Complications in pregnancy Flashcards
What is meant by a spontaneous miscarriage?
Loss of pregnancy before 24 weeks
What are the different classes of spontaneou smiscarriage?
Threatened- vaginal bleeding +/- pain, closed cervix, viable pregnancy
Inevitable- viable pregnancy, open cervix with bleeding (+/- clots)
Incomplete- most of pregnancy expelled out. some products remain in uterus
Compete- Passed all products on contraception, cervix closed
Septic- miscarriage due to sepsis
Missed- no symptoms, could have bleeding, gestational sac seen on scan but no clear fetus
What are the causes of spontaneous miscarriages?
Abnormal chromosomes, genes or structure Uterine abnormality- congenital/fibroids Cervical incompetence (primary, secondary) Maternal- increasing age, diabetes Unknown
How do you manage a miscarriage?
Threatened- conservative
Inevitable- if bleeding heavy may need evacuation
missed- medical (prostaglandins), surgical evacuation
Septic- antibiotics and evacuate uterus
How does an ectopic pregnancy present?
Ectopic pregnancy is the implantation of a pregnancy outside the uterus
Vaginal bleeding
Pain in abdomen
GI/urinary symptoms
What are the risk factors for an ectopic pregnancy?
STD's Pelvic inflammatory disease Previous tubal surgery Previous ectopic IVF
How do you investigate a suspected ectopic pregnancy?
Scan,serum BHCG levels, may need to track over 48 hours
Serum progesterone levels
What is the management of an ectopic pregnancy?
Methotrexate
Salpingectomy for few indications
What is an antipartum haemorrhage?
Bleeding from the uterine tract after the 24th week of pregnancy but before the delivery of the baby
What are some of the causes of antepartum haemorrhage?
Placenta praevia Placental abruption APH of unknown origin Local lesions of the genital tract Vasa praevia (very rare)
What is placenta praevia?
What group is it most common in?
Implantation of the placenta in the lower uterine segments
More common in multiparous women
Multiple pregnancies
Previous cesarean section
What are the different classifications of placenta praevia?
Class I- placenta encroaches on the lower segment but no ton the internal cervical OS
Class II- Placenta reaches the internal OS
Class III- Placenta essentially covers the OS
Class IV- Central placenta praevia
How can placenta praevia present?
Painless bleeding
Malpresentation of the fetus and soft non tender uterus
Incidental presentation
How do you manage suspected placenta praevia?
USS to confirm
DO NOT DO vaginal exam
Management depends on pregnancy stage. C-section and watch for PPH
How do you manage a post partum heamorrhage
Oxytocin, ergmetrine,carbaprost, tranexemic acid to reduce bleeding
Baloon tamponade- surgical B lynch suture, ligation of uterine iliac vessels, hysterectomy
What is a placental abruption?
Haemorrhage resulting from premature separation of the placenta before the birth of the baby
Occurs in 0.6% of all pregnancies
What factors are associated with placental abruption
Pre eclampsia/chronic hypertension Multiple pregnancies Polyhydroaminos smoking, increasing age, parity Previous abruption Cocaine use
How can a placental abruption present?
Revealed- external bleeding
Concealed- no bleeding
Mixed- slight bleeding
pain, bleeding, Increased uterine activity
What are the complications of placental abruption?
Maternal shock, collapse Fetal death Maternal disseminated intravascular coagualtion syndrome Renal failure Postpartum heamorrhage
What are the different types of preterm labour?
24-28 weeks- extremely preterm
28-32 weeks- very preterm
32-36weeks- extremely preterm
Spontaneous or induced
What are some predisposing factors to a preterm labour?
Multiple pregnancies Polyhydroaminos APH Pre-eclampsia Infection e.g. UTI Prelabour premature rupture of membranes
How do you manage a preterm delivery?
Consider possible cause
24-26 weeks- consider steroids, tocolysis to prolong pregnancy, need NICU facilities
What neonatal complications may arise from premature birth?
Respiratory distress syndrome Intraventricular haemorrhage Cerebral palsy Poor temperature control Jaundice Infections Visual impairment Hearing loss
