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Complications in pregnancy Flashcards

1
Q

What is spontaneous miscarriage?

A

Loss of pregnancy before 24 weeks gestation

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2
Q

What are categories of spontaneous miscarriage?

A 
Threatened
Inevitable
Incomplete
Complete
Septic
Missed
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3
Q

What is a threatened miscarriage?

A

Bleeding from the gravid uterus before 24 weeks gestation when there is a viable fetus and no evidence of cervical dilatation

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4
Q

What is missed abortion?

A

A pregnancy in which the fetus has died but the uterus has made no attempt to expel the products of the pregnancy

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5
Q

What are clinical features of threatened miscarriage?

A

Vaginal bleeding +/- pain
Viable pregnancy
Closed cervix on speculum examination

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6
Q

What are clinical features of inevitable miscarriage?

A

Viable pregnancy with open cervix with bleeding

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7
Q

What are clinical features of missed miscarriage?

A

Bleeding or no symptoms
Gestational sac seen on scan
No clear fetus

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8
Q

What are clinical features of incomplete miscarriage?

A

Most of the pregnancy has been expelled out with some products of pregnancy remaining in the uterus
Open cervix with vaginal bleeding

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9
Q

What is septic miscarriage?

A

Infection in the uterus as a result of miscarriage

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10
Q

What is the aetiology of spontaneous miscarriage?

A

Abnormal conceptus
Uterine abnormality
Cervical incompetence
Maternal illness

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11
Q

How is threatened miscarriage managed?

A

Conservative management

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12
Q

How is inevitable miscarriage managed?

A

If bleeding is heavy may require evacuation

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13
Q

How is septic miscarriage managed?

A

Antibiotics and evacuation of uterus

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14
Q

What is an ectopic pregnancy?

A

Implantation outside of the uterine cavity

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15
Q

What are risk factors of ectopic pregnancy?

A

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

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16
Q

How does ectopic pregnancy present?

A

Period of ammenorrhoea

May have vaginal bleeding, abominal pain, or GI/urinary symptoms

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17
Q

What investigations are done if ectopic pregnancy is suspected?

A

Scan - no intrauterine gestational sac
Serum Beta human chorionic hormone - normal intrauterine pregnancy will see raised levels
Serum progesterone - viable pregnancy levels will be >25ng/ml

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18
Q

How is ectopic pregnancy managed?

A

Methotrexate

Laparoscopic salpingectomy or salpingotomy

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19
Q

Why is methotrexate given in ectopic pregnancy?

A

It prevents further growth of the fetus

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20
Q

What is antepartum haemorrhage?

A

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

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21
Q

What are causes of antepartum haemorrhage?

A 
Placenta praevia
Placental abruption
APH of unknown origin
Local lesions of the genital tract
Vasa praevia
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22
Q

What is placenta praevia?

A

Where the placenta is attached to the lower segment of the uterus

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23
Q

What is Placental abruption?

A

Placenta detaches from the uterine wall before the birth of the baby

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24
Q

Who is more at risk of placenta praevia?

