Complications of Pregnancy 1

Question 1

What is an abortion/spontaneous miscarriage?

Answer 1

Termination/loss of pregnancy before 24 weeks (with no evidence of life)

Question 2

What is the incidence of spontaneous miscarriage?

Answer 2

15%

Question 3

What are the types of spontaneous miscarriage?

Answer 3

Threatened
Inevitable 
Incomplete
Complete
Septic
Missed

Question 4

What is a threatened miscarriage?

Answer 4

Bleeding from gravid uterus <24 weeks where fetus is viable with NO EVIDENCE of cervical dilation

Question 5

When does abortion become “inevitable”?

Answer 5

When the cervix begins to dilate

Question 6

What is a septic abortion?

Answer 6

Incomplete abortion leading to an ascending infection into the uterus, leading to PID

Question 7

What is a missed abortion?

Answer 7

Pregnancy where fetus dies but the uterus makes no attempt to expel to the products

Question 8

How does a threatened miscarriage present?

Answer 8

Vaginal bleeding +/- pain
Viable pregnancy
Closed cervix

Question 9

How does an inevitable miscarriage present?

Answer 9

Viable pregnancy

Open cervix with ?heavy bleeding +/- clots

Question 10

How does a missed miscarriage present?

Answer 10

Asymptomatic
or
Brown/bleeding vaginal loss

Question 11

How is missed miscarriage found?

Answer 11

Gestational sac on scan

No clear fetus/fetal pole/no fetal heart

Question 12

How does an incomplete miscarriage present?

Answer 12

Most of pregnancy expelled out, some products remaining
Open cervix
Vaginal bleeding ?heavy

Question 13

When is septic miscarriage most likely?

Answer 13

Cases of incomplete miscarriage

Question 14

How does a complete miscarriage present?

Answer 14

Passed all products of conception
Cervix closed
Bleeding stopped

Question 15

How should a complete miscarriage be managed?

Answer 15

Confirmed by scan

Question 16

What are the main causes of spontaneous miscarriage?

Answer 16

Abnormal conceptus
Unknown
Maternal
Uterine abnormality
Cervical incompetence

Question 17

What are the most common abnormal concepti leading to miscarriage?

Answer 17

Chromosomal
Genetic
Structural

Question 18

What are the most common uterine abnormalities leading to miscarriage?

Answer 18

Congenital issues

Fibroids

Question 19

What are the most common maternal factors leading to miscarriage?

Answer 19

Increasing age

Diabetes

Question 20

How is threatened miscarriage managed?

Answer 20

Conservative management

Question 21

How is inevitable miscarriage managed?

Answer 21

Evacuation if bleeding is heavy

Question 22

How is missed miscarriage managed?

Answer 22

Conservative
Medical - prostaglandins (Misoprostol)
Surgical - SMM (surgical management of miscarriage)

Question 23

How is septic miscarriage managed?

Answer 23

Evacuate uterus

Antibiotics

Question 24

What is the most common type of ectopic pregnancy?

Answer 24

Ampullary Tubal ectopic

Then isthmus, then cornual

Question 25

How common are ectopic pregnancies?

Answer 25

1 in 90 pregnancies

Question 26

What are the risk factors for ectopic pregnancies?

Answer 26

``` (damage to fallopian tubes) PID Previous Tubal surgery Previous ectopic Assisted conception ```

Question 27

What is the presentation of ectopic pregnancy?

Answer 27

``` Period of ammenorrhoea (+ +ve pregnancy test) Maybe: Vaginal bleeding Painful abdomen GI/urinary symptoms ```

Question 28

How should a suspected ectopic pregnancy be investigated?

Answer 28

Scan Serum beta-hCG levels tracked over 48hrs Serum Progesterone

Question 29

How will ectopic pregnancies appear on scan?

Answer 29

No intrauterine gestational sac Possible adnexal mass Fluid in pouch of Douglas

Question 30

How are ectopic pregnancies managed?

Answer 30

Methotrexate | Salpingectomy/Salpingotomy

Question 31

What is antepartum haemorrhage?

