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YEAR 3 REPRO > Complications of pregnancy 1 > Flashcards

Complications of pregnancy 1 Flashcards

1
Q

definition of abortion or spontaneous miscarriage

A

(abortion is termination) miscarriage is spontaneous loss of pregnancy before 24 weeks gestation

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2
Q

what is the incidence of psontaneous miscarriage?

A

15%

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3
Q

what is a threatened miscarriage ?

A

bleeding from the gravid uterus before 24 weeks gestation, when there is still a viable fetus but no evidecne of cervical dilatation

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4
Q

what is an inevitable miscarriage?

A

there is a open cervix with bleeding however the fetus is still viable

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5
Q

what is septic miscarriage?

A

following an incomplete abortion there is a risk of ascending infection into the uterus which can spread throughout the pelvis

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6
Q

what is an incomplete miscarriage?

A

When there is only partial expulsion of the products of conception, there is an open cervix and vaginal bleeding

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7
Q

what is a missed miscarriage?

A

when the fetus has died but the uterushas made no attempt to expel the products of conception, gestation sac seen in scan but there is no clear fetus

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8
Q

what is a complete miscarriage?

A

all products of conception are passed, the cervix is closed and bleeding has stopped

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9
Q

Aetiology of a spontaneous miscarriage

A 
abnormal conceptus (chromosomal, genetic or structural), uterine abnormality (congenital, fibroids), cervical incompetence (1 or 2dary), maternal (age, DM).
PCOS, hypothyroidism, SLE, protein s and c deficiency, anti-phospholipid syndrome, fibroids etc…
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10
Q

what are the ways the fetal development may be abnormal?

A

chromosomal, genetic or structural

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11
Q

name 2 diseases (maternal) which increase the risk of miscarriage

A

SLE (systemic lupus erythematous) and thyroid disease. PCOS, hypothyroidism, SLE, protein s and c deficiency, anti-phospholipid syndrome, fibroids etc…

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12
Q

name 2 acute infections which may cause miscarriage?

A

pyelitis and appendicitis, by causing a general toxic illness with high temperature can stimulate uterine activity and loss of pregnancy.

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13
Q

Ix for misscarriage?

A

FSH, LH, TFT, Prolactin, testosterone, protein c and s, coag studies. USS, hysteroscopy, karyotype.

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14
Q

Mx of a missed miscarriage

A

prostaglandins, surgical and conservative

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15
Q

Mx of a septic miscarriage

A

Abx and evacuation of the uterus

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16
Q

advice for pre-pregnency

A

don’t travel post 24 weeks, folic acid 3 months prior to conception an during pregnancy, avoid cats (toxoplasmosis), smoking cessation, alcohol avoidance, use of unsfe medications, optimism control of DM.

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17
Q

common case seen –>

A

Recurrent spontaneous miscarriages - loss of 3 or more foetuses under 500g in weight, Case: 34f, vaginal bleeding and abdo pain, 22wks pregnant, 3 previous miscarriages.

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18
Q

Define - ECTOPIC PREGNANCY

A

pregnancy implanted outside the uterine cavity

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19
Q

what is the most common site of an ectopic pregnancy (list in order of most to least common)

A

Amupllary, isthmus, interstitial, ovary, cervical, fimbrial (very rare)

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20
Q

what is the incidence of a ectopic pregnancy?

A

1 in 90

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21
Q

RF of an ectopic pregnancy

A

(PID) pelvic inflamatory disease, previous tubal surgery, endometriosis, previous ectopic, assisted contraception, failed sterilisaiton.

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22
Q

DDX for ectopic pregnancy…

A

appendicitis, ovarian cyst rupture, misscarriage, late period, PID, PCOS

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23
Q

Presentation?

A

Lower abdomen pain, period of ammenhorhoaea, with a positive pregnancy test, vagincal bleeding, GI or urinary symptoms

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24
Q

what does a presentation of pain in the shoulder mean?

A

Ruptured ectopic pregnancy!

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25
Q

Ix?

A

Scan, serum Beta human chorionic gonadotropin (BHCG) levels, serum progesterone levels. Bloods - crp, fbc, u and e, serum beta HCG. Urinary pregnancy test.

26
Q

wha is seen on the scan in an ectopic pregnancy?

A

no intrauterine sac, may see adnexal mass, fluid in rectouterine pouch (pouch of douglas)

27
Q

what is a BHCG test?

A

Abeta HCGtest is a blood test used to diagnose pregnancy, and usually becomes positive around the time of the first missed period (it is produced by the placenta)

28
Q

Mx?

A

Methotrexate, surgical excision (salpingectomy laproscopically) or conservative. Prepare for surgery: iv fluids, roiutine bloods to group and save, keep NBM, obtian consent.

29
Q

what does methotrexate do?

A

shrinks the pregnancy tissue

30
Q

Define ANTEPARTUM HAEMORRHAGE (APH)

A

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

31
Q

list the causes of APH

A

placenta previa, placental abruption, APH of unknown origin, local lesions of the genital tract, vasa previa

32
Q

Urgent Mx of APH

A

ABC then iv access and fluids, blood bank for urgent blood, take to theatre for an urgent caesarean and possible hysterectomy.

