Complications in pregnancy Flashcards
What is miscarriage?
Spontaneous loss of pregnancy within 24 weeks gestation
What is abortion?
Voluntary termination of pregnancy
What are the different categories of spontaneous miscarriage?
Threatened Inevitable Incomplete Complete Septic Missed
How does threatened miscarriage present?
Vaginal bleeding
Possibly pain
Viable pregnancy
Closed cervix on speculum examination
How does inevitable miscarriage present?
Viable pregnancy
Open cervix
Bleeding
Possibly clots
How does a missed miscarriage present?
No symptoms
Possible bleeding
Gestational sac seen on scan
No clear fetus
How does incomplete miscarriage present?
Most of pregnancy expelled
Some stuff remains in uterus
Open cervix
Vaginal bleeding
How does complete miscarriage present?
Passed all products of conception
Cervix closed
Bleeding stopped
What are some maternal factors in spontaneous miscarriage?
Increasing age
Diabetes
What are some uterine abnormalities which may cause spontaneous miscarriage?
Congenital
Fibroid
How is threatened miscarriage managed?
Conservative
Wait and see
How is inevitable miscarriage managed?
May need evacuation if bleeding heavy
How is missed miscarriage managed?
Conservatively
Misoprostol
Surgical
How is septic miscarriage managed?
Antibiotics
Evacuate uterus
What is an ectopic pregnancy?
Pregnancy implanted outside uterus
What are some risk factors for ectopic pregnancy?
Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception
How does ectopic pregnancy present?
Vaginal bleeding
Amenorrhoea with positive preg test
Abdominal/back/shoulder bleeding
How would you tell an ectopic pregnancy on a scan?
No intrauterine gestational sac
Adnexal mass
Fluid in pouch of douglas
How are ectopic pregnancies managed?
Methotrexate
Laparoscopy
What is salpingectomy?
Removal of the tube
What is salpingotomy?
Leave damaged tube
Remove embryo
What is APH?
Antepartum haemorrhage
Haemorrhage from genital tract after 24th week of pregnancy but before delivery
What are some causes of APH?
Placenta praevia Placental abruption APH of unknown origin Local lesions of the genital tract Vasa praevia (very rare)
What is placenta praevia?
All or part of placenta implants in lower uterine segment
How does placenta praevia present?
Painless PV bleeding
Malpresentation of fetus
Incidental
How is placenta praevia diagnosed?
Ultrasound
NO VAGINAL EXAM
How is placenta praevia managed?
C section
Watch for PPH
Oxytocin, ergometrine, carboprost
Balloon tamponade
Can smoking affect chances of placental abruption?
Yes, increases them
How does placental abruption usually present?
Pain
Vaginal bleeding
Increased uterine activity
Placental abruption can lead to what kind of complications?
Maternal shock/collapse Fetal distress/death Maternal DIC Maternal renal failure PPH
What is preterm labour?
Onset of labour before 37 completed weeks gestation
What are some factors which may predispose a mother to preterm labour?
Multiple pregnancy Polyhydramnios APH Pre-eclampsia Infection eg UTI Prelabour premature rupture of membranes
What is polyhydramnios?
Too much amniotic fluid
How is preterm delivery managed?
Tocolysis considered
Steroids unless contraindicated
Transfer to NICU equipped unit
Aim for vaginal delivery
What is tocolysis?
Medications used to prevent uterine contractions and suppress labour
What are some neonatal morbidities associated with prematurity?
Respiratory distress syndrome Intraventricular haemorrhage Cerebral palsy Nutrition Temperature control Jaundice Infections Visual impairment Hearing loss
What is mild HT in pregnancy?
Diastolic 90-99
Systolic 140-149
What is moderate HT in pregnancy?
Diastolic 100-109
Systolic 150-159
What is severe HT in pregnancy?
Diastolic 110 or greater
Systolic 160 or greater
How is pre-eclampsia different from gestational hypertension (PIH)?
Both new hypertension after 20 weeks but pre-eclampsia is associated with significant proteinuria
How is proteinuria tested for in pre-eclampsia?
Automated reagent strip urine protein estimation >1+
Spot urinary protein creatine >30mg/mmol
How is hypertension managed in pregnant mothers?
Change drugs if needed
Labetolol, nifedipine and methyldopa are popular
Monitor for superimposed pre-eclampsia
Monitor fetal growth
Do hypertensive patients have a higher or lower incidence of placental abruption?
Higher
What are the main causes of pre-eclampsia?
Immunological
Genetic
How is reduced placental infusion caused in pre-eclampsia?
Secondary invasion of maternal spiral arterioles by trophoblasts impaired
Are mothers more or less likely to develop pre-eclampsia in their first pregnancy?
More
How does age affect chances of developing pre-eclampsia?
Extremes of maternal age increase chances
Does a multiple pregnancy increase or decrease chances of developing pre-eclampsia?
Increase
What are some underlying health conditions which may pre-dispose a pregnant person to develop pre-eclampsia?
Chronic HT
Renal disease
Diabetes
Autoimmune disorders like SLE
What are some possible maternal complications in pre-eclampsia?
Seizures Haemorrhage Stroke HELLP DIC Renal failure Pulmonary oedema Cardiac failure
What are some possible fetal complications in pre-eclampia?
Impaired placental perfusion IUGR Fetal distress Prematurity Increased perinatal mortality
What is IUGR?
Intrauterine Growth Restriction
What is the only “cure” for pre-eclampsia?
Delivery of baby and placenta
Describe the ideal conservative management of pre-eclampsia?
Close observation into postnatal period
Anti-hypertensives
Steroids for fetal lung maturity if gestation <36 weeks
What is the treatment for seizure?
Magnesium sulphate bolus + IV infusion BP control (IV Labetolol) Avoid fluid overload
Describe the prophylactic management for mothers with previous pre-eclampsia?
Low dose aspirin from 12 weeks until delivery
How is the effect of diabetes on pregnancy managed and mitigated?
Better glycaemic control before
Folic acid 5mg
Dietary advice
Retinal and renal assessment
When is labour usually induced?
38-40 weeks
Earlier if fetal or maternal concerns
How is GDM checked up on after delivery?
OGTT at 6-8 weeks
What is Virchow’s triad?
Stasis
Vessel wall injury
Hypercoagulability
How is stasis increased in pregnancy?
Progesterone
Effects of enlarging uterus
How may pregnancy cause vascular damage?
Delivery
C section
Describe VTE prophylaxis in pregnancy.
TED stockings
Increased mobility
Hydrate
Maybe anti-coagulation if indicated with 3 or more risk factors
How does VTE present?
Pain in calf Increased girth of affected leg Calf muscle tenderness Breathlessness Pain on breathing Cough Tachycardia Hypoxia Pleural rub
What are some useful tests for VTE?
ECG Blood gases Doppler V/Q lung scan CTPA
