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Year 3 Reproductive > Complications of pregnancy 1 > Flashcards

Complications of pregnancy 1 Flashcards

1
Q

What is a miscarriage?

A

the spontaneous loss of pregnancy before the fetus reaches viability

This includes all pregnancy losses from the time of conception until 24 weeks gestation

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2
Q

What are the categories of miscarriage?

A

Threatened

Inevitable

Incomplete

Complete

Septic

Missed

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3
Q

What is a ‘threatened’ miscarriage?

What features will it have?

A

A threatened miscarriage refers to bleeding from the gravid uterus before 24 weeks gestation when there is a viable fetus and no evidence of cervical dilatation

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4
Q

What is an ‘inevitable’ miscarriage?

A

Miscarriage becomes inevitable if the cervix has already begun to dilate

Ie - bleeding from gravid uterus with cervical dilation, <24 weeks

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5
Q

What is the difference between a complete and incomplete miscarriage?

A

When there is only partial expulsion of the products of conception this is referred to as an incomplete miscarriage whilst complete expulsion of the products of conception is referred to as a complete miscarriage

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6
Q

What is a septic miscarriage?

A

Following an incomplete miscarriage there is always a risk of ascending infection into the uterus which can spread throughout the pelvis and this is known as a septic abortion.

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7
Q

What is a ‘missed’ miscarriage?

A

Missed miscarriage describes a pregnancy in which the fetus has died but the uterus has made no attempt to expel the products of conception.

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8
Q

What are the clinical features of a threatened miscarriage?

A

Vaginal bleeding +/- pain

Viable pregnancy

Closed cervix on speculum examination

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9
Q

What are the features of an inevitable miscarriage?

A

Viable pregnancy

Open cervix with bleeding (can be heavy)

May also be clots

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10
Q

What are the features of a missed miscarriage?

A

No symptoms or vaginal bleeding/brown discharge

Gestational sac seen on scan

No clear fetus (empty gestational sac) or a fetal pole with no fetal heart seen in the gestational sa

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11
Q

What are the features of an incomplete miscarriage?

A

Most of pregnancy expelled out, some products of pregnancy remaining in the uterus (on scan)

Open cervix, vaginal bleeding (may be heavy)

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12
Q

What are the features of a complete miscarriage?

A

Passed out all products of conception (POC)

Closed cervix

Bleeding stopped

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13
Q

What are the causes & risk factors for miscarriages?

A

Abnormal conceptus:

  • Chromosomal (50% all miscarriages)
  • Genetic
  • Structural

Uterine abnormality:

  • Congenital
  • Fibroids

Cervical weakness:

  • Primary or secondary

Maternal:

  • Increasing age
  • Diabetes
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14
Q

How is a threatened miscarriage managed?

A

Conseratively - ‘just wait’, most stop bleeding and are okay

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15
Q

How is an inevitable miscarriage managed?

A

If bleeding is heavy may need evacuation

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16
Q

How is a missed miscarriage managed?

A

Conservatively

Medically:

  • Prostaglandins (misoprostol)

Surgically:

  • SMM (surgical management of miscarriage)
17
Q

How is a septic miscarriage managed?

A

Antibiotics and evacuate uterus

18
Q

Ectopic pregnancies happen when implantation occurs outside the uterus

Where can this happen?

How likely^

A

Tubal (fallopian tube):

  • Ampullary (most common)
  • Isthmus (also common)

Cornual (interstitial) (rare)

Cervical (rare)

Ovary (rare)

19
Q

What are risk factors for an ectopic pregnancy?

What is the incidence of ectopic pregnancies?

A

Pelvic inflammatory disease

Previous tubal surgery

Previous ectopic pregnancy

Assisted conception

Incidence 1:90 pregnancies

20
Q

How do ectopic pregnancies present?

A

Period of ammenorhoea (with +ve urine pregnancy test)

+/- Vaginal bleeding

+/- Abdo pain

+/- GI or urinary symptoms

21
Q

How is an ectopic pregnancy investigated?

A

US Scan:

  • No intrauterine gestational mass
  • May see adexnal mass (outside of uterus)
  • Fluid in pouch of douglas (rectouterine pouch)

Serum BHCG levels:

  • may need to serially track levels over 48 hour intervals- if a normal early intrauterine pregnancy HCG levels will increase by at least 66%ish
  • Ectopic miscarriage = BHCG drops
22
Q

How is an ectopic pregnancy managed?

