Complications of early pregnancy Flashcards
Miscarriage - def & types
- Spontaneous loss of a pregnancy before 24 weeks gestation
- First Trimester: before 13 weeks
- Complete miscarriage: all products expelled and bleeding stopped
- Threatened: when a patient knows she is pregnant, she is bleeding but she hasn’t not miscarriaged yet
- Missed miscarriage: pregnancy failed but no bleeding
- Recurrent: spontaneous consecutive loss of three pregnancies before 24 weeks gestation
Miscarriage - Causes
Foetal:
- abnormal zygotic development
- aneuploid abortion
Maternal:
- Systemic: infectious, chronic d/s, TB, carcinomatosis, coeliac sprue
- Local: trauma, Asherman’s syndrome, uterine leiomyomas, incompetent cervix
- Endocrine: hypothyroidism, DM, progesterone deficiency
- Env: smoking, alcohol, caffeine, radiation
Paternal
Miscarriage - S&S
- Known pregnancy or period of amenorrhoea present with vaginal bleeding prior 24 week gestation
- Lower abdominal cramping
- LBP
Miscarriage - Management
o Hospital- USS
o Threatened miscarriage: if bleeding gets worse or persists for 14 days- return for assessment otherwise normal ANC
o Depending on type: complete no Rx, missed/incomplete miscarriage-misoprostol (vaginal or oral), surgery (suction or ERPC)
Ectopic pregnancy - what is it?
= Pregnancy outside uterine cavity
Ectopic pregnancy - where?
Most tubal, can occur abdomen, ovary, cervix, caesarean scar
Heterotopic pregnancy - def
Multiple gestation with 1 in the uterine cavity & the other outside of the uterus
Ectopic pregnancy - causes
Fallopian tube damage
Ectopic pregnancy - risks
- Previous ectopic
- PID
- Damage due to surgery (sterilisation, reversal sterilisation, tubal reconstruction)
- IUD
- Assisted fertility
- Smoking, age
- Multiple partners
Ectopic pregnancy - Cx
maternal death tubal rupture intra-abdominal bleeding spontaneous abortion recurrence
Ectopic pregnancy - S&S
o Abdominal/pelvic pain o GI symptoms o Fainting, dizziness o Low BP o Shoulder tip pain o Vaginal bleeding o May not have symptoms of pregnancy (+ hCG)
Ectopic pregnancy - Tx
o Wait and see but monitored -hCG
o Drug: methotrexate then monitor
o Surgery: emergency
Trophoblastic disorder - what is it?
- Hydatidiform/ molar pregnancy: unsuccessful pregnancy- issues with development
- Can contain no foetal tissue
Trophoblastic disorder - When is it more common?
- More common at extremes of fertility age- early or perimenopausal
- Over 35 years ➤ 2 fold risk, over 40 ➤ 5 to 10 fold risk
Trophoblastic disorder - S&S
o Through routine USS
o Positive hCG
o Vaginal bleeding- 50% cases
o Hyperemesis: high hCG
o Signs of hyperthyroidism due to high levels of hCG
o Examination- wrong size for dates, ovarian cysts, bulky uterus
o Rarely: twins- viable foetus and mole
Trophoblastic disorder - Ix
o Bloods: platelets and look for anaemia, liver function tests o Clotting o Beta-hCG o USS o Imaging- chest X-ray
Trophoblastic disorder - Tx
o Surgery
o Treatment
o Considered malignant if serum hCG levels plateau or rise once pregnancy removed- 15- 20% cases
o 1 in 500-600 pregnancies will be choriocarcinoma - increases with age
o If neoplastic- staging
o Metastases- lungs, brain, liver, GI tract
N&V in pregnancy - causes
o hCG
o Oestrogen
o Nutritional deficiency (hyperemesis gravidarium deficient in vitamin B6)
o Gastric dysfunction- increased progesterone
Hyperemesis gravudarum - S&S
prolonged nausea and vomiting
dehydration
electrolyte imbalance
ketosis
N&V in pregnancy - associated factors
o Female foetus o Previous history in pregnancies o History of motion sickness o History of migraines o First pregnancy o Obesity o Stress
N&V in pregnancy - Management
o History: onset, duration, what is being tolerated, associated symptoms, coexisting conditions eg diabetes
o Examine for dehydration, test for ketones
o Reassure
o Small frequent meals, drink little and often
o Ginger and acupressure (NICE, 2008) evidence weak
o Rest
o Urgent medical care: very dark urine, abdominal pain, fever, faint, dizziness, vomiting blood, inability to keep food or fluids down for 24 hours
