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Reproductive system > Complications in pregnancy > Flashcards

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
Q

What are classifications of placenta praevia?

A

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

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26
Q

How does placenta praevia present?

A

Painless PV bleeding
Malpresentation of the fetus
Incidental

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27
Q

How is placenta praevia diagnosed?

A

Ultrasound scan to locate the placental site

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28
Q

How is placenta praevia managed?

A

Cesearean section

29
Q

What are factors associated with placental abruption?

A 
Pre-eclampsia/chronic hypertension
Multiple pregnancy
Polyhydraminos
Smoking
Increasing age
Parity
Previous abruption
Cocaine use
30
Q

How does placental abruption present?

A

Pain
Vaginal bleeding
Increased uterine activity

31
Q

What are complications of placental abruption?

A

Maternal shock
Fetal death
Maternal renal failure
Postpartum haemorrhage

32
Q

What is preterm labour?

A

Onset of labour befroe 37 weeks gestation or 259 days

33
Q

How is preterm labour graded?

A

Mildly preterm - 32-36 weeks
Very preterm - 28-32 weeks
Extremely preterm - 24-28 weeks

34
Q

What are predisposing factors for preterm labour?

A 
Multiple pregnancy
Polyhydramnios
APH
Pre-eclampsia
Infection
Prelabour premature rupture of membranes
35
Q

What is gestational hypertension?

A

Hypertension that develops after 20 weeks of gestation

36
Q

What is pre-eclampsia?

A

Hypertension after week 20 associated with significant proteinuria

37
Q

How is significant proteinuria defined for pre-eclampsia?

A

Urine dipstick >1+
Spot urinary Protein:creatinine ratio >30mg/mmol
24 hours urine protein collection >300mg/day

38
Q

What actions should be taken in pregnancies with maternal hypertension?

A

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
Q

How is pre-eclampsia diagnostically defined?

A

Mild hypertension on two occassions more than 4 hours apart or moderate to severe hypertension
AND
Proteinuria of >300mgs/24 hours

40
Q

What is pathophisiology of pre-eclampsia?

A

Immunological
Genetic predisposition - secondary invasion of maternal spiral arterioles by trophoblasts impaired, imbalance between vasodilators/vasoconstrictors in pregnancy

41
Q

What are risk factors for developing pre-eclampsia?

A

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
Q

What organs are affected by pre-eclampsia?

A 
Kidneys
Liver
Vasculation
Brain
Lungs
43
Q

What are maternal complications of pre-eclampsia?

A

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
Q

What are fetal complications of pre-eclampsia?

A

Impaired placental perfusion leading to Intrauterine Growth Restriction, fetal distress, prematurity, increased perinatal mortality

45
Q

What are signs and symptoms of severe pre-eclampsia?

A 
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
Q

What are biochemical abnormalities of severe pre-eclampsia?

A

Raised liver enzymes/bilirubin

Raised urea and creatinine, raised urate

47
Q

What are haematological abnormalities of severe pre-eclampsia?

A

Low platelets
Low haemoglobin
Features of disseminated intravascular coagulation

48
Q

How shoud pre-eclampsia be managed?

A 
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
Q

What is the only ‘cure’ for pre-eclampsia?

A

Delivery of the baby and placenta

50
Q

How should eclamptic seizures be managed?

A

Magnesium sulphate bolus
Control of blood pressure
Avoid fluid overload

51
Q

What is gestational diabetes?

A

Diabetes first presenting in pregnancy which returns to normal after delivery

52
Q

Is someone who develops gestational diabetes at increased risk of developing type 2 diabetes in later life?

A

Yes

53
Q

What causes insulin requirements of the mother to increase?

A

Human placental lactogen, progesterone, human chorionic gonadotrophin, and cortisol from placenta are all anti-insulin

54
Q

What is fetal macrosomia?

A

Abnormally large baby weighing over 4000 grams at any gestation

55
Q

What are potential complications of diabetes in pregnancy?

A 
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
Q

What is polyhydramnios?

A

Excess of amniotic fluid in the amniotic sac

57
Q

How is diabetes managed before pregnancy

A

Better glycemic control
Folic acid 5mg
Dietary advice
Retinal and renal assessment

58
Q

How is gestational diabetes managed?

A

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
Q

How should diabetes be managed during labour?

A

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
Q

What are risk factors for gestational diabetes?

A

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
Q

How is gestational diabetes screened?

A

Offer HbA1C if risk factor present, if >43mmol/mol OGTT to be done, if normal repeat at 24-28 weeks

62
Q

What is Virchow’s triad of venous thromboembolism?

A

Stasis
Vessel wall injury
Hypercoagulability

63
Q

Why is risk of thromboembolism increased in pregnancy?

A

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
Q

What are risk factors for VTE in pregnancy?

A 
Older mothers, increasing parity
Increased BMI
Smokers
IVDU
Pre-eclampsic
Dehydration
Decreased mobility
Infection
Operative delivery
Haemorrhage
Previous VTE
Sickle cell disease
65
Q

How is VTE managed in pregnancy?

A

TED stockings

Advise increased mobility, hydration

66
Q

What are signs/symptoms of VTE?

A 
Pain in calf
Increased girth of affected leg
Calf muscle tenderness
Breathlessness
Pain on breathing
Cough
Tachycardia
Hypoxic 
Pleural rub
67
Q

What investigations can be done if VTE is suspected?

A

ECG
Blood gases
Doppler
Ventilation perfusion (V/Q)

68
Q

How is preterm labour diagnosed?

A

Contractions with evidence of cervical change on vaginal examination

69
Q

What neonatal morbidity results from prematurity?

A 
Respiratory distress syndrome
Intraventricular haemorrhage
Cerebral palsy
Nutrition
Temperature control
Jaundice
Infections
Visual impairment
Hearing loss

Reproductive system (26 decks)

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