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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
What is the medical treatment of an ectopic?
Methotrexate
26
What are the surgical options for an ectopic?
Salpingectomy | Salpingotomy
27
When is surgical management of an ectopic used?
If woman is unstable, or ectopic close to rupture
28
When is a salpingostomy used in an ectopic
If other tube already removed
29
When is conservative management of an ectopic used?
Woman is stable
30
What is the conservative management of an ectopic?
Monitor for rupture and allow to pass normally
31
What is an antepartum haemorrhage?
Haemorrhage from genital tract after 24th week of pregnancy but before delivery of baby
32
What are the causes of antepartum haemorrhage?
``` Placenta praaevia Placental abruption Unknown Local lesions of genital tract Vasa praevia ```
33
What is placenta praaevia?
Placenta attached to lower segment of uterus
34
Who is placenta praaevia most common in?
Multiparous women Previous C section Multiple pregnancies
35
What is the classification of placenta praaevia?
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
What are the clinical features of placenta praaevia?
Painless PV bleeding Malpresentation of foetus, normally oblique Soft, non tender uterus
37
What investigations are done for placenta praaevia?
US | NEVER do a vaginal exam if you suspect placenta praevia
38
What is the management of placenta praaevia?
Dependent on severity and gestation | C section and monitor for PPH
39
What is placenta abruption?
Placenta begins to separate from uterine wall before birth
40
What are the risk factors for placental abruption?
``` Pre-eclampsia Chronic hypertension Multiple pregnancy Parity Previous abruption Polyhydramnios Smoking Cocaine use Increasing age ```
41
What are the types of placental abruption?
Revealed- major haemorrhage apparent externally | Concealed- haemorrhage between placenta and uterine wall
42
What are the clinical features of Placental abruption?
Pain Vaginal bleeding Increased uterine activity
43
What is the management of less severe placental abruption?
Monitor baby and mother
44
What is the management of more severe placental abruption?
Induction or c section
45
What are the complications of Placental abruption?
Maternal shock, collapse- may be disproportionate to amount of blood Foetal death Maternal DIC, renal failure PPH
46
What is vasa praevia?
Rupture of foetal vessel within foetal membranes
47
What is the management of an antenatal haemorrhage?
Varies massively depending on severity and gestation | Up to and including c section
48
What is the management of PPH?
Medical- oxytocin, ergometrine, carbaprost, tranexemic acid Balloon tamponade Surgical
49
What is preterm labour?
Onset of labour before 37 weeks
50
What are the grades of preterm labour?
Mild- 32-36 weeks Very- 28-32 weeks Extremely- 24-28 weeks
51
What are the risk factors for preterm labour?
``` Multiple pregnancy Polyhydramnios APH Pre-eclampsia Infection Prelabour premature rupture of membranes ```
52
How is preterm labour diagnosed?
Contractions with evidence of cervical changes on vaginal examination
53
What is the management of preterm labour?
Labour suppressants Steroids unless contraindicated Transfer to unit with NICU Aim for vaginal delivery
54
What are the neonatal morbidities resulting from prematurity?
``` Respiratory distress syndrome Intraventricular haemorrhage Cerebral palsy Jaundice Infections Visual impairment Hearing loss ```
55
What is chronic hypertension in pregnancy?
Hypertension from pre pregnancy or developing before 20 weeks
56
What is mild hypertension?
140-149/90-99
57
What is moderate hypertension?
150-159/100-109
58
What is severe hypertension?
>160/>110
59
What is the management of hypertension in pregnancy?
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
What is pre-eclampsia?
Mild hypertension on two occasions or moderate to severe hypertension once with proteinuria
61
What is the pathophysiology of pre-eclampsia?
Immunological | Genetic predisposition- imbalance between vasodilators and vasocontristors
62
What are the risk factors for pre-eclampsia?
``` First pregnancy Extrenes of maternal age Previous pre-eclampsia Pregnancy interval >10 years FH Multiple pregnancy Underlying medical disorders ```
63
What are the signs and symptoms of pre-eclampsia?
``` Headache Blurred vision Epugastric pain Pain below ribs Vomiting Sudden Stellung of hands, face, legs Clonus/brisk reflexes Reduced urine output ```
64
What are the findings on biochemistry with pre-eclampsia?
Raised liver enzymes | Raised urea, creatinine and urate
65
What are the findings on haematology with pre-eclampsia?
Low platelets Low haemoglobin, signs of haemolytic Features of DIC
66
What is the management of pre-eclampsia?
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
What is done for prophylaxis of pre-eclampsia?
Low dose aspirin form 12 weeks until delivery
68
What are the maternal complications of pre-eclampsia?
``` Seizures Cerebral haemorrhage Stroke HAemolysis, elevated liver enzymes, low platelets DIC Renal failure Pulmonary oedema Cardiac failure ```
69
What are the foetal complications of pre-eclampsia?
Impaired [lacental function- IUGR, foetal distress, prematurity, increased perinatal mortality
70
What changes about diabetes in pregnancy?
Insulin requirements increase due to anti-insulin properties of hormones
71
What is the effect of maternal diabetes on the foetus?
Maternal glucose crosses placenta and induces insulin production- causing macrosomnia
72
What is the management of diabetes pre-conception?
optimise glycemic control 5mg folic acid Dietary advice Retinal and renal assessment
73
What is the management of diabetes during pregnancy?
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
What is the treatment of diabetes in labour?
Dextrose insulin infusion COntinuous CTG Early feeding of baby
75
What is gestational diabetes?
Abnormal glucose intolerance that reverts to normal after delivery
76
What ar the risk factors fir gestational diabetes?
``` BMI >30 Previous baby >4.5kg Previous gestational diabetes FH Polyhydramnios or big baby ```
77
How is gestational diabetes screened for?
Offer HbA1C at booking if any risk factors | Offer OGTT at 16 and 28 weeks if any risk factors
78
Wha is the management of gestational diabetes?
Diet Metformin and insulin Check OGTT 6-8 weeks postnatally Yearly check of HbA1C and blood sugar annually
79
What does diabetes during pregnancy increase the risk of?
``` Foetal congenital abnormalities Miscarriage Foetal macrosomnia Polyhydramnios Operative delivery Shoulder dystocia Stillbirth Pre-eclampsia Infections Neonatal- impaired lung maturity, neonatal hypo, jaundice ```
80
What are the factors in Virchow's triad?
Stasis Vessel wall injury Hypercoagulability
81
Why is pregnancy a risk with VTE?
Hyercoaguable state | Increased stasis due to progesterone
82
What are the risk factors for VTE in pregnancy?
``` Older mothers Parity High BMI Smokers IV drug use Dehydration Decreased mobility Infections Haemorrhage Previpus VTE Sickle cell disease ```
83
What are the signs and symptoms of a VTE?
``` Pain in calf Swelling and erythema of affected leg Breatlessness PAin breathing Cough Tachycardia Hypoxic Pleura; rub ```
84
What investigations are done for VTE?
ECG ABG Soppler V/Q lung scan CTPA
85
What is done for prophylaxis of VTE?
TED stockings Advice on mobility and hydration Prophylactic anticoagulation of >3 risk factors

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