Complications in Pregnancy Flashcards
What is meant by miscarriage / abortion?
Termination / loss of pregnancy before 24 weeks gestation.
What is a spontaneous miscarriage?
Threatened = bleeding from gravid when there is a viable fetus and no evidence of cervical dilatation. OR vaginal bleeding and pain, closed cervix on speculum. Management = Conservative.
What is an inevitable miscarriage?
Abortion if the cervix has already begun to dilate. Open cervix with bleeding.
Management = if bleeding heavy may need evacuation.
What is incomplete miscarriage?
Partial expulsion of products of conception. Products remaining in the uterus, open cervix, vaginal bleeding.
What is a complete miscarriage?
Compete expulsion of the products of conception - complete abortion. Cervix closed and bleeding stopped.
What is septic abortion?
Following incomplete always a risk of ascending infection into the uterus which can spread throughout pelvis - septic abortion.
Management = antibiotics and evacuate uterus.
What is missed miscariage?
Fetus has died but the uterus has made no attempt to expel the products. No symptoms, could have bleeding or brown loss vaginally. Gestational sac seen on scan.
No clear fetus or fetal pole.
Managment = conservative, medical - prostaglandins, surgical.
What causes spontaneous miscarriage?
Abnormal conceptus = chromosomal, genetic, structural.
Uterine abnormality - congenital, fibroids.
Cervical incompetence - primary, secondary.
Maternal - Increasing age, diabetes.
What is an ectopic pregnancy?
Pregnancy implanted outside the uterine cavity. Ampulla is most common place followed by the isthmus. 1:90 pregnancies.
What are the risk factors for ectopic pregnancy?
Pelvic inflammatory disease, previous tubal surgery, previous ectopic, assisted conception.
How does an ectopic pregnancy present?
Period of ammenorhoea (with +ve pregnancy rest) +/- vaginal bleeding, +/- pain in abdomen, +/- GI or urinary symptoms.
What investigations take place for ectopic pregnancy?
Scan - no intrauterine gestational sac, may see adnexal mass, fluid in pouch of douglas.
Serum BHCG levels.
Serum progesterone.
What is the management for ectopic pregnancy?
Medical - methotrexate
Surgical - Mostly laproscopical - Salpingectomy.
Conservative.
What is Antepartum Haemorrhage?
Haemorrhage from the genital tract after 24th week of pregnancy but before delivery of the baby.
What causes Antepartum haemorrhage?
Placenta praevia.
Mulitparous women, multiple pregnancies, previous caesarean section.
Presentation of Antepartum haemorrhage
Painless PV bleeding. Malpresentation of fetus. Risk of PPH.
What is placenta praevia?
Placenta is attached to lower segment of uterus - 1/200 pregnancies.
What are the 4 grades of Placenta Praevia?
1 - encroaching lower segment but not the internal cervical os.
2 - Placenta reaches the internal os.
3- Placenta eccentrically covers the os.
4- Central placenta praevia.
How does Placenta Praevia present?
Maternal condition correlates with amount of bleeding PV. Soft non tender uterus =/- fetal malpresentation.