Complications of Pregnancy 1 Flashcards
Characteristics of a threatened miscarriage
- Viable pregnancy
- Vaginal bleeding +/- pain
- Closed cervix
Characteristics of an inevitable miscarriage
- Viable pregnancy
- Open cervix with bleeding
Characteristics of a missed miscarriage (early foetal demise)
- On US gestational sac seen
- No clear foetus (empty gestational sac) or a foetal pole with no foetal hear seen in the gestational sac
Characteristics of an incomplete miscarriage
- Most of pregnancy expelled out some products of pregnancy remaining n uterus
- Open cervix
- Vaginal bleeding (may be heavy)
Characteristics of a complete miscarriage
- Passed al products of conception (POC)
- Cervix closed and bleeding has stopped (should ideally have confirmed the POC or should have had a scan previously that confirmed an intrauterine pregnancy)
Aetiology of a spontaneous miscarriage
- Abnormal conceptus (chromosomal, genetic, structural)
- Uterine abnormality (congenital, fibroids)
- Cervical incompetence (primary, secondary)
- Maternal (increasing age, diabetes)
- Unkown
Management of a threatened and inevitable miscarriage
- Threatened = conservative
- Inevitable =
Management of a threatened and inevitable miscarriage
- Threatened = conservative
- Inevitable = If bleeding is heavy may need to evacuate
Management of a missed or septic miscarriage
- Missed = conservative, medical (prostaglandins e.g. misoprostol), surgical (SMM surgical management of miscarriage)
- Septic = Antibiotic and evacuate the uterus
4 risk factors for an ectopic pregnancy
- Pelvis inflammatory disease
- Previous tubal surgery
- Previous ectopic
- Assisted conception
4 symptoms of an ectopic pregnancy
- Period of amenorrhea (1 or more missed periods), with +ve urine pregnancy test
- +/- vaginal bleeding
- +/- Abdo pain
- +/- GI or urinary symptoms
Investigations to confirm ectopic pregnancy
- US
- Serum B-hCG levels (may need to serially tack levels
- Serum progesterone levels
What would be seen on an Ultrasound scan of an ectopic pregnancy
- No intrauterine gestational sac
- May see adnexal mass
- Fluid in pouch of Douglas
Management of an ectopic pregnancy
- Medical = Methotrexate
- Surgical = Mostly laproscopical salpingectomy/salpingotomy (removal of fallopian tube)
- Conservative = If pregnancy is small enough it may dissolve by itself
Define antepartum haemorrhage (APH)
Haemorrhage from genital tract after 24th week of pregnancy but before delivery
5 causes of antepartum haemorrhage (APH)
- Placenta praevia
- Placental abruption
- Local lesions of unknown origin
- Vasa praevia (very rare)(baby’s blood vessels run near the internal opening for uterus and are at risk of rupture when the membranes rupture)
- APH of unknown origin
Define Placenta Praevia and give 3 risk factors for it
- All or part of the placenta implants in the lower uterine segment
- Multiparous women
- Multiple pregnancies
- Previous caesarean section
How is placenta praevia classified
- Grade 1, Placenta encroaching on lower segment but not the internal cervical os
- Grade 2, Placenta reaches the internal os
- Grade 3, Placenta eccentrically covers the os
- Grade 4, Central placenta praevia
Presentation of placenta praevia
- Painless PV bleeding
- Malpresentation of foetus
- Soft non tender uterus +/-foetal malpresentation
- Incidental
How to diagnose placenta praevia
US to locate placental site
What must NEVER be done with a suspected placenta praevia
Never perform a vaginal exam
Management of placenta praevia
- Caesarean section
- Watch for post partum haemorrhage (PPH)
Define placental abruption
Haemorrhage due to the premature separation of the placenta before birth
6 risk factors for placental abruption
- Pre-eclampsia/chronic hypertension
- Multiple pregnancies
- Polyhydramnios (excessive amniotic fluid)
- Smoking, increasing age, parity
- Previous abruption
- Cocaine use
3 types of placental abruption
- Revealed
- Concealed
- Mixed (concealed and revealed)
Presentation of placental abruption
- Pain
- Vaginal bleeding (may be minimal)
- Increased uterine activity
Management for antepartum haemorrhage
-Will vary from expectant treatment to attempting vaginal delivery to caesarean section
-Depends on;
Amount of bleeding
Condition of mother + baby
Gestation
Complications of placental abruption
- Maternal shock, collapse (may be disproportionate to amount of bleeding seen
- Foetal Death
- Maternal DIC(clots form throughout the body), renal failure
- Postpartum haemorrhage (couvelaire uterus, life-threatening condition causes bleeding penetrates into the uterine myometrium forcing its way into the peritoneal cavity)
Define preterm labour
Onset of labour before 37 completed weeks of gestation
3 categories of preterm labour
- Mildly preterm (32-36 weeks)
- Very preterm (28-32weeks)
- Extremely preterm (24-28weeks)
Risk factors of preterm labour
- Multiple pregnancies
- Polyhydramnios
- APH
- Pre-eclampsia
- Infection e.g. UTI
- Prelabour premature rupture of membranes
Majority no cause (idiopathic)
Management of preterm delivery
- Consider possible cause (abruption, infection)
- <24-26 weeks, Generally regarded as very poor prognosis
-Cases considered viable;
Consider tocolysis to allow steroid transfer,
Steroids unless contraindicated
Transfer to NICU
Aim for vaginal delivery
Neonatal morbidity resulting from prematurity
- Respiratory distress syndrome
- Intraventricular haemorrhage
- Cerebral palsy
- Temperature control
- Jaundice
- Infections
- Visual impairment and hearing loss
