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Clinical OBS/GYN > Complications of Pregnancy > Flashcards

Complications of Pregnancy Flashcards

1
Q

Incidence and Common Sites of Ectopic Pregnancies?

A

1/60

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2
Q

Risk Factors for Ectopic Pregnancies?

A

History of PID (particularly Chlamydia)

History of infertility or assisted conception (especially IVF)

Endometriosis

Pelvic or tubal surgery

Previous ectopic pregnancy (recurrence risk is 10-20%)

IUCD in situ (prevents intrauterine pregnancy)

Smoking

Maternal age >40 years

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3
Q

Investigations for Ectopic Pregnancy?

A
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4
Q

Management of Ectopic Pregnancy?

A
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5
Q

Definition of Miscarriage?

A

Pregnancy loss before 24 weeks of gestation (at a stage when fetus would be incapable of independent survival and weighing less than 500g)

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6
Q

Epidemiology of Miscarriages?

A

Miscarriage occurs in 10-15% of clinically recognised pregnancies, up to 40% of conceptions

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7
Q

Risk Factors for Miscarriage?

A
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8
Q

Primary cause of Miscarriage?

A

Chromosomal abnormalities account for 50% of all miscarriages

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9
Q

Miscarriage in which cervical os is closed, and the fetus is present with cardiac activity?

A

Threatened miscarriage

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10
Q

Miscarriage in which cervical os is open, and the fetus is present?

A

Inevitable Miscarriage

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11
Q

Miscarriage in which fetus has passed, some placental tissue remains, the cervical os is open?

A

Incomplete Miscarriage

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12
Q

Miscarriage in which the fetus and placenta have passed, the cervical os is closed?

A

Complete Miscarriage

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13
Q

Classification of Miscarriage?

A
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14
Q

Management of Miscarriage?

A
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15
Q

Severe form of Nausea and vomiting in pregnancy (NVP)?

What contributes to it?

A

Hyperemesis Gravidarum: Persistent and intractable vomiting; inability to keep food and fluid down

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16
Q

Associations with Hyperemesis Gravidarum?

A

● Multiple pregnancy

● Trophoblastic disease (molar pregnancy)

● Hyperthyroidism (HG is associated with gestational thyrotoxicosis because HCG is structurally similar to TSH)

● Nulliparity

● Obesity

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17
Q

Timing of Hyperemesis Gravidarum?

A

Presents in the first trimester (most commonly between 8-12 weeks)

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18
Q

Complications of Hyperemesis Gravidarum?

A

Electrolyte imbalances (common)– hypokalaemia, hyponatremia, hypochloraemia, metabolic alkalosis

Mallory Weiss tear

Wernicke encephalopathy (rare; due to thiamine deficiency)

Acute tubular necrosis

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19
Q

Diagnosis of Hyperemesis Gravidarum?

A

Consider also other causes of nausea, vomiting including urinary tract infections, gastroenteritis, small bowel tumors, adhesions, etc

Triad of:

  • 5% weight loss
  • Dehydration
  • Electrolyte imbalance
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20
Q

Staging of Hyperemesis Gravidarum?

A

Pregnancy Unique Quantification of Emesis (PUQE) Score: quantifies frequency of nausea, vomiting and dry retching, and impact on quality of life

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21
Q

Investigations for Hyperemesis Gravidarum?

A
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22
Q

Management of Hyperemesis Gravidarum?

A
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23
Q

Physiologic changes during pregnancy that favour a state of insulin resistance?

A

Increased caloric intake and reduced exercise

Placental lactogen and progesterone

Increased cortisol and growth hormone

These changes support the fetus – the resulting maternal hyperglycemia and hyperinsulinemia provides glucose to the fetus and stimulate fetal insulin production

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24
Q

Risk Factors for Gestational Diabetes Mellitus?

A

Maternal age >40 years

PCOS

Previous unexplained stillbirth

Obesity (BMI >30kg/m2)

Previous macrosomic baby (>4.5kg)

History of gestational diabetes

Family history of diabetes

Ethnic predisposition to diabetes (South Asian, black Caribbean, and Middle Eastern)

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25
Q

Complications of Gestational Diabetes?

