Complications of pregnancy Flashcards
What are the risk factors for ectopic pregnancies?
Assisted conception, previous ectopic, Pelvic inflammatory disease
How are ectopic preganacies managed?
They are not viable.
Medical: methotrexate
Surgical: Salpingectomy (removal of fallopian tube)
What is antepartum haemorrhage?
Bleeding occuring after 24 weeks gestation but before fetus born.
What are the causes of antepartum haemorrhage?
This is a medical emergency. It can be caused by:
Placenta previa
Placental abruption
Local lesions such as polyps in genital tract
Vasa praevia (fetal vessels lie over cervical os)
What are the 2 types of placenta previa?
Low lying - less 20mm from cervical os
Placenta previa- covering cervical os
Risk factors for Placenta previa
Multiparous women
Multiple preganancies
Prevous cesarian section
Often will be an incidental finding or will present with painless PV bleeding
Difference between chronic hypertension and gestational hypertension?
Both raised blood pressure but
chronic hypertension occurs/presnts either pre-pregnancy or within 20 weeks gestation
whereas
gestational hypertension occurs/presents after 20 weeks gestation
What is pre-eclampsia?
New hypertension (present after 20 weeks gestation) associated with significant proteinuria
How is chronic/essential hypertension managed in pregnant women?
Change antihypertensives if needed
Keep BP <150/100
Montior fetal growth and for pre-eclampsia
There is a higher incidence of placental abruption.
Define pre-eclampsia
Mild Hypertension on 2 occasions more than 4hrs apart or moderate-severe hypertension
with
proteinuria of more 300mgms/24hrs
What can this pre-eclampsia cause?
HELLP symptoms
Haemolysis
Elevated Liver enzymes
Low Platelet syndrome
Risk factors for Pre-eclampsia (PET)
first pregnancy extremes of maternal age Previous pre-eclampsia BMI >35 Family history Multiple pregnancy
Pre-existsing hypertension, diabetes or renal disease
How is Pre-eclampsia managed?
Monitoring Symptomatic management (headaches, visual disturbances ect) Scans for growth Cardiotocography Bloods
Only cure is to delivery baby and placenta
Give hypertensives e.g. labetolol, methyldopa
Give steroids to encourage fetal lung maturation if occur <36 weeks
Consider induction or c-section if fetal or maternal condition deteriorates
How would seizures in pre-eclampsia or eclampsia be tretaed?
Magnesium sulphate bolus
IV labetolol
Give low does Aspirin in subsequent pregnancy
How is diabetes managed in pregnancy/ birth?
Want good control pre conception and maintained throughout pregnancy
Watch for fetal macrosomia- may need c-section
Induce early if fetal or maternal condition declines
Give dextrose insulin infusion during labour
Continous CTG fetal monitioring
Watch for respiratory distress and hypoglycaemia after birth
What increases risk of VTE in pregnancy?
Older mothers Increased BMI Smokers IV drug users PET Decreased mobility Infections Prolonged labour Previous VTE Sickle cell disease
How is risk of VTE managed in pregnancy?
TED stockings
Increased mobility
Hydration
Prophylactic anticoagulates in 3 or more risk factors
Possible early induction
SYmptoms of VTE
Pain in calf Increase leg girth Calf muscle tenderness Pain on breathing Cough Tachycaria Pleural rub
What is the best imaging to do if a pregnant woman has a suspected VTE?
Computed tomography pulmonary angiogram
