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Year 3 > Complications of Pregnancy 1 > Flashcards

Complications of Pregnancy 1 Flashcards

1
Q

what is a spontaneous miscarriage?

A

a termination/loss of pregnancy before 24 weeks gestation

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2
Q

list the types of spontaneous miscarriage

A 
threatened
inevitable
incomplete
complete
septic 
missed
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3
Q

what is a threatened miscarriage?

A

This results in vaginal bleeding with or without pain in a viable pregnancy. Upon speculum examination the cervix is closed.

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4
Q

what is an inevitable miscarriage?

A

This is a viable pregnancy, but the cervix is open. Bleeding may be heavy and may have clots.

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5
Q

what is a missed miscarriage?

A

There is no symptoms of this but there may be bleeding/brown loss vaginally. On scanning a gestational sac can be seen. However, the sac is empty with no clear foetus or a foetal pole with no foetal heart seen in the gestational sac.

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6
Q

what is an incomplete miscarriage?

A

Most of the pregnancy is expelled out but some products of the pregnancy remain in the uterus. The cervix is open and there is vaginal bleeding which may be heavy.

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7
Q

what is a complete miscarriage?

A

A complete miscarriage is when all the products of conception (POC) are passed. The cervix is closed, and bleeding has stopped. Ideally it should have confirmed the POC or should have had a scan previously that confirmed an intrauterine pregnancy.

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8
Q

what kind of miscarriages are most likely to be septic?

A

incomplete

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9
Q

causes of spontaneous miscarriage

A 
• Abnormal conceptus
o Chromosomal, genetic, structural
• Uterine abnormality
o Congenital, fibroids
• Cervical incompetence
o Primary, secondary
• Maternal
o Increasing age, diabetes
• Unknown
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10
Q

management of miscarriage: threatened

A

conservative

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11
Q

management of miscarriage: inevitable

A

if bleeding may need evacucation

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12
Q

management of miscarriage: missed

A

conservative
medical - PGs (misoprostol)
surgical - SMM (surgical management of miscarriage)

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13
Q

management of miscarriage: septic

A

antibiotics and evacuation

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14
Q

what is an ectopic pregnancy?

A

pregnancy that is implanted outside the uterine cavity

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15
Q

ectopic pregnancy: risk factors

A

PID
previous tubal surgery
previous ectopic
assisted conception

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16
Q

ectopic pregnancy: presentation

A 
• Period of amenorrhoea
(with +ve urine pregnancy test)
• +/- vaginal bleeding
• +/- pain in abdomen
• +/- GI or urinary symptoms
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17
Q

ectopic pregnancy: common sites

A 
ampullary
isthmus
interstital
ovary
cervix
intraabdominal
18
Q

ectopic pregnancy: investigations

A

On scanning no intrauterine gestational sac can be seen. It may be possible to see an adnexal mass or fluid in the Pouch of Douglas. Serum BHCG levels, may need to serially track levels over 48hr intervals, if a normal early intrauterine pregnancy HCG levels will increase by at least 66%. With a viable IU pregnancy serum progesterone levels are high at >25ng/ml

19
Q

ectopic pregnancy: management

A

• Medical
o Methotrexate
• Surgical
o Mostly laparoscopically – salpingectomy, salpingotomy for a few indications

20
Q

what is antepartum haemorrhage?

A

haemorrhage from the genital tract after the 24th week of pregnancy but before delivery of the baby

21
Q

causes of antepartum haemorrhage

A 
• Placenta praevia
• Placental abruption
• APH of unknown origin
Figure 3 Sites of Ectopic Pregnancy
Figure 4 Ectopic Pregnancy
• Local lesions of the genital tract
• Vasa praevia (very rare)
22
Q

what is placenta praevia?

A

all or part of the placenta impants in thelower uterine segment

23
Q

placenta praevia: risk factors

A

multiparous
multiple pregnancies
previous c section

24
Q

placenta praevia classification: grade 1

A

placenta encroaching on the lower segment but not the internal cervical os

25
Q

placenta praevia classification: grade 2

A

placenta reaches the inernal os

26
Q

placenta praevia classification: 3

A

placental eccentrically covers the os

27
Q

placenta praevia classification: 4

A

central placenta praevia

28
Q

placenta praevia: presentation

A

painless PV bleeding
malpresentation of the foetus
incidental

29
Q

placenta praevia: diagnosis

A

USS to locate the placental site

30
Q

what must you not perform on a woman with placenta praevia?

A

vaginal exam

31
Q

placenta praevia: management

A

gestation
severity
if performing a c-section watch for PPH

32
Q

managment of PPH

A

• Medical
o Oxytocin, ergometrine, carbaprost, tranexamic acid
• Balloon tamponade
• Surgical
o B Lynch cutre, ligation of uterine and iliac vessels, hysterectomy

33
Q

what is placenta abruption?

A

This is haemorrhage resulting from premature separation of the placenta before the birth of the baby.

34
Q

factors associated the placental abruption

A
  • Pre-eclampsia/chronic hypertension
  • Multiple pregnancy
  • Polyhydramnios
  • Smoking, increasing age, parity
  • Previous abruption
  • Cocaine use
35
Q

types of placental abruption

A

revealed
concealed
mixed

36
Q

presentation of placental abruption

A

o Pain
o Vaginal bleeding (may be minimal)
o Increased uterine activity

37
Q

complications of placental abruption

A
  • Maternal shock, collapse (may be disproportionate to the amount of bleeding seen)
  • Foetal death
  • Maternal DIC, renal failure
  • PPH
  • Couvelaire uterus
38
Q

general managemnt of APH

A 
Management will vary from expectant treatment to attempting a vaginal delivery to immediate Csection
depending on:
1. Amount of bleeding
2. General condition of mother and baby
Figure 8 Classification of Abruption
3. Gestation
39
Q

what is preterm labour

A

Preterm labour is defined as the onset of labour before 37 completes weeks gestation (259 days). Mildly preterm if born 32-36 weeks, from 28-32 weeks it is known as very preterm, and from 24-28 weeks it is known as extremely preterm. Preterm labour may be spontaneous or induced.

40
Q

predisposing factors to preterm labour

A

• Multiple pregnancy
• Polyhydramnios
• APH
• Pre-eclampsia
• Infection e.g. UTI
• Prelabour premature rupture of membranes
In the majority there is no cause (idiopathic).

41
Q

managment of preterm labour

A

Diagnose by identifying contractions with evidence of cervical change on VE. Consider the possible
causes such as abruption and infection.
• <24-26 weeks
o Generally regarded as very poor prognosis
o Decisions made in discussion with parents and neonatologists
• All cases considered viable
o Consider tocolysis to allow steroids/transfer
o Steroids unless contraindicated
o Transfer to unit with NICU facilities
o Aim for vaginal delivery
Preterm delivery is a major cause of perinatal mortality and morbidity. It is gestation dependent

42
Q

neonatal morbidity resulting from prematurity

A
  • Respiratory distress syndrome
  • Intraventricular haemorrhage
  • Cerebral palsy
  • Nutrition
  • Temperature control
  • Jaundice
  • Infections
  • Visual impairment
  • Hearing loss

Year 3 (164 decks)

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