A

Medical:

  • Methotrexate injection
    • Follow up with serum BHCG measurement

Surgical:

  • Salpingectomy - take out tube
  • Salpingotomy - take out embryo, leave tube

Conservative:

  • If patient’s BhCG levels low and are haemodynamically stable
23
Q

What is an antepartum haemorrhage?

A

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

associated with significant maternal and neonatal morbidity and mortality

24
Q

What are the causes of antepartum haemorrhage?

A

Placenta praevia

Placental abruption

APH of unknown origin

Local lesions of the genital tract

Vasa praevia (very rare)

25
Q

What is placenta praevia?

What are risk factors for it?

A

When all or part of the placenta implants in the lower uterine segment and lies in front of the presenting part of the fetus

Risk factors:

  • Multiparous women / multiple pregnancies
  • Previous C-section
26
Q

How would placenta praevia present?

A

Painless bleeding (APH)

Soft, non-tender uterus

Malpresentation of fetus

Often incidentally found prior to APH (USS)

27
Q

How is placenta praevia investigated/diagnosed?

What must you never do to a patient with suspected PP?

A

Transvaginal ultrasound scan - best

Often picked up incidentally at 20 week antenatal abdo US though

NEVER DO VAGINAL EXAMINATION ON SUSPECTED PLACENTA PRAEVIA

28
Q

How is placenta praevia managed?

A

depends on many factors including the gestation at presentation and the severity of the blood loss

Management of blood loss (if APH etc):

  • Blood is cross matched and blood transfused depending on the maternal condition

C-section for delivery, watch for PPH

29
Q

How is postpartum haemorrhage dealth with?

A

Medical management:

  • Oxytocin
  • Ergometrine
  • Carboprost
  • Tranexemic acid

Surgical options may be needed:

  • Balloon tamponade (not surgery but shut up)
  • B-lynch cutre
  • Ligation of uterine, iliac vessels
  • Hysterectomy
30
Q

What factors are associated with placental abruption?

A

Pre-eclampsia/hypertension

Multiple pregnancies

Polyhydramnios

Smoking

Increasing age, parity

Previous abruption

Cocaine

31
Q

How does a patient with placental abruption present?

A

Severe abdominal pain

APH - can be mild to heavy bleeding (‘revealed’), can also be absent* (‘concealed’)

Increased uterine tone +/- contractions

*in concealed abruption - haemorrhage occurs between placenta & uterine wall so will not pass through vagina

32
Q

What are the complications of placental abruption

A

Maternal shock, collapse

Fetal distress & death

Maternal DIC, renal failure

Postpartum haemorrhage

Couvelaire uterus

33
Q

What is a Couvelaire uterus?

A

Complication of placental abruption

Trapped blood between the placenta & uterus penetrates the uterus giving it a bruised (couvelaire) appearance

34
Q

Define what pre-term labour is

What are the different categories of preterm-ness

A

Onset of labour < 37 completed weeks…

  • 32-36 weeks = mildly preterm
  • 28-32 weeks = very preterm
  • 24-28 weeks = extremely preterm
35
Q

From when in gestation can a baby be resuscitated

A

22 weeks onward

36
Q

What are risk factors for a preterm labour?

A

Multiple pregnancies

Polyhydramnios

Abruption

APH

Pre-eclampsia

Infection - eg UTI

Prelabour premature rupture of membranes

Iatrogenic

Usually idiopathic

37
Q

How is preterm labour diagnosed?

A

Contractions with evidence of cervical dilatation on VE

Fetal fibronectin test

38
Q

How is preterm labour managed?

A

Tocolysis (prevents uterine contractions)

Steroids unless contraindicated

Transfer to NICU facilities

Aim for vaginal delivery

39
Q

The more preterm the delivery - the higher the risk of morbidity and mortality in the beby

What morbidity can result from preterm delivery for the neonate

A

Respiratory distress syndrome

Intraventricular haemorrhage

Cerebral palsy

Problems with:

  • Nutrition
  • Temperature control
  • Infections
  • Jaundice
  • Visual impairments
  • Hearing loss

Year 3 Reproductive (40 decks)

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