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Complications in pregnancy Flashcards

1
Q

What is miscarriage?

A

Spontaneous loss of pregnancy within 24 weeks gestation

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2
Q

What is abortion?

A

Voluntary termination of pregnancy

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3
Q

What are the different categories of spontaneous miscarriage?

A 
Threatened 
Inevitable
Incomplete
Complete
Septic
Missed
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4
Q

How does threatened miscarriage present?

A

Vaginal bleeding
Possibly pain
Viable pregnancy
Closed cervix on speculum examination

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5
Q

How does inevitable miscarriage present?

A

Viable pregnancy
Open cervix
Bleeding
Possibly clots

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6
Q

How does a missed miscarriage present?

A

No symptoms
Possible bleeding
Gestational sac seen on scan
No clear fetus

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7
Q

How does incomplete miscarriage present?

A

Most of pregnancy expelled
Some stuff remains in uterus
Open cervix
Vaginal bleeding

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8
Q

How does complete miscarriage present?

A

Passed all products of conception
Cervix closed
Bleeding stopped

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9
Q

What are some maternal factors in spontaneous miscarriage?

A

Increasing age

Diabetes

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10
Q

What are some uterine abnormalities which may cause spontaneous miscarriage?

A

Congenital

Fibroid

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11
Q

How is threatened miscarriage managed?

A

Conservative

Wait and see

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12
Q

How is inevitable miscarriage managed?

A

May need evacuation if bleeding heavy

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13
Q

How is missed miscarriage managed?

A

Conservatively
Misoprostol
Surgical

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14
Q

How is septic miscarriage managed?

A

Antibiotics

Evacuate uterus

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15
Q

What is an ectopic pregnancy?

A

Pregnancy implanted outside uterus

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16
Q

What are some risk factors for ectopic pregnancy?

A

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

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17
Q

How does ectopic pregnancy present?

A

Vaginal bleeding
Amenorrhoea with positive preg test
Abdominal/back/shoulder bleeding

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18
Q

How would you tell an ectopic pregnancy on a scan?

A

No intrauterine gestational sac
Adnexal mass
Fluid in pouch of douglas

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19
Q

How are ectopic pregnancies managed?

A

Methotrexate

Laparoscopy

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20
Q

What is salpingectomy?

A

Removal of the tube

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21
Q

What is salpingotomy?

A

Leave damaged tube

Remove embryo

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22
Q

What is APH?

A

Antepartum haemorrhage

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

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23
Q

What are some causes of APH?

A 
Placenta praevia
Placental abruption
APH of unknown origin
Local lesions of the genital tract
Vasa praevia (very rare)
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24
Q

What is placenta praevia?

A

All or part of placenta implants in lower uterine segment

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25
How does placenta praevia present?
Painless PV bleeding Malpresentation of fetus Incidental
26
How is placenta praevia diagnosed?
Ultrasound | NO VAGINAL EXAM
27
How is placenta praevia managed?
C section Watch for PPH Oxytocin, ergometrine, carboprost Balloon tamponade
28
Can smoking affect chances of placental abruption?
Yes, increases them
29
How does placental abruption usually present?
Pain Vaginal bleeding Increased uterine activity
30
Placental abruption can lead to what kind of complications?
``` Maternal shock/collapse Fetal distress/death Maternal DIC Maternal renal failure PPH ```
31
What is preterm labour?
Onset of labour before 37 completed weeks gestation
32
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 ```
33
What is polyhydramnios?
Too much amniotic fluid
34
How is preterm delivery managed?
Tocolysis considered Steroids unless contraindicated Transfer to NICU equipped unit Aim for vaginal delivery
35
What is tocolysis?
Medications used to prevent uterine contractions and suppress labour
36
What are some neonatal morbidities associated with prematurity?
``` Respiratory distress syndrome Intraventricular haemorrhage Cerebral palsy Nutrition Temperature control Jaundice Infections Visual impairment Hearing loss ```
37
What is mild HT in pregnancy?
Diastolic 90-99 | Systolic 140-149
38
What is moderate HT in pregnancy?
Diastolic 100-109 | Systolic 150-159
39
What is severe HT in pregnancy?
Diastolic 110 or greater | Systolic 160 or greater
40
How is pre-eclampsia different from gestational hypertension (PIH)?
Both new hypertension after 20 weeks but pre-eclampsia is associated with significant proteinuria
41
How is proteinuria tested for in pre-eclampsia?
Automated reagent strip urine protein estimation >1+ | Spot urinary protein creatine >30mg/mmol
42
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
43
Do hypertensive patients have a higher or lower incidence of placental abruption?
Higher
44
What are the main causes of pre-eclampsia?
Immunological | Genetic
45
How is reduced placental infusion caused in pre-eclampsia?
Secondary invasion of maternal spiral arterioles by trophoblasts impaired
46
Are mothers more or less likely to develop pre-eclampsia in their first pregnancy?
More
47
How does age affect chances of developing pre-eclampsia?
Extremes of maternal age increase chances
48
Does a multiple pregnancy increase or decrease chances of developing pre-eclampsia?
Increase
49
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
50
What are some possible maternal complications in pre-eclampsia?
``` Seizures Haemorrhage Stroke HELLP DIC Renal failure Pulmonary oedema Cardiac failure ```
51
What are some possible fetal complications in pre-eclampia?
``` Impaired placental perfusion IUGR Fetal distress Prematurity Increased perinatal mortality ```
52
What is IUGR?
Intrauterine Growth Restriction
53
What is the only "cure" for pre-eclampsia?
Delivery of baby and placenta
54
Describe the ideal conservative management of pre-eclampsia?
Close observation into postnatal period Anti-hypertensives Steroids for fetal lung maturity if gestation <36 weeks
55
What is the treatment for seizure?
``` Magnesium sulphate bolus + IV infusion BP control (IV Labetolol) Avoid fluid overload ```
56
Describe the prophylactic management for mothers with previous pre-eclampsia?
Low dose aspirin from 12 weeks until delivery
57
How is the effect of diabetes on pregnancy managed and mitigated?
Better glycaemic control before Folic acid 5mg Dietary advice Retinal and renal assessment
58
When is labour usually induced?
38-40 weeks | Earlier if fetal or maternal concerns
59
How is GDM checked up on after delivery?
OGTT at 6-8 weeks
60
What is Virchow's triad?
Stasis Vessel wall injury Hypercoagulability
61
How is stasis increased in pregnancy?
Progesterone | Effects of enlarging uterus
62
How may pregnancy cause vascular damage?
Delivery | C section
63
Describe VTE prophylaxis in pregnancy.
TED stockings Increased mobility Hydrate Maybe anti-coagulation if indicated with 3 or more risk factors
64
How does VTE present?
``` Pain in calf Increased girth of affected leg Calf muscle tenderness Breathlessness Pain on breathing Cough Tachycardia Hypoxia Pleural rub ```
65
What are some useful tests for VTE?
``` ECG Blood gases Doppler V/Q lung scan CTPA ```

Reproduction (25 decks)

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