Complications in pregnancy

Question 1

What is meant by a spontaneous miscarriage?

Answer 1

Loss of pregnancy before 24 weeks

Question 2

What are the different classes of spontaneou smiscarriage?

Answer 2

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

Question 3

What are the causes of spontaneous miscarriages?

Answer 3

Abnormal chromosomes, genes or structure
Uterine abnormality- congenital/fibroids
Cervical incompetence (primary, secondary)
Maternal- increasing age, diabetes
Unknown

Question 4

How do you manage a miscarriage?

Answer 4

Threatened- conservative
Inevitable- if bleeding heavy may need evacuation
missed- medical (prostaglandins), surgical evacuation
Septic- antibiotics and evacuate uterus

Question 5

How does an ectopic pregnancy present?

Answer 5

Ectopic pregnancy is the implantation of a pregnancy outside the uterus

Vaginal bleeding
Pain in abdomen
GI/urinary symptoms

Question 6

What are the risk factors for an ectopic pregnancy?

Answer 6

STD's 
Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
IVF

Question 7

How do you investigate a suspected ectopic pregnancy?

Answer 7

Scan,serum BHCG levels, may need to track over 48 hours

Serum progesterone levels

Question 8

What is the management of an ectopic pregnancy?

Answer 8

Methotrexate

Salpingectomy for few indications

Question 9

What is an antipartum haemorrhage?

Answer 9

Bleeding from the uterine tract after the 24th week of pregnancy but before the delivery of the baby

Question 10

What are some of the causes of antepartum haemorrhage?

Answer 10

Placenta praevia
Placental abruption
APH of unknown origin
Local lesions of the genital tract
Vasa praevia (very rare)

Question 11

What is placenta praevia?

What group is it most common in?

Answer 11

Implantation of the placenta in the lower uterine segments
More common in multiparous women
Multiple pregnancies
Previous cesarean section

Question 12

What are the different classifications of placenta praevia?

Answer 12

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

Question 13

How can placenta praevia present?

Answer 13

Painless bleeding
Malpresentation of the fetus and soft non tender uterus
Incidental presentation

Question 14

How do you manage suspected placenta praevia?

Answer 14

USS to confirm
DO NOT DO vaginal exam
Management depends on pregnancy stage. C-section and watch for PPH

Question 15

How do you manage a post partum heamorrhage

Answer 15

Oxytocin, ergmetrine,carbaprost, tranexemic acid to reduce bleeding

Baloon tamponade- surgical B lynch suture, ligation of uterine iliac vessels, hysterectomy

Question 16

What is a placental abruption?

Answer 16

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

Occurs in 0.6% of all pregnancies

Question 17

What factors are associated with placental abruption

Answer 17

Pre eclampsia/chronic hypertension
Multiple pregnancies
Polyhydroaminos
smoking, increasing age, parity
Previous abruption
Cocaine use

Question 18

How can a placental abruption present?

Answer 18

Revealed- external bleeding
Concealed- no bleeding
Mixed- slight bleeding

pain, bleeding, Increased uterine activity

Question 19

What are the complications of placental abruption?

Answer 19

Maternal shock, collapse 
Fetal death
Maternal disseminated intravascular coagualtion syndrome
Renal failure
Postpartum heamorrhage

Question 20

What are the different types of preterm labour?

Answer 20

24-28 weeks- extremely preterm
28-32 weeks- very preterm
32-36weeks- extremely preterm

Spontaneous or induced

Question 21

What are some predisposing factors to a preterm labour?

Answer 21

Multiple pregnancies
Polyhydroaminos
APH
Pre-eclampsia
Infection e.g. UTI
Prelabour premature rupture of membranes

Question 22

How do you manage a preterm delivery?

Answer 22

Consider possible cause

24-26 weeks- consider steroids, tocolysis to prolong pregnancy, need NICU facilities

Question 23

What neonatal complications may arise from premature birth?

Answer 23

Respiratory distress syndrome
Intraventricular haemorrhage
Cerebral palsy
Poor temperature control
Jaundice
Infections
Visual impairment
Hearing loss