother and baby and gestation
What are the complications of placental abruption?
Maternal shock and collapse
Foetal distress then death
Maternal DIC and renal failure
Postpartum haemorrhage - couvelaire uterus
How is preterm labour defined?
Onset of labour before 37 weeks gestation
32-36 weeks is mild
28-32 is very preterm
24-38 is extremely
What is preterm labour characterised into?
Spontaneous or induced (iatrogenic)
What are the predisposing factors of preterm labour?
Multiple pregnancy, polyhydramnios, APH, pre-eclampsia, infection (UTI) and prelabour premature rupture of membranes
Also unknown
How is preterm delivery diagnosed?
Contraction with evidence of cervical change on VE
Test - foetal fibronectin
Consider the possible cause
When is poor prognosis for preterm delivery?
Under 24 to 26 weeks
Decisions made with parents and neonatologists
What is done for preterm delivery for all cases?
Consider tocolysis to allow steroid/ transfer
Steroid unless contraindications
Transfer to unit with NICU
Aim for vaginal delivery
What are neonatal morbidity resulting from prematurity?
Respiratory distress syndrome, intraventricular haemorrhage, cerebral palsy, nutrition, tempreture control, jaundice, infections, visual impairment and hearing loss
