complications in pregnancy Flashcards
misscarriage
spontaneous loss of pregnancy before foetus reaches viability
all pregnancy losses from time of conception until 24wks gestation
classifications of spontaneous miscarriages
threatened inevitable incomplete complete septic missed
threatened misscarriage
refers to bleeding from gravid uterus before 24wks gestation when there is a viable foetus and no evidence of cervical dilatation
vaginal bleeding +/-pain
viable pregnancy
closed cervix on speculum exam
inevitable misscarriage
cervix has already begun to dilate
viable pregnancy
open cervix with bleeding that could be heavy (+/- clots)
incomplete misscarriage
only partial expulsion of products of conception
most of pregnancy expelled, some products of pregnancy remaining in uterus
open cervix, vaginal bleeding (may be heavy)
complete misscarriage
complete expulsion of products of conception
passed all products of conception (POC), cervix closed and bleeding stopped
should ideally confirm POC or scan that has prev confirmed a intrauterine pregancy
septic miscarriage
following incomplete miscarriage there is risk of ascending infection into uterus which can spread throughout pelvis
missed miscarriage (early fetal demise)
fetus has died but uterus hasn’t made attempt to expel POC
no symptoms, could have bleeding/brown loss vaginally
gestational sac on scan
no clear foetus (empty sac) or foetal pole with no heart
aetiology of spontaneous miscarriage: abnormal conceptus
chromosomal, genetic, structural
abnormal fetal development
aetiology of spontaneous miscarriage: uterine abnormality
congenital fibroids
aetiology of spontaneous miscarriage: cervical weakness
primary, secondary
cervix opens prematurely with absent/minimal uterine activity and pregnancy expelled
aetiology of spontaneous miscarriage: maternal
inc age, diabetes
SLE
thyroid disease
acute maternal infection - pyelitis, appendicitis
management of miscarriage: threatened
conservative
‘just wait’ - most stop bleeding and are okay
management of miscarriage: inevitable
if bleeding heavy may need evacuation
management of miscarriage: missed
conservative
medical: prostaglandins (misoprostol )
surgical - SMM (surgical management of miscarriage)
management of miscarriage: septic
antibiotics and evacuate uterus
ectopic pregnany
pregnancy implanted outside uterus
most commonly found in fallopian tube esp ampullary area
risk factors of ectopic pregnancy
pelvic inflammatory disease
previous tubal surgery
previous ectopic
assisted conception
presentation of ectopic pregnancy
period of amenorrhoea (with +ive urine pregnancy test)
+/- vaginal bleeding
+/- pain abdomen
+/- GI or urinary symptoms
ectopic pregnancy investigations
scan: no intrauterine gestational sac, may see adnexal mass, fluid in pouch of douglas
serum B-HCG levels
management of ectopic pregnancy
methotrexate
surgery - salpingectomy, salpingotomy
salpingectomy
remove fallopian tube
salpingotomy
leave damaged tube, remove embryo
antepartum haemorrhage
haemorrhage from genital tract after 24th week of pregnancy and before birth of baby
causes antepartum heamorrhage
placenta praevia placental abruption APH unknown origin local lesions of genitla tract vase praevia
placental abruption
placenta started to separate from uterine wall before birth
assoc with a retroplacental clot
placenta praevia
all or part of placenta implants in lower uterine segment and lies infront of the presenting part of the fetus
placenta praevia is more common in…
multiparous women
multiple pregnancies where placenta mass increased
woman with previous C sec
placenta praevia presentation
painless PV bleeding
soft, non-tender uterus +/- fetal malpresentation
malpresentation USS
what is bleeding in placenta praevia due to
separation of placenta as lower uterine segment forms and the cervix effaces
blood loss occurs from venous sinuses in lower segment
diagnosis of placenta praevia
USS
*vaginal examination must not be done with suspected placenta praevia
factors associated with placental abruption
pre-eclampsia chronic HTN multiple pregnancy polyhydramnios smoking inc age parity previous abruption cocaine use
types of placental abruption
revealed
concealed
mixed (revealed and concealed)