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Reproductive > Complications in Pregnancy > Flashcards

Complications in Pregnancy Flashcards

1
Q

What is a threatened miscarriage?

A

Vaginal bleeding +/- pain, viable pregnancy and closed cervix on speculum examination

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2
Q

What is an inevitable miscarriage?

A
  • Viable pregnancy

- Open cervix with bleeding that could be heavy (+/- clots)

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3
Q

What is a missed miscarriage?

A
  • No symptoms (could have bleeding/brown loss vaginally)
  • Gestational sac seen on scan
  • No clear fetus or a fetal pole with no fetal heart seen in the gestational sac
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4
Q

What is an incomplete miscarriage?

A
  • Most of the pregnancy expelled out but some products of pregnancy remaining in the uterus
  • Open cervix with vaginal bleeding (may be heavy)
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5
Q

What is a complete miscarriage?

A
  • Passed all products of conception
  • Cervix is closed and all bleeding has stopped
  • Ideally should have confirmed the POC or had a scan previously that confirmed an intrauterine pregnancy
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6
Q

When is a septic miscarriage more common?

A

In the case of an incomplete miscarriage - infection

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7
Q

What are the causes of spontaneous miscarriage?

A

Abnormal conceptus, uterine abnormality, cervical incompetence, maternal (increasing age, diabetes etc.) and unknown causes

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8
Q

What is the management of miscarriage?

A
  • Threatened: conservative
  • Inevitable: evacuation if bleeding is heavy
  • Missed: conservative, medical (misoprostol) and surgical
  • Septic: antibiotics and evacuate uterus
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9
Q

What are the risk factors for an ectopic pregnancy?

A

Pelvic inflamm. disease, previous tubal surgery, previous ectopic and assisted conception

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10
Q

What is the presentation of ectopic pregnancies?

A

Ammenorhoea (+ positive pregnancy test), vaginal bleeding, abdominal pain and GI/urinary symptoms

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11
Q

What investigations are used to diagnose ectopic pregnancies?

A

USS, serum BhCG and serum progesterone

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12
Q

What are the management options for ectopic pregnancies?

A

Medical (methotrexate), surgical and conservative

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13
Q

What is an antepartum haemorrhage?

A

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

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14
Q

What are the causes of antepartum haemorrhage?

A

Placenta praevia, placental abruption, APH of unknown origin, local lesions of the genital tract and vasa praevia (rare)

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15
Q

What is the presentation of placenta praevia?

A

Painless PV bleeding, malpresentation of the fetus, soft non tender uterus and incidental findings

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16
Q

How is placenta praevia diagnosed and how is it managed?

A
  • USS (cannot do vaginal examination)
  • Depends on gestation and severity
  • C section
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17
Q

What is the management of PPH?

A

Medical: oxytocin, ergometrine, carbaprost and tranexemic acid
Balloon tamponade
Surgical: B lynch suture, ligation of uterine , iliac vessels and hysterectomy

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18
Q

What is placental abruption?

A

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

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19
Q

Which factors are associated with placental abruption?

A

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

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20
Q

What is the presentation of placental abruption?

A

Pain, vaginal bleeding and increased uterine activity

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21
Q

What is the general management of APH?

A

Varies from expectant treatment to vaginal delivery to C section depending on the amount of bleeding, condition of mother and baby and gestation

22
Q

What are the complications of placental abruption?

A

Maternal shock/collapse, fetal death, maternal DIC/renal failure and postpartum haemorrhage

23
Q

What is the classification of preterm labour?

A

Onset of labour before 37 completed weeks

24
Q

What are the predisposing factors for preterm labour?

A

Multiple pregnancy, polyhydramnios, APH, pre-eclampsia, infection e.g. UTI and prelabour premature rupture of membranes

25
Q

How is preterm delivery managed?

A
  • Diagnosis
  • Consider possible cause
  • Steroids unless contraindicated, transfer to unit with NICU and aim for vaginal delivery
26
Q

Which neonatal morbidities are associated with prematurity?

A

Resp. distress syndrome, intraventricular haemorrhage, cerebral palsy, nutrition, temp. control, jaundice, infections, visual impairment and hearing loss

27
Q

How is placenta praevia classified?

A
  • Grade 1: placenta encroaching on the lower segment
  • Grade 2: placenta reaches the internal os
  • Grade 3: placenta eccentrically covers the os
  • Grade 4: central placenta praevia
28
Q

What are the types of placental abruption?

A
  • Revealed
  • Concealed
  • Mixed
29
Q

Describe how chronic hypertension is classified

A
  • Mild: Diastolic 90-99 and systolic 140-49
  • Moderate: Diastolic 100-109 and systolic 150-159
  • Severe: Diastolic >110 and systolic >160
30
Q

What is gestational hypertension?

A

New hypertension which develops after 20 weeks

31
Q

What is pre-eclampsia?

A

New hypertension > 20 weeks in association with significant proteinuria

32
Q

What is classed as significant proteinuria>

A
  • Reagent strip estimation > 1+
  • Spot urinary protein: creatinine ratio > 30mg/mmol
  • 24hrs urine protein collection > 300mg/day
33
Q

How should essential hypertension be managed during pregnancy?

A
  • Change anti-hypertensives if indicated
  • Aim to keep BP <150/100
  • Monitor for superimposed pre-eclampsia
  • Monitor fetal growth
  • May have higher incidence of placental abruption
34
Q

What is the definition of pre-eclampsia?

