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Complications in pregnancy Flashcards

1
Q

What is a spontaneous miscarriage?

A

Spontaneous termination of pregnancy before 24 weeks gestation

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2
Q

What are the types of miscarriage?

A 
Threatened
Inevitable
Incomplete
Complete
Septic
Missed
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3
Q

What is a threatened miscarriage?

A

Bleeding from gravid uterus before 24 weeks when there is a viable foetus
No evidence of cervical dilatation

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4
Q

What are the clinical features of a threatened miscarriage?

A

Vaginal bleeding +/- pain
Viable pregnancy
Closed cervix

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5
Q

What is the management of a threatened miscarriage?

A

Conservative

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6
Q

What is an inevitable miscarriage?

A

Cervix starts to dilate

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7
Q

What are the clinical features of an inevitable miscarriage?

A

Viable pregnancy

Open cervix with heavy bleeding +/- clots

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8
Q

What is the management of an inevitable miscarriage?

A

Evacuation for heavy bleeding

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9
Q

What is an incomplete miscarriage?

A

Partial expulsion of products of conception

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10
Q

What is a complete miscarriage?

A

Complete expulsion of products of conception

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11
Q

What is a septic miscarriage?

A

Ascending inflammation into the uterus which can spread through the pelvis

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12
Q

When is septic miscarriage most common?

A

In cases of incomplete miscarriage

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13
Q

What is the management of a septic miscarriage?

A

Antibiotics

Evacuate uterus

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14
Q

What is a missed miscarriage?

A

Foetus has died, but uterus has made no attempt to expel

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15
Q

What are the clinical features of a missed miscarriage?

A

Normally no symptoms
May have bleeding/brown discharge
Gestational sac seen on scan
No clear foetus or foetal pole with no heartbeat

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16
Q

What is the management of a missed miscarriage?

A

Conservative
Prostaglandins
Surgical evacuation

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17
Q

What are the categories of causes of miscarriage?

A 
Abnormal conceptus
Uterine abnormality
Cervical imcompetence
MAternal factors
Unknown
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18
Q

What maternal factor can increase the risk of miscarriage?

A

Increasing age

Diabetes

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19
Q

What is an ectopic pregnancy?

A

Pregnancy implanted outside of uterine cavity

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20
Q

Where is the most common location for an ectopic to implant?

A

Fallopian tube

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21
Q

What are the risk factors for an ectopic pregnancy?

A

PID
Previous ectopic
Previous tubal surgery
Assisted conception

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22
Q

What are the clinical features of an ectopic?

A

Period of amenorrhoea and + urine pregnancy test

May have- vaginal bleeding, abdominal pain, GI/urinary symptoms from pressure, shoulder tip referred pain

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23
Q

What investigations are done for an ectopic?

A

US
Serum betaHCG levels
Serum progesterone

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24
Q

What are the findings on US in an ectopic?

A

No intrauterine gestational sac

May have adnexal mass or fluid in pouch of Douglas

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25
Q

What is the medical treatment of an ectopic?

A

Methotrexate

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26
Q

What are the surgical options for an ectopic?

A

Salpingectomy

Salpingotomy

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27
Q

When is surgical management of an ectopic used?

A

If woman is unstable, or ectopic close to rupture

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28
Q

When is a salpingostomy used in an ectopic

A

If other tube already removed

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29
Q

When is conservative management of an ectopic used?

A

Woman is stable

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30
Q

What is the conservative management of an ectopic?

A

Monitor for rupture and allow to pass normally

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31
Q

What is an antepartum haemorrhage?

A

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

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32
Q

What are the causes of antepartum haemorrhage?

A 
Placenta praaevia
Placental abruption
Unknown
Local lesions of genital tract
Vasa praevia
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33
Q

What is placenta praaevia?

A

Placenta attached to lower segment of uterus

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34
Q

Who is placenta praaevia most common in?

A

Multiparous women
Previous C section
Multiple pregnancies

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35
Q

What is the classification of placenta praaevia?