A

Maternal Complications:

  • Shoulder Dystocia
  • Pregnancy Induced Hypertension
  • Pre-Eclampsia

Fetal Complications

  • Macrosomia (may cause Pre-Term Labor)
  • Polyhydramnios (buildup of increased amniotic fluid)
  • Intrauterine growth restriction
  • Intrauterine Death

Neonatal Complications

  • Hypoglycemia
  • Polycythemia (May cause jaundice)
  • Birth Trauma (Fractures Brachial Plexus Injury, Asphyxia, respiratory Distress Syndrome)
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26
Q

Investigations for Gestational Diabetes?

A

Oral glucose tolerance test (OGTT)
or
Glucose Challenge test followed by GTT (two-step)

Note that HbA1c measurements are not useful for GDM

If DM is diagnosed in the first trimester, suspect undiagnosed pre-existing DM

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27
Q

Management of Gestational Diabetes?

A
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28
Q

Definition of Antepartum haemorrhage?

A

Bleeding from the genital tract during pregnancy at >24 weeks gestation, and before the onset of labor (Note that bleeding prior to 24 weeks is known as threatened miscarriage)

Complicates 3-5% of pregnancies

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29
Q

Causes of Antepartum Haemorrhage?

A
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30
Q

Investigations for Antepartum Hemorrhage? (Maternal/Fetal)

A

Maternal

  • FBC
  • Crossmatch
  • Keilhauer Test (determine the amount of fetal haemoglobin that has been transferred from a fetus to the mother’s bloodstream; it is useful to determine if a higher dose of anti-D is required)
  • Clotting Screen (abruption suspected)

Fetal

  • Ausclate Fetal HR
  • CTG
  • Fetal Growth and Wellbeing
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31
Q

Management of Antepartum Hemorrage?

A

Admission (minimum 24 hrs)

Corticosteroids (from 24 weeks if risk of pre-term delivery)

Anti-D Immunoglobulin (all rhesus negative women given at least 500 IU, more if determined by Kailhauer Test)

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32
Q

Complications of Antepartum Hemorrhage? (Maternal/Fetal)

A
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33
Q

What is Placenta Previa?

Classifications?

A

Placenta that is inserted, wholly or in part, into the lower segment of the uterus; more recently diagnosed as placental edge within 2cm of the internal cervical os (.5% of pregnancies)

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34
Q

Assessment of Placenta Previa?

A
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35
Q

Management of Placenta Previa?

  • Asymptomatic
  • w/ Hemmorage
  • Delivery
A
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36
Q

Placental villi adhere superficially to the myometrium but do not invade it?

A

Placenta Accreta

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37
Q

Placental villi deeply penetrate the myometrium down to the serosa

A

Placenta Increta

38
Q

Placental villi penetrate through the uterine wall and may involve other pelvic organs

A

Placenta Percreta

39
Q

Risk Factors for Placenta Accreta?

A
40
Q

Clinical Features of Placenta Accreta?

A

Consider PAS in presence of anterior low lying placenta or placenta praevia in patient with previous caesarean

41
Q

Assessment of Placenta Accreta?

A
42
Q

Management of Placenta Accreta?

A
43
Q

Complications of Placenta Accreta? (Maternal/Fetal)

A
44
Q

Separation of the placenta, partially or completely, from the uterus before delivery

A

Placental Abruption

45
Q

Risk Factors for Placental Abruption

A

Hypertension

Trauma

History of Abruption

Smoking/Cocaine Use

46
Q

Pathogenesis of Pre-Eclamsia?

A
47
Q

Risk Factors for Pre-Eclamsia?

A

● Aged <20 or >40 years

● History of pre-eclampsia (7x)

● Multiple pregnancy (5x)

● Family history (4x)

● Primiparity (2-3x)

● Pregnancy interval >10 years (2-3x)

● Obesity (2x)

● Maternal disease – hypertension, diabetes, renal disease, autoimmune disease, thrombophilia

● Fetal hydrops

● Hydatidiform mole

48
Q

Prevention of Pre-Eclampsia

A
49
Q

Diagnosis of Pre-Eclamsia?

