Complications of pregnancy

Question 1

What are the risk factors for ectopic pregnancies?

Answer 1

Assisted conception, previous ectopic, Pelvic inflammatory disease

Question 2

How are ectopic preganacies managed?

Answer 2

They are not viable.

Medical: methotrexate
Surgical: Salpingectomy (removal of fallopian tube)

Question 3

What is antepartum haemorrhage?

Answer 3

Bleeding occuring after 24 weeks gestation but before fetus born.

Question 4

What are the causes of antepartum haemorrhage?

Answer 4

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)

Question 5

What are the 2 types of placenta previa?

Answer 5

Low lying - less 20mm from cervical os

Placenta previa- covering cervical os

Question 6

Risk factors for Placenta previa

Answer 6

Multiparous women
Multiple preganancies
Prevous cesarian section

Often will be an incidental finding or will present with painless PV bleeding

Question 7

Difference between chronic hypertension and gestational hypertension?

Answer 7

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

Question 8

What is pre-eclampsia?

Answer 8

New hypertension (present after 20 weeks gestation) associated with significant proteinuria

Question 9

How is chronic/essential hypertension managed in pregnant women?

Answer 9

Change antihypertensives if needed

Keep BP <150/100

Montior fetal growth and for pre-eclampsia

There is a higher incidence of placental abruption.

Question 10

Define pre-eclampsia

Answer 10

Mild Hypertension on 2 occasions more than 4hrs apart or moderate-severe hypertension

with
proteinuria of more 300mgms/24hrs

Question 11

What can this pre-eclampsia cause?

Answer 11

HELLP symptoms

Haemolysis
Elevated Liver enzymes
Low Platelet syndrome

Question 12

Risk factors for Pre-eclampsia (PET)

Answer 12

first pregnancy
extremes of maternal age
Previous pre-eclampsia
BMI >35
Family history
Multiple pregnancy

Pre-existsing hypertension, diabetes or renal disease

Question 13

How is Pre-eclampsia managed?

Answer 13

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

Question 14

How would seizures in pre-eclampsia or eclampsia be tretaed?

Answer 14

Magnesium sulphate bolus
IV labetolol

Give low does Aspirin in subsequent pregnancy

Question 15

How is diabetes managed in pregnancy/ birth?

Answer 15

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

Question 16

What increases risk of VTE in pregnancy?

Answer 16

Older mothers
Increased BMI
Smokers
IV drug users
PET
Decreased mobility
Infections
Prolonged labour
Previous VTE
Sickle cell disease

Question 17

How is risk of VTE managed in pregnancy?

Answer 17

TED stockings
Increased mobility
Hydration

Prophylactic anticoagulates in 3 or more risk factors

Possible early induction

Question 18

SYmptoms of VTE

Answer 18

Pain in calf
Increase leg girth
Calf muscle tenderness
Pain on breathing
Cough
Tachycaria
Pleural rub

Question 19

What is the best imaging to do if a pregnant woman has a suspected VTE?

Answer 19

Computed tomography pulmonary angiogram