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Year 3- Reproduction > Complications of Pregnancy > Flashcards

Complications of Pregnancy Flashcards

1
Q

Abortion?

A

Voluntary termination of pregnancy

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2
Q

Miscarriage?

A

Spontaneous loss of pregnancy before 24wks gestation

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3
Q

There are many categories of miscarriage.
What happens in a threatened miscarriage?

A

Bleeding from uterus before 24wks gestation in a viable pregnancy

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4
Q

There are many categories of miscarriage.
What happens in an inevitable miscarriage?

A

Cervix already began to dilate in a viable pregnancy

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5
Q

There are many categories of miscarriage.
What happens in an incomplete miscarriage?

A

Only partial expulsion of the products of conception

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6
Q

There are many categories of miscarriage.
What happens in a complete miscarriage?

A

Complete expulsion of the products

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7
Q

What is he risks following an incomplete miscarriage?

A

Risk of ascending infection into the uterus which can then spread throughout the pelvis

->this is known as septic miscarriage

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8
Q

There are many categories of miscarriage.
What happens in a missed miscarriage?

A

Foetus has died but uterus makes no attempts to expel the products on conception

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9
Q

When is a missed miscarriage diagnosed?

A

No symptoms/could have bleeding or brown loss vaginally
Gestational sac seen on scan
No clear foetus, no foetal heart

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10
Q

What are some of the causes of spontaneous miscarriage?

A

Abnormal conceptus- chromosomal, genetic, structural
Uterine abnormality- congenital, fibroids
Cervical weakness
Maternal- increasing age, diabetes

->usually difficult to identify the underlying factor

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11
Q

What are some maternal health conditions which are known to increases risks of spontaneous miscarriage?

A

SLE- lupus
Thyroid conditions
Diabetes
Infections e.g. pyelitis, appendicitis

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12
Q

Management of threatened miscarriage?

A

Conservative management
Just wait, most cases, bleeding stops

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13
Q

Management of inevitable miscarriage?

A

If bleeding is heavy, may need evacuation

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14
Q

Management of missed miscarriage?

A

Conservative
Medical- prostaglandins
Surgical- suction evacuation

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15
Q

Management of septic miscarriage?

A

Antibiotics and evacuate uterus

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16
Q

Ectopic pregnancy?

A

Pregnancy implanted outwith the uterine cavity

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17
Q

Where is the most common location of ectopic pregnancy?

A

Fallopian tube, especially in the ampullary region

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18
Q

Risk factors of ectopic pregnancy?

A

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic pregnancy
Assisted conception

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19
Q

Presentation of ectopic pregnancy?

A

Period of amenorrhoea (with +ve urine pregnancy test)
+/- vaginal bleeding
+/- abdominal pain
+/- GI or urinary symptoms

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20
Q

Investigations done to investigate a potential ectopic pregnancy?

A

Scan- no intrauterine gestational sac.
Serum BHCG levels

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21
Q

Medical management of ectopic pregnancy?

A

Methotrexate injection

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22
Q

Surgical management of ectopic pregnancy?

A

Most laparoscopy- salpingectomy, salpingotomy for few indications)

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23
Q

Where is the pouch of Douglas?

A

Behind the uterus

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24
Q

Antepartum haemorrhage?

A

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

->one of the greatest obstetric emergencies

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25
Q

Causes of Antepartum haemrrohage?

A

Placenta praevia
Placental abruption
Local lesions of genital tract
Vasa praevia (v rare)

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26
Q

Placenta praevia?

A

Placenta is attached to the lower segment of the uterus

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27
Q

Placental abruption?

A

Placenta has started to sperate from the uterine wall

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28
Q

When is placenta praevia more common?

A

Multiparous women (women who have given birth one or more times in the past)
Multiple pregnancies
Previous C-section

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29
Q

Presentation of placenta praevia?

A

Painless PV bleeding
Malpresentation of the foetus on US

->may be incidental upon US of foetus for another reason

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30
Q

How is diagnosis of placenta praevia usually made?

A

Via ultrasound

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31
Q

Management of placenta praevia?

A

Depends on gestation and severity of blood loss
Patient admitted to hospital, diagnosis made by ultrasound and blood transfusion may be required.
Deliver baby via C-section, watch for postpartum haemorrhage

->note that vaginal examination is contraindicated

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32
Q

Postpartum haemorrhage>

A

Any bleeding after delivery >500mls

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33
Q

How can postpartum haemorrhage be managed medically?

A

Oxytocin
Ergometrine
Carboprost
Tranexamic acid

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34
Q