Complications in Pregnancy Flashcards by Sophie Pitcairn

What is a miscarriage?

Spontaneous loss of pregnancy before 24 weeks gestation

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What is abortion?

Voluntary termination

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What are spontaneous miscarriage classified into?

Threatened, inevitable, incomplete, complete, septic and missed

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Describe a threatened miscarriage

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

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Describe an inevitable miscarriage

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

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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

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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

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Describe a complete miscarriage

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

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What miscarriage can cause septic miscarriage?

Incomplete miscarriage

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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

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What is the management for threatened miscarriage?

Conservative
Most stop bleeding and are okay

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What is the management for inevitable miscarriage?

If bleeding heavy may need evacuation

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What is the management of missed miscarriage?

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

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What is the management of septic miscarriage?

Antibiotics and evacuate uterus

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What is an ectopic pregnancy?

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

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What are the risk factors for ectopic pregnancy?

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

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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