A

Hypertension (>140/90mmHg) on more than one occasion

Proteinuria (>300mg/24h or PCR of 30mg/mmol or urine dipstick protein of ≥2+), in the absence of UTI

The diagnosis of pre-eclampsia should also be made in case of:

  • sustained systolic blood pressure > 160 mmHg
  • rise in creatinine, alanine transaminases
  • fall in platelets
  • symptoms of severe pre-eclampsia such as pulmonary edema
50
Q

Clinical Features of Pre-Eclampsia

A

Hypertension

Protinuria

Edema

Abdominal Pain (Subcapsular Hemorages of Liver)

51
Q

Mild pre-eclampsia?

A

BP >140/90mmHg

Absent or low proteinuria (<300mg/24h or 1+ on dipstick)

No maternal complications

52
Q

Moderate pre-eclampsia?

A

BP >140/90mmHg

Significant proteinuria (>300mg/24h or 2+)

No maternal complications

53
Q

Severe Pre-Eclampsi?

A

BP >160/110mmHg

Significant proteinuria (>1g/24h or >2+)

Maternal complications have occurred

54
Q

Maternal Complications of Pre-Eclampsia

A

Presence of ANY of the Following Defines Severe Pre-Eclampsia:

  • BP: SBP >160mmHg or DBP >110mmHg
  • Proteinuria: 1g/24h or ≥3+ protein on urine dipstick
  • Renal insufficiency – creatinine >90micromol/L
  • Haematologic – thrombocytopenia (platelets <100,000), haemolysis, DIC, haemorrhage (abruption, stroke, etc.)
  • Hepatic – raised serum transaminases, severe epigastric or RUQ pain or tenderness, nausea and vomiting
  • Neurologic – eclampsia, confusion, hyperreflexia, clonus, persistent new headache, visual disturbance, stroke
  • Respiratory – pulmonary oedema (dyspnoea)
55
Q

Timing of Eclampsia?

A

40% Before Delivery

20% During Delivery

40% After Delivery

56
Q

HELLP Syndrome?

A
57
Q

Fetal Complications of Pre-Eclampsia?

A

IUGR (40% of cases)

Prematurity (iatrogenic)

Intrauterine death

58
Q

Investigations for Pre-Eclampsia

A
59
Q

Management of Severe Pre-Eclampsia?

A

Admission to a high-dependency unit (HDU)

Monitoring

  • BP and HR (every 15-30 minutes)
  • urine output
  • oxygen saturations
  • fluid balance
  • neurologic assessment (reflexes, GCAESAREAN, AVPU)
  • fetal wellbeing (CTG, US)

Magnesium sulphate – indicated for the management or prevention of seizures

Antihypertensives: Methyl Dopa, Hydralizine, Leabtetalol

Delivery – delivery of the placenta is usually curative (though complications may occur postnatally)
▪
Delivery is usually curative

60
Q

Indications for immediate delivery?

A

Indications for immediate delivery:

  • eclampsia
  • HELLP syndrome
  • worsening thrombocytopenia or coagulopathy or liver or renal function
  • severe symptoms (especially epigastric pain)
  • reversed umbilical artery end-diastolic flow
61
Q

Management of Mild/Moderate Pre-Eclampsia?

A
62
Q

Production of antibodies against antigens that are foreign to the individual but native to another individual of the same species?

A

Isoimmunization

63
Q

Abnormal accumulation of fluid in two or more fetal compartments (fetal ascites, pleural effusion, pericardial effusion or skin oedema)

A

Hydrops

64
Q

Pathophysiology of Rhesus Disease?

A
65
Q

Prevention of Rhesus Disease?

A

Check Fetal Rhesus after 11 weeks’ gestation in all Rhesus negative women (blood test in the mother)

Anti-D immunoglobulin – anti-D (1500IU) is given to all Rhesus negative women with Rhesus positive fetuses (or unknown fetal Rhesus status) routinely at 28 weeks, within 72h of any potentially sensitizing event, and after delivery

66
Q

What is the Keilhauer test?

