Complications of Pregnancy 1 Flashcards
What is an abortion/spontaneous miscarriage?
Termination/loss of pregnancy before 24 weeks (with no evidence of life)
What is the incidence of spontaneous miscarriage?
15%
What are the types of spontaneous miscarriage?
Threatened Inevitable Incomplete Complete Septic Missed
What is a threatened miscarriage?
Bleeding from gravid uterus <24 weeks where fetus is viable with NO EVIDENCE of cervical dilation
When does abortion become “inevitable”?
When the cervix begins to dilate
What is a septic abortion?
Incomplete abortion leading to an ascending infection into the uterus, leading to PID
What is a missed abortion?
Pregnancy where fetus dies but the uterus makes no attempt to expel to the products
How does a threatened miscarriage present?
Vaginal bleeding +/- pain
Viable pregnancy
Closed cervix
How does an inevitable miscarriage present?
Viable pregnancy
Open cervix with ?heavy bleeding +/- clots
How does a missed miscarriage present?
Asymptomatic
or
Brown/bleeding vaginal loss
How is missed miscarriage found?
Gestational sac on scan
No clear fetus/fetal pole/no fetal heart
How does an incomplete miscarriage present?
Most of pregnancy expelled out, some products remaining
Open cervix
Vaginal bleeding ?heavy
When is septic miscarriage most likely?
Cases of incomplete miscarriage
How does a complete miscarriage present?
Passed all products of conception
Cervix closed
Bleeding stopped
How should a complete miscarriage be managed?
Confirmed by scan
What are the main causes of spontaneous miscarriage?
Abnormal conceptus Unknown Maternal Uterine abnormality Cervical incompetence
What are the most common abnormal concepti leading to miscarriage?
Chromosomal
Genetic
Structural
What are the most common uterine abnormalities leading to miscarriage?
Congenital issues
Fibroids
What are the most common maternal factors leading to miscarriage?
Increasing age
Diabetes
How is threatened miscarriage managed?
Conservative management
How is inevitable miscarriage managed?
Evacuation if bleeding is heavy
How is missed miscarriage managed?
Conservative
Medical - prostaglandins (Misoprostol)
Surgical - SMM (surgical management of miscarriage)
How is septic miscarriage managed?
Evacuate uterus
Antibiotics
What is the most common type of ectopic pregnancy?
Ampullary Tubal ectopic
Then isthmus, then cornual
How common are ectopic pregnancies?
1 in 90 pregnancies
What are the risk factors for ectopic pregnancies?
(damage to fallopian tubes) PID Previous Tubal surgery Previous ectopic Assisted conception
What is the presentation of ectopic pregnancy?
Period of ammenorrhoea (+ +ve pregnancy test) Maybe: Vaginal bleeding Painful abdomen GI/urinary symptoms
How should a suspected ectopic pregnancy be investigated?
Scan
Serum beta-hCG levels tracked over 48hrs
Serum Progesterone
How will ectopic pregnancies appear on scan?
No intrauterine gestational sac
Possible adnexal mass
Fluid in pouch of Douglas
How are ectopic pregnancies managed?
Methotrexate
Salpingectomy/Salpingotomy
What is antepartum haemorrhage?
APH - haemorrhage from genital tract after 24th week of pregnancy, before delivery of baby
Antepartum haemorrhage is associated with what?
Significant maternal & neonatal morbidity and mortality
What are the causes of Antepartum haemorrhage?
Placenta praevia Placental abruption Unknown Local lesions of genital tract Vasa praevia
What is placenta praevia?
All/part of placenta implants in the lower uterine segment
What is the incidence of placenta praevia?
1 in 200 pregnancies
When is placenta praevia more common?
Multiparous women
Multiple pregnancies
Previous C-sections
How is placenta praevia classified?
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
How does placenta praevia present?
Painless PV bleeding
Malpresentation of fetus
Incidental finding
Soft, non-tender uterus
How is placenta praevia diagnosed?
USS to locate placental site
DO NOT DO VAGINAL EXAM
How is placenta praevia managed?
Depends on gestation and degree of bleeding
C-section
OBSERVE FOR PPH
How is PPH managed?
Medical - Oxytocin, Ergometrine, Carbaprost, Tranexamic acid
Surgical - Balloon tamponade, Ligation of uterine vessels
What is placental abruption?
Haemorrhage resulting from premature separation of placenta before birth
What is the incidence of placental abruption?
0.6%
Placental abruption is associated with what?
Retroplacental clot
Incidence of placental abruption is associated with what?
Cocaine use Previous abruption Pre-eclampsia/HTN Polyhydramnios Maternal age Parity Social status Smoking
What are the types of placental abruption?
Revealed
Concealed
Mixed
What is a revealed placental abruption?
Major haemorrhage revealed as blood escapes and passes through os
What is a concealed placental abruption?
Blood is concealed behind the placenta, increasing fundal height consistent with gestation
Uterus appears bruised (Couvelaire uterus)
How does placental abruption present?
PAIN
Vaginal bleed (may be minimal)
Increased uterine activity
How is placental abruption managed?
Varies depending on volume of bleed, condition of mother, gestation
Vaginal delivery
Immediate C-section
What complications are associated with placental abruption?
Maternal shock - collapse
Fetal death
Maternal DIC, renal failure
Post-artum haemorrhage
What is the range of preterm labour?
32-36 wks mildly preterm
28-32 wks very preterm
24-28 wks extremely preterm
What are the types of preterm labour?
Spontaneous
Iatrogenic (induced)
What is the incidence of preterm labour?
5-7% in singletons
30-40% in multiples
What factors predispose preterm labour?
Multiple pregnancy Polyhydramnios Antepartum Haemorrhage Pre-eclampsia Infection Premature rupture of membranes
What is the largest cause of preterm labour?
Idiopathic
How is preterm labour managed?
Confirm: Contractions with evidence of cervical change
Consider cause
How is <24-26wk preterm labour managed?
Poor prognosis All considered viable: Consider tocolysis Steroids unless contraindicated Transfer to NICU Aim for vaginal delivery
What neonatal morbidities occur due to prematurity?
IRDS Intraventricular haemorrhage Cerebral palsy Nutrition issues Temperature control Jaundice Infections Visual impairment Hearing loss
