Complications of pregnancy 1 Flashcards
What is Miscarriage?
Is it common?
Miscarriage, also known as spontaneous abortion and pregnancy loss, is the natural death of an embryo or fetus before it is able to survive independently. Some use the cutoff of 24 weeks of gestation, after which fetal death is known as a stillbirth.
Miscarrige is quite common, figures claim spontaneous miscarriage occurs in around 15% of pregnancies.
What are the different categories into which miscarriage can be divided?
- Threatened
- Inevitable
- Incomplete
- Complete
- Septic
- Missed
What is a threatened miscarriage?
A threatened miscarriage refers to bleeding from the gravid uterus before 24 weeks gestation when there is a viable fetus and no evidence of cervical dilatation.
Presentations can include:
- Vaginal bleeding +/- pain
- Viable pregnancy
- Closed cervix on speculum examination
What is an inevitable miscarraige?
What are the features of this?
Viable pregnancy
Cervix is open, with heavier bleeding (+/- clots) - heavy bleeding indicates that the loss of foetus cannot be prevented.
What is a missed miscarriage and what are the features of this?
Missed abortion describes a pregnancy in which the fetus has died but the uterus has made no attempt to expel the products of conception.
No symptoms, or there may have been some bleeding/brown loss vaginally.
Gestational sac seen on scan, however there is no clear foetus )sac is empty) or no foetal pole with no foetal heart present.
What is an incomplete misscarraige and the features of this?
When there is only partial expulsion of the products of conception this is referred to as an incomplete miscarriage whilst complete expulsion of the products of conception is referred to as a complete abortion.
Most of the pregnancy is expelled out, some products of the pregnancy remain in the uterus.
Open cervic, vaginal bleeding which may be heavy.
Following an incomplete abortion there is always a risk of ascending infection into the uterus which can spread throughout the pelvis and this is known as a septic abortion.
What is a complete misscarriage and its features?
- Passed all products of conception (POC)
- Cervix is closed
- Bleeding should have stopped
- (should ideally have confirmed there was POC or had a scan confirming intrauterine pregnancy prior)
WHat is a septic miscarriage?
When infection occurs following miscarriage, this most commonl occurs follwoing an incomplete miscarriage.
What are some of the causes of Spontaneous Miscarriage?
- Abnormal conceptus
- Chromosomal
- Genetic
- Structural
- Uterine abnormality
- Congenital
- Fibroids
- Cervical incompetence - particularly in the second trimester
- Primary
- Secondary - trauma to the cervix can cause of premature dilation.
- Maternal - hormones levels such as progesterone are lower in women with threatened miscarraige, associated with the corpus luteum.
- Increasing age
- Diabetes
- Conditions - SLE, Thyroid Disease,
- Maternal Infection - general toxicity & high temp.
- Unknown
What are the managements of the following types of miscarraiges?
- Threatened
- Inevitable
- Missed
- Septic
- Threatened - Conservative Management
- Inevitable - if very heavy bleeding evacuation may be required (danger to the mother here)
- Missed
- Conservative
- Medical - prostaglandins (misoprostol)
- Surgical - SMM (Surgical Management of Miscariage)
- Septic - Antibiotcics and evaculation of uterus
What is an Ectopic Preganacy?
A pregnancy in which the fertilised egg implants outide of the endometrium of the uterus.
The most common place for ectopics to be found is in one of the fallopian tubes.
The ovary and cervix can occur but are quite uncommon.
What are the risk factors for an ectopic pregnancy?
Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception
What are the common presentations of ectopic pregnancies?
Period of ammenorhoea (with +ve urine pregnancy test)
+/- Vaginal bleeding
+/- Pain abdomen
+/- GI or urinary symptoms
What are the invesitagations of choice in an Ectopic Pregnancy?
Scan – no intrauterine gestational sac, may see adnexal mass, fluid in Pouch of Douglas (this is blood)
Serum BHCG levels – may need to serially track levels over 48 hour intervals- if a normal early intrauterine pregnancy HCG levels will increase by at least 66%ish
Serum Progesterone levels – with viable IU pregnancy high levels > 25ng/ml
What are the different types of managemnt of an ectopic pregnancy?
Medical – Methotrexate
Surgical – (mostly laparosciopical
– Salpingectomy, Salpingotomy for few indications)
Conservative – if the woman is stable…
What are the differnet classifications of Placenta praevia?
- Grade 1 - Placenta encroaching on the lower segment, but hasnt reached the internal cervical os.
- Grade 2 - Placenta has reached the internal os.
- Grade 3 - Placenta eccentrically covers the os.
- Grade 4 - Central placenta praevia
What are the clinical types of Placental Abruption?
-
Revealed
- The major haemorrhage is apparent externally becuase the blood released from teh placenta escapes through the cervical os.
-
Concealed
- Haemorrhage occurs between the placenta and the uterine wall. Uterine contents increase in volume and the volume of fundus would be larger than it should be for gestational age. In some situations the blood penetrates the uterine wall and the uterus appears bruised (Couvelaire uterus).
-
Mixed
- Both revealed and concealed haemorrhage are present.