A

If a large fetomaternal haemorrhage is suspected, the standard dose of anti-D may not be sufficient; in this case, the Keilhauer test can be performed to determine if more anti-D immunoglobulin is required

67
Q

Investigations and Management of Rheusus Disease Antenatally?

A
68
Q

Postnatal Management of Rhesus Disease?

A
69
Q

Causes/Risk Factors of Pre-Term Labor?

A

Causes:

  • Idiopathic
  • Iatrogenic
  • Cervical weakness
  • Ascending infection
  • Uterine stretch (abruption, polyhydramnios, MP)

Risk Factors

  • History of Pre-term birth
  • Mulitple pregnancy
  • Cervical Surgery
  • Renal Disease
  • Pre-Eclampsia
  • IUGR
70
Q

Management of Pre-Term Labor

A

● Steroids – 12mg betamethasone IM, two doses 24h apart

● Tocolysis – tocolytic agents (nifedipine, oxytocin receptor antagonists) may be used to delay delivery until steroids have been administered; do not use tocolysis for >24h; contraindicated if infection is suspected or if membranes are ruptured

● Magnesium sulphate - fetal neuroprotection, offer up to 30 weeks’ gestation

● Intrapartum IV antibiotics are indicated only if features of infection are present

71
Q

Indications/Screening Procedure for Pre-Term Labor

A
72
Q

Prevention of Pre-term Labor?

A
73
Q

PROM vs. PPROM

A

Prelabour rupture of membranes at term (PROM) is defined as leakage of amniotic fluid in the absence of uterine activity after 37 completed weeks of gestation (8% of pregnancies)

Preterm prelabour rupture of membranes (PPROM) – membranes rupture before the onset of labour and before 37 weeks of gestation

74
Q

Causes of PROM?

A
75
Q

Assessment of Patient w/ PPROM?

A
76
Q

Complications of PPROM?

A

Maternal risks – chorioamnionitis, sepsis, placental abruption

Fetal risks – prematurity, infection, cord prolapse, pulmonary hypoplasia, limb contractures, intrauterine death

77
Q

Signs/Symptoms of Chorioamnionitis?

A
78
Q

Management of PPROM?

A

24-34 weeks – admission, daily review for signs of infection, steroids, antibiotics (erythromycin 250mg QDS PO for 10 days or until established labour) Intrapartum antibiotic prophylaxis for all pre-term deliveries, irrespective of GBS status

  • Aim for induction of labour at 37 weeks if no signs of infection
  • May consider induction of labour from 34 weeks if significant risk factors for infection (e.g. known GBS carriage)

Evidence of infection – admission, steroids, IV antibiotics, induction of labour (indicated regardless of gestational age), Broad-spectrum antibiotic coverage (benzylpenicillin and gentamicin and metronidazole)

78
Q

Management of PROM?

A
79
Q

Risk Factors for PPROM?

A
80
Q

Antenatal Steroids

  • Indicaitons
  • Administration
  • Benefits
  • Cautions
A
81
Q

Classification of Breechn Presentations

A
82
Q

Breech Presenation occures in ______% of pregnancies at term; More common preterm (_____% at 28 weeks)

A

Breech presentation occurs in 3-4% of pregnancies at term; More common preterm (50% at 28 weeks)

83
Q

Causes and Associations for Breech Presentation

A
84
Q

Complications of Breech Presentation

A
85
Q

Features of breech presentation?

A

longitudinal lie

the head is palpable in the fundus

the presenting part is not hard

the fetal heart is best auscultated high up in the uterus

85
Q

Management of Breech Presentation?

A
86
Q

What is ECV and how is it Performed?

  • Timing
  • Pre/Post Procedure
  • Complications?
  • Contraindications?
A
87
Q

Causes of Abnormal Lie?

A
88
Q

Management of Abdnomarl Lie?

A

Clinical OBS/GYN (13 decks)

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