A

Grade I- placenta encroaching on lower segment
Grade II- placenta reached internal os
Grade III- placenta eccentrically covers os
Grace IV- Central placenta praevia

36
Q

What are the clinical features of placenta praaevia?

A

Painless PV bleeding
Malpresentation of foetus, normally oblique
Soft, non tender uterus

37
Q

What investigations are done for placenta praaevia?

A

US

NEVER do a vaginal exam if you suspect placenta praevia

38
Q

What is the management of placenta praaevia?

A

Dependent on severity and gestation

C section and monitor for PPH

39
Q

What is placenta abruption?

A

Placenta begins to separate from uterine wall before birth

40
Q

What are the risk factors for placental abruption?

A 
Pre-eclampsia
Chronic hypertension
Multiple pregnancy
Parity
Previous abruption
Polyhydramnios
Smoking
Cocaine use
Increasing age
41
Q

What are the types of placental abruption?

A

Revealed- major haemorrhage apparent externally

Concealed- haemorrhage between placenta and uterine wall

42
Q

What are the clinical features of Placental abruption?

A

Pain
Vaginal bleeding
Increased uterine activity

43
Q

What is the management of less severe placental abruption?

A

Monitor baby and mother

44
Q

What is the management of more severe placental abruption?

A

Induction or c section

45
Q

What are the complications of Placental abruption?

A

Maternal shock, collapse- may be disproportionate to amount of blood
Foetal death
Maternal DIC, renal failure
PPH

46
Q

What is vasa praevia?

A

Rupture of foetal vessel within foetal membranes

47
Q

What is the management of an antenatal haemorrhage?

A

Varies massively depending on severity and gestation

Up to and including c section

48
Q

What is the management of PPH?

A

Medical- oxytocin, ergometrine, carbaprost, tranexemic acid
Balloon tamponade
Surgical

49
Q

What is preterm labour?

A

Onset of labour before 37 weeks

50
Q

What are the grades of preterm labour?

A

Mild- 32-36 weeks
Very- 28-32 weeks
Extremely- 24-28 weeks

51
Q

What are the risk factors for preterm labour?

A 
Multiple pregnancy
Polyhydramnios
APH
Pre-eclampsia
Infection
Prelabour premature rupture of membranes
52
Q

How is preterm labour diagnosed?

A

Contractions with evidence of cervical changes on vaginal examination

53
Q

What is the management of preterm labour?

A

Labour suppressants
Steroids unless contraindicated
Transfer to unit with NICU
Aim for vaginal delivery

54
Q

What are the neonatal morbidities resulting from prematurity?

A 
Respiratory distress syndrome
Intraventricular haemorrhage
Cerebral palsy
Jaundice
Infections
Visual impairment
Hearing loss
55
Q

What is chronic hypertension in pregnancy?

A

Hypertension from pre pregnancy or developing before 20 weeks

56
Q

What is mild hypertension?

A

140-149/90-99

57
Q

What is moderate hypertension?

A

150-159/100-109

58
Q

What is severe hypertension?

A

> 160/>110

59
Q

What is the management of hypertension in pregnancy?

A

Ideally should have pre pregnancy care- change if necessary
Pharm- labetolol, nifedipine or methyldopa
Aim to keep BP <150/100
Monitor for foetal growth and pre-eclampsia

60
Q

What is pre-eclampsia?

A

Mild hypertension on two occasions or moderate to severe hypertension once with proteinuria

61
Q

What is the pathophysiology of pre-eclampsia?

A

Immunological

Genetic predisposition- imbalance between vasodilators and vasocontristors

62
Q

What are the risk factors for pre-eclampsia?

A 
First pregnancy
Extrenes of maternal age
Previous pre-eclampsia
Pregnancy interval >10 years
FH
Multiple pregnancy
Underlying medical disorders
63
Q

What are the signs and symptoms of pre-eclampsia?

