Complications of Pregnancy 1 Flashcards
what is a spontaneous miscarriage?
a termination/loss of pregnancy before 24 weeks gestation
list the types of spontaneous miscarriage
threatened inevitable incomplete complete septic missed
what is a threatened miscarriage?
This results in vaginal bleeding with or without pain in a viable pregnancy. Upon speculum examination the cervix is closed.
what is an inevitable miscarriage?
This is a viable pregnancy, but the cervix is open. Bleeding may be heavy and may have clots.
what is a missed miscarriage?
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.
what is an incomplete miscarriage?
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.
what is a complete miscarriage?
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.
what kind of miscarriages are most likely to be septic?
incomplete
causes of spontaneous miscarriage
• Abnormal conceptus o Chromosomal, genetic, structural • Uterine abnormality o Congenital, fibroids • Cervical incompetence o Primary, secondary • Maternal o Increasing age, diabetes • Unknown
management of miscarriage: threatened
conservative
management of miscarriage: inevitable
if bleeding may need evacucation
management of miscarriage: missed
conservative
medical - PGs (misoprostol)
surgical - SMM (surgical management of miscarriage)
management of miscarriage: septic
antibiotics and evacuation
what is an ectopic pregnancy?
pregnancy that is implanted outside the uterine cavity
ectopic pregnancy: risk factors
PID
previous tubal surgery
previous ectopic
assisted conception
ectopic pregnancy: presentation
• Period of amenorrhoea (with +ve urine pregnancy test) • +/- vaginal bleeding • +/- pain in abdomen • +/- GI or urinary symptoms
ectopic pregnancy: common sites
ampullary isthmus interstital ovary cervix intraabdominal
ectopic pregnancy: investigations
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
ectopic pregnancy: management
• Medical
o Methotrexate
• Surgical
o Mostly laparoscopically – salpingectomy, salpingotomy for a few indications
what is antepartum haemorrhage?
haemorrhage from the genital tract after the 24th week of pregnancy but before delivery of the baby
causes of antepartum haemorrhage
• 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)
what is placenta praevia?
all or part of the placenta impants in thelower uterine segment
placenta praevia: risk factors
multiparous
multiple pregnancies
previous c section
placenta praevia classification: grade 1
placenta encroaching on the lower segment but not the internal cervical os
placenta praevia classification: grade 2
placenta reaches the inernal os
placenta praevia classification: 3
placental eccentrically covers the os
placenta praevia classification: 4
central placenta praevia
placenta praevia: presentation
painless PV bleeding
malpresentation of the foetus
incidental
placenta praevia: diagnosis
USS to locate the placental site
what must you not perform on a woman with placenta praevia?
vaginal exam
placenta praevia: management
gestation
severity
if performing a c-section watch for PPH
managment of PPH
• Medical
o Oxytocin, ergometrine, carbaprost, tranexamic acid
• Balloon tamponade
• Surgical
o B Lynch cutre, ligation of uterine and iliac vessels, hysterectomy
what is placenta abruption?
This is haemorrhage resulting from premature separation of the placenta before the birth of the baby.
factors associated the placental abruption
- Pre-eclampsia/chronic hypertension
- Multiple pregnancy
- Polyhydramnios
- Smoking, increasing age, parity
- Previous abruption
- Cocaine use
types of placental abruption
revealed
concealed
mixed
presentation of placental abruption
o Pain
o Vaginal bleeding (may be minimal)
o Increased uterine activity
complications of placental abruption
- Maternal shock, collapse (may be disproportionate to the amount of bleeding seen)
- Foetal death
- Maternal DIC, renal failure
- PPH
- Couvelaire uterus
general managemnt of APH
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
what is preterm labour
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.
predisposing factors to preterm labour
• Multiple pregnancy
• Polyhydramnios
• APH
• Pre-eclampsia
• Infection e.g. UTI
• Prelabour premature rupture of membranes
In the majority there is no cause (idiopathic).
managment of preterm labour
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
neonatal morbidity resulting from prematurity
- Respiratory distress syndrome
- Intraventricular haemorrhage
- Cerebral palsy
- Nutrition
- Temperature control
- Jaundice
- Infections
- Visual impairment
- Hearing loss