33
Q

define PLACENTA PREVIA

A

where the placenta is implanted into the lower segment of the uterus and lies infront of the presenting part of the fetus

34
Q

in what cases is placental previa most common? RF’s…

A

Previous placenta previa, multiparous women, multiple pregnancies, previous caesarian section. (1 in 200 incidence)

35
Q

3 types of PP are

A

lateral, marginal central

36
Q

Classify Grade 1 (MARGINAL)

A

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

37
Q

Classify Grade 2 (LATERAL)

A

placenta reaches the internal os

38
Q

Classify Grade 3 (CENTRAL)

A

placenta eccentrically/ slightly covers the os

39
Q

Classify Grade 4 (CENTRAL)

A

central placent praevia

40
Q

Px of placenta praevia?

A

painless vaginal bleeding, malpresentation of the uterus, incidental finding

41
Q

clincical features of placenta praevia

A

soft, non tender uterus with or without fetal malpresentation

42
Q

what Ix are done?

A

USS

43
Q

what Ix must you not do if there is suspected placenta praevia?

A

A Vaginal exam

44
Q

Mx of placenta praevia?

A

Caesarian section, also watch for PPH. Mx is dependent of the gestaiton and severity.

45
Q

Define PPH (POSTPARTUM HAEMORRHAGE)

A

PPH is classified as a genital blood loss of above 500ml within the first 24 hours of giving birth. This may come from the uterus, cervix, vagina or labia

46
Q

cause of PPH

A

Poor contraction of the uterus following childbirth. Not all of the placenta being delivered, a tear of the uterus, or poor blood clotting are other possible causes. It occurs more commonly in those who: already have a low amount of red blood, are Asian, with bigger or more than one baby, are obese or are older than 40 years of age

47
Q

CAUSES OF PPH… THE 4 T’S

A

Tone - prolonged labour, multiple pregnancy

Trauma - Cesarean, instrumental delivery, episiotomy

Tissue - retained placenta, placenta accretta

Thrombin - coagulopathies (secondary to pre-eclampsia/sepsis/anticoagulants)

48
Q

what is the Mx of PPH?

A

OXYTOCIN, ERGOTAMINE, carboprost, balloon tamponade, blood transfusions, surgical (B lynch suture, ligation of uterine or iliac vessels or a hysterectomy)

49
Q

Define PLACENTLA ABRUPTION

A

Haemorrhage resulting from premature separation of the placenta before the birth of the baby (incididence of 0.6% of all pregnancies), where the placenta has started to separate from the uterine wall before the birth of the baby and is associated with a retroplacental clot.

50
Q

What are the factors associated with placental abruption?

A

pre-eclampsia, multiple pregnancy, polyhydramnios (excessive accumulation of amniotic fluid), smoking, age, parity (number of pregnancies), previous abruption, cocaine use

51
Q

types of placental abruption

A

revealed, concealed, mixed

52
Q

Px of placental abruption

A

Abdominal pain, vaginal bleeding, increased uterine activity

53
Q

Complications of placental abruption

A

maternal shock, fetal death, Maternal DIC (Disseminated intravascular coagulation is a condition in which blood clots form throughout the body, blocking small blood vessels), renal failure, PPH.

54
Q

Define PRETERM LABOUR

A

onset of labour before 37 completed weeks gestation, 24-28 extremely preterm, 28-32 is very preterm, 32-36 weeks is mildly preterm, this may be spontaneous or induced

55
Q

what are the predisposing factors to preterm labour?

A

multiple pregnancy, polyhdramnios, APH, pre-eclampsia, maternal febrile ilness, infection e.g. UTI or genital tract infection (GROUP B STREP), premature rupture of membranes, (PROM), HOWEVER this is mainly idiopathic.
Low socio-economic status, extremes of maternal age, stressful work, smoking, substance abuse, cervical incompetance,

56
Q

how is preterm labour diagnosed?

A

contractions with evidence of cervial change on Vaginal exam, also consider abruption and infection

57
Q

what drugs may be used to postpone the onset of labour?

A

Beta Agonists, CCB’s, GTN.

58
Q

What is the Mx of preterm labour?

A

Tocolysis (anticontraction medicsation) to allow steroids, transfer to NICU and aim for a vaginal delivery. If before 26 weeks then there is a very poor prognosis so discuss with parents and neonatologists.

59
Q

what morbitities are a result of prematurity?

A

Rresp distress syndrome, intraventricular haemorrhage, cerebral palsy, temoerature control, jaundice, infections, visual impairment, hearing loss.

60
Q

when considering giving the mother steriods, after how many weeks is it acceptable to give steroids?

A

After 28-34 weeks.

61
Q

why are steroids given for preterm labour?

A

fetal lung maturation.

62
Q

If untreated with iv benzylpenicillin, what complicaitons can group b strep cause in neonates?

A

chest infections, speticaemia, meningitis (all within 3 months of age).

YEAR 3 REPRO (27 decks)

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