A

-Mild HT on two occassions or moderate/severe HT
Plus
-Proteinuria of more than 300mgms/24hrs

35
Q

What are the risk factors for developing pre-eclampsia?

A
  • First pregnancy
  • Extremes of maternal age
  • Pre-eclampsia in a previous pregnancy
  • Pregnancy interval > 10yrs
  • FH
  • Multiple pregnancy
  • Underlying medical conditions: chronic hypertension, renal disease, diabetes and autoimmune disorders
36
Q

What are the potential complications of pre-eclampsia?

A
  • Seizures
  • Cerebral haemorrhage or stroke
  • Haemolysis, elevated liver enzymes and low platelets
  • DIC
  • Renal failure
  • Pulmonary oedema and cardiac failure
  • Impaired placental perfusion
37
Q

How does severe pre-eclampsia present?

A
  • Headache, blurred vision, epigastric pain, pain below ribs, vomiting and sudden swelling of hands, face and legs
  • Severe hypertension and proteinuria
  • Clonus, brisk reflexes
  • Reducing urine output
  • Convulsions
  • Raised liver enzymes and bilirubin
  • Raised urea, creatinine and urate
  • Low platelets
  • Low haemoglobin and signs of haemolysis
  • Features of DIC
38
Q

How can severe pre-eclampsia be managed?

A
  • Frequent BP and urine protein checks
  • Check symptomatology
  • FBC, LFTs, U&Es and coagulation tests
  • Scan for fetal growth and cardiotocography
  • Anti-hypertensives (labetolol, methyldopa and nifedipine)
  • Steroids for fetal lung maturity if <36wks
  • Consider induction of labour or C section if maternal or fetal condition deteriorates
39
Q

How can seizures be treated in eclampsia?

A
  • Magnesium sulphate
  • Control of blood pressure
  • Avoid fluid overload
40
Q

How can pre-ecampsia be avoided in subsequent pregnancy?

A

Low dose aspirin from 12 weeks to delivery

41
Q

What is gestational diabetes?

A
  • Carbohydrate intolerance with onset in pregnancy

- Abnormal glucose tolerance that reverts to normal after delivery

42
Q

What happens to pre-existing diabetes in pregnancy?

A
  • Insulin requirements of the mother increase
  • Fetal hyper-insulinemia (maternal glucose crosses the placenta and induces increased insulin production in the fetus)
  • Post delivery: more risk of neonatal hypoglycaemia and increased risk of respiratory disease
43
Q

What are the risks of diabetes in pregnancy?

A
  • Fetal congenital abnormalities
  • Miscarriage
  • Fetal macrosomia and polyhydramnios
  • Operative delivery and shoulder dystocia
  • Stillbirth and increased perinatal mortality
  • Increased risk of pre-eclampsia
  • Worsening of maternal nephropathy, retinopathy and hypoglycaemia (+ reduced awareness)
  • Infections
  • Impaired neonatal lung maturity, neonatal hypoglycaemia and jaundice
44
Q

How can diabetes be managed prior to conception?

A
  • Better glycaemic control
  • Folic acid
  • Dietary advice
  • Retinal and renal assessment
45
Q

How should diabetes be managed during pregnancy?

A
  • Optimise glucose control
  • Can continue oral anti-diabetic meds but may need to switch to insulin for better control
  • Risk of hypoglycaemia: provide glucagon injections/conc. glucose solution
  • Watch for ketouria/infections
  • Repeat retinal assessments at 28 and 34 wks
  • Watch fetal growth
  • Observe for pre-eclampsia
  • Labour usually induced earlier
  • Consider elective C section if significant fetal macrosomia
  • Maintain blood sugar during labour
  • Continuous CTG fetal monitoring in labour
  • Early feeding of baby
46
Q

What are the risk factors for developing gestational diabetes?

A
  • Increased BMI
  • Previous macrosomic baby
  • Previous GDM
  • FH of diabetes
  • High risk groups e.g. Asian origin
  • Polyhydramnios or big baby
  • Recurrent glycouria in current pregnancy
47
Q

How can GDM be screened for (if risk factors present)?

A
  • HbA1C estimation
  • OGTT
  • If OGTT is normal then repeat at 24-38 weeks
48
Q

How can GDM be managed?

A
  • Control blood sugars: diet and metformin/insulin
  • Post delivery: check OGTT 6-8 weeks post delivery
  • Yearly HbA1c/ blood sugar check
49
Q

Why is there a higher risk of venous thrombo-embolism in pregnancy?

A
  • Hypercoagulable state (to protect mother against bleeding post delivery)
  • Increased stasis
  • May be vascular damage at delivery/C-section
50
Q

Which risk factors increase the risk of a VTE in pregnancy?

A
  • Older mothers, increasing parity
  • Increased BMI
  • Smoking
  • IVDA
  • Pre-eclampsia
  • Dehydration
  • Decreased mobility
  • Infections
  • Operative delivery and prolonged delivery
  • Haemorrhage
  • Previous VTE
  • Strong FH of VTE
  • Sickle cell disease
51
Q

How can VTE risk be managed prophylactically in pregnancy?

A
  • TED stockings
  • Advise increased mobility and hydration
  • Prophylactic anti-coagulation with 3 or more risk factors
52
Q

How should a suspected VTE be investigated and how is it treated?

A
  • ECG, blood gases, doppler, V/Q scan and CTPA

- Anticoagulants

Reproductive (26 decks)

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