A

Multiparous women
Multiple pregnancies
Previous caesarean

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25
What are classifications of placenta praevia?
Grade I - placenta encroaching on the lower segment but not the internal os Grade II - Placenta reaches the internal os Grade III - Placenta partially covers the os Grade IV - Central placenta praevia
26
How does placenta praevia present?
Painless PV bleeding Malpresentation of the fetus Incidental
27
How is placenta praevia diagnosed?
Ultrasound scan to locate the placental site
28
How is placenta praevia managed?
Cesearean section
29
What are factors associated with placental abruption?
``` Pre-eclampsia/chronic hypertension Multiple pregnancy Polyhydraminos Smoking Increasing age Parity Previous abruption Cocaine use ```
30
How does placental abruption present?
Pain Vaginal bleeding Increased uterine activity
31
What are complications of placental abruption?
Maternal shock Fetal death Maternal renal failure Postpartum haemorrhage
32
What is preterm labour?
Onset of labour befroe 37 weeks gestation or 259 days
33
How is preterm labour graded?
Mildly preterm - 32-36 weeks Very preterm - 28-32 weeks Extremely preterm - 24-28 weeks
34
What are predisposing factors for preterm labour?
``` Multiple pregnancy Polyhydramnios APH Pre-eclampsia Infection Prelabour premature rupture of membranes ```
35
What is gestational hypertension?
Hypertension that develops after 20 weeks of gestation
36
What is pre-eclampsia?
Hypertension after week 20 associated with significant proteinuria
37
How is significant proteinuria defined for pre-eclampsia?
Urine dipstick >1+ Spot urinary Protein:creatinine ratio >30mg/mmol 24 hours urine protein collection >300mg/day
38
What actions should be taken in pregnancies with maternal hypertension?
Change anti-hypertensive drugs if indicated ie teratogenic/fetotoxic drugs such as ACEinhibitors Aim to keep BP <150/100 Monitor for superimposed pre-eclampsia Monitor fetal growth May have a higher incidence of placental abruption so be aware
39
How is pre-eclampsia diagnostically defined?
Mild hypertension on two occassions more than 4 hours apart or moderate to severe hypertension AND Proteinuria of >300mgs/24 hours
40
What is pathophisiology of pre-eclampsia?
Immunological Genetic predisposition - secondary invasion of maternal spiral arterioles by trophoblasts impaired, imbalance between vasodilators/vasoconstrictors in pregnancy
41
What are risk factors for developing pre-eclampsia?
First pregnancy Extremes of maternal age Pre-eclampsia in previous pregnancyPregnancy interval >10 years BMI>35 Family history Underlying disorders - hypertension, diabetes, renal disease, autoimmune disorders
42
What organs are affected by pre-eclampsia?
``` Kidneys Liver Vasculation Brain Lungs ```
43
What are maternal complications of pre-eclampsia?
Eclampsia - seizures Severe hypertension leading to cerebral haemorrhage or stroke HELLP - Hemolysis, Elevated Liver enzymes, Low Platelets Disseminated intravascular coagulation Renal failure Pulmonary oedema, cardiac failure
44
What are fetal complications of pre-eclampsia?
Impaired placental perfusion leading to Intrauterine Growth Restriction, fetal distress, prematurity, increased perinatal mortality
45
What are signs and symptoms of severe pre-eclampsia?
``` Headache, blurred vision, epigastric pain/tenderness, pain below ribs, vomiting, swelling of hands, face, legs Severe hypertension Clonus, brisk reflexes, papillodoema Reduced urine output Convulsions ```
46
What are biochemical abnormalities of severe pre-eclampsia?
Raised liver enzymes/bilirubin | Raised urea and creatinine, raised urate
47
What are haematological abnormalities of severe pre-eclampsia?
Low platelets Low haemoglobin Features of disseminated intravascular coagulation
48
How shoud pre-eclampsia be managed?
``` Frequent blood pressure checks/urine protein Check symptoms Check for hyperreflexia Check for tenderness over the liver Bloods - FBC for hemolysis/platelets Liver function tests Renal function tests Cardiotocography (CTG) ```
49
What is the only 'cure' for pre-eclampsia?
Delivery of the baby and placenta
50
How should eclamptic seizures be managed?
Magnesium sulphate bolus Control of blood pressure Avoid fluid overload
51
What is gestational diabetes?
Diabetes first presenting in pregnancy which returns to normal after delivery
52
Is someone who develops gestational diabetes at increased risk of developing type 2 diabetes in later life?
Yes
53
What causes insulin requirements of the mother to increase?
Human placental lactogen, progesterone, human chorionic gonadotrophin, and cortisol from placenta are all anti-insulin
54
What is fetal macrosomia?
Abnormally large baby weighing over 4000 grams at any gestation
55
What are potential complications of diabetes in pregnancy?
``` Fetal congenital abnormalities Miscarriage Fetal macrosmia Polyhydramnios Shoulder dystocia during delivery Stillbirth Increase risk of pre-eclampsia Worsening maternal nephropathy, retinopathy Infections Impaired neonatal lung maturity, neonatal hypoglycaemia, jaundice ```
56
What is polyhydramnios?
Excess of amniotic fluid in the amniotic sac
57
How is diabetes managed before pregnancy
Better glycemic control Folic acid 5mg Dietary advice Retinal and renal assessment
58
How is gestational diabetes managed?
Optimise glucose control, insulin requirements increase Could continue oral agents such as metformin but may need to change to insulin for tighter control Provide glucagon injections/concentrated glucose solution in case of hypo Watch for ketonuria
59
How should diabetes be managed during labour?
Induce labour 38-40 weeks or earlier if fetal or maternal concerns Consider caesarean if significant fetal macrosomia Maintain blood sugar with insulin Continous CTG Early feeding of baby to reduce neonatal hypoglycaemia
60
What are risk factors for gestational diabetes?
Increased BMI>30 Previous macrosomic baby Previous gestational diabetes Family history of diabetes High risk groups eg Asian origin Polyhydramnios or big baby in current pregnancy Recurrent glycosuria in current pregnancy
61
How is gestational diabetes screened?
Offer HbA1C if risk factor present, if >43mmol/mol OGTT to be done, if normal repeat at 24-28 weeks
62
What is Virchow's triad of venous thromboembolism?
Stasis Vessel wall injury Hypercoagulability
63
Why is risk of thromboembolism increased in pregnancy?
Hypercoagulable state to protect mother against bleeding post delivery - increase in fibrinogen, factor VIII, VW factor, platelets - decrease in natural anticoagulants Increased staiss May be vascular damage at delivery
64
What are risk factors for VTE in pregnancy?
``` Older mothers, increasing parity Increased BMI Smokers IVDU Pre-eclampsic Dehydration Decreased mobility Infection Operative delivery Haemorrhage Previous VTE Sickle cell disease ```
65
How is VTE managed in pregnancy?
TED stockings | Advise increased mobility, hydration
66
What are signs/symptoms of VTE?
``` Pain in calf Increased girth of affected leg Calf muscle tenderness Breathlessness Pain on breathing Cough Tachycardia Hypoxic Pleural rub ```
67
What investigations can be done if VTE is suspected?
ECG Blood gases Doppler Ventilation perfusion (V/Q)
68
How is preterm labour diagnosed?
Contractions with evidence of cervical change on vaginal examination
69
What neonatal morbidity results from prematurity?
``` Respiratory distress syndrome Intraventricular haemorrhage Cerebral palsy Nutrition Temperature control Jaundice Infections Visual impairment Hearing loss ```

Reproductive system (26 decks)

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