Answer 31

APH - haemorrhage from genital tract after 24th week of pregnancy, before delivery of baby

Question 32

Antepartum haemorrhage is associated with what?

Answer 32

Significant maternal & neonatal morbidity and mortality

Question 33

What are the causes of Antepartum haemorrhage?

Answer 33

``` Placenta praevia Placental abruption Unknown Local lesions of genital tract Vasa praevia ```

Question 34

What is placenta praevia?

Answer 34

All/part of placenta implants in the lower uterine segment

Question 35

What is the incidence of placenta praevia?

Answer 35

1 in 200 pregnancies

Question 36

When is placenta praevia more common?

Answer 36

Multiparous women Multiple pregnancies Previous C-sections

Question 37

How is placenta praevia classified?

Answer 37

Grade I - IV Grade I - encroaching lower segment (not in os) Grade II - Placenta reaches the internal os Grade III - Placenta eccentrically covers the os Grade IV - Central placenta praevia

Question 38

How does placenta praevia present?

Answer 38

Painless PV bleeding Malpresentation of fetus Incidental finding Soft, non-tender uterus

Question 39

How is placenta praevia diagnosed?

Answer 39

USS to locate placental site | DO NOT DO VAGINAL EXAM

Question 40

How is placenta praevia managed?

Answer 40

Depends on gestation and degree of bleeding C-section OBSERVE FOR PPH

Question 41

How is PPH managed?

Answer 41

Medical - Oxytocin, Ergometrine, Carbaprost, Tranexamic acid | Surgical - Balloon tamponade, Ligation of uterine vessels

Question 42

What is placental abruption?

Answer 42

Haemorrhage resulting from premature separation of placenta before birth

Question 43

What is the incidence of placental abruption?

Answer 43

0.6%

Question 44

Placental abruption is associated with what?

Answer 44

Retroplacental clot

Question 45

Incidence of placental abruption is associated with what?

Answer 45

``` Cocaine use Previous abruption Pre-eclampsia/HTN Polyhydramnios Maternal age Parity Social status Smoking ```

Question 46

What are the types of placental abruption?

Answer 46

Revealed Concealed Mixed

Question 47

What is a revealed placental abruption?

Answer 47

Major haemorrhage revealed as blood escapes and passes through os

Question 48

What is a concealed placental abruption?

Answer 48

Blood is concealed behind the placenta, increasing fundal height consistent with gestation Uterus appears bruised (Couvelaire uterus)

Question 49

How does placental abruption present?

Answer 49

PAIN Vaginal bleed (may be minimal) Increased uterine activity

Question 50

How is placental abruption managed?

Answer 50

Varies depending on volume of bleed, condition of mother, gestation Vaginal delivery Immediate C-section

Question 51

What complications are associated with placental abruption?

Answer 51

Maternal shock - collapse Fetal death Maternal DIC, renal failure Post-artum haemorrhage

Question 52

What is the range of preterm labour?

Answer 52

32-36 wks mildly preterm 28-32 wks very preterm 24-28 wks extremely preterm

Question 53

What are the types of preterm labour?

Answer 53

Spontaneous | Iatrogenic (induced)

Question 54

What is the incidence of preterm labour?

Answer 54

5-7% in singletons | 30-40% in multiples

Question 55

What factors predispose preterm labour?

Answer 55

``` Multiple pregnancy Polyhydramnios Antepartum Haemorrhage Pre-eclampsia Infection Premature rupture of membranes ```

Question 56

What is the largest cause of preterm labour?

Answer 56

Idiopathic

Question 57

How is preterm labour managed?

Answer 57

Confirm: Contractions with evidence of cervical change | Consider cause

Question 58

How is <24-26wk preterm labour managed?

Answer 58

``` Poor prognosis All considered viable: Consider tocolysis Steroids unless contraindicated Transfer to NICU Aim for vaginal delivery ```

Question 59

What neonatal morbidities occur due to prematurity?

Answer 59

``` IRDS Intraventricular haemorrhage Cerebral palsy Nutrition issues Temperature control Jaundice Infections Visual impairment Hearing loss ```