A 
Headache
Blurred vision
Epugastric pain
Pain below ribs
Vomiting
Sudden Stellung of hands, face, legs
Clonus/brisk reflexes
Reduced urine output
64
Q

What are the findings on biochemistry with pre-eclampsia?

A

Raised liver enzymes

Raised urea, creatinine and urate

65
Q

What are the findings on haematology with pre-eclampsia?

A

Low platelets
Low haemoglobin, signs of haemolytic
Features of DIC

66
Q

What is the management of pre-eclampsia?

A

Frequent BP checks
Urine protein monitoring
Foetal monitoring- growth, CTG
Antihypertensives- labetolol, methyldopa, nifedipine
Steroids if <36 weeks gestation
Anticonvulsants
Induction of labour/c section if situation deteriorates

67
Q

What is done for prophylaxis of pre-eclampsia?

A

Low dose aspirin form 12 weeks until delivery

68
Q

What are the maternal complications of pre-eclampsia?

A 
Seizures
Cerebral haemorrhage
Stroke
HAemolysis, elevated liver enzymes, low platelets
DIC
Renal failure
Pulmonary oedema
Cardiac failure
69
Q

What are the foetal complications of pre-eclampsia?

A

Impaired [lacental function- IUGR, foetal distress, prematurity, increased perinatal mortality

70
Q

What changes about diabetes in pregnancy?

A

Insulin requirements increase due to anti-insulin properties of hormones

71
Q

What is the effect of maternal diabetes on the foetus?

A

Maternal glucose crosses placenta and induces insulin production- causing macrosomnia

72
Q

What is the management of diabetes pre-conception?

A

optimise glycemic control
5mg folic acid
Dietary advice
Retinal and renal assessment

73
Q

What is the management of diabetes during pregnancy?

A

Optimise glycemic control
Change drugs/add insulin
Monitor for hypo/hyper, ketonuria, infections
Monitor foetal growth
Induce labour at 38-40 weeks and consider section

74
Q

What is the treatment of diabetes in labour?

A

Dextrose insulin infusion
COntinuous CTG
Early feeding of baby

75
Q

What is gestational diabetes?

A

Abnormal glucose intolerance that reverts to normal after delivery

76
Q

What ar the risk factors fir gestational diabetes?

A 
BMI >30
Previous baby >4.5kg
Previous gestational diabetes
FH
Polyhydramnios or big baby
77
Q

How is gestational diabetes screened for?

A

Offer HbA1C at booking if any risk factors

Offer OGTT at 16 and 28 weeks if any risk factors

78
Q

Wha is the management of gestational diabetes?

A

Diet
Metformin and insulin
Check OGTT 6-8 weeks postnatally
Yearly check of HbA1C and blood sugar annually

79
Q

What does diabetes during pregnancy increase the risk of?

A 
Foetal congenital abnormalities
Miscarriage
Foetal macrosomnia
Polyhydramnios
Operative delivery
Shoulder dystocia
Stillbirth
Pre-eclampsia
Infections
Neonatal- impaired lung maturity, neonatal hypo, jaundice
80
Q

What are the factors in Virchow’s triad?

A

Stasis
Vessel wall injury
Hypercoagulability

81
Q

Why is pregnancy a risk with VTE?

A

Hyercoaguable state

Increased stasis due to progesterone

82
Q

What are the risk factors for VTE in pregnancy?

A 
Older mothers
Parity
High BMI
Smokers
IV drug use
Dehydration
Decreased mobility
Infections
Haemorrhage
Previpus VTE
Sickle cell disease
83
Q

What are the signs and symptoms of a VTE?

A 
Pain in calf
Swelling and erythema of affected leg
Breatlessness
PAin breathing
Cough
Tachycardia
Hypoxic
Pleura; rub
84
Q

What investigations are done for VTE?

A

ECG
ABG
Soppler V/Q lung scan
CTPA

85
Q

What is done for prophylaxis of VTE?

A

TED stockings
Advice on mobility and hydration
Prophylactic anticoagulation of >3 risk factors

Reproduction (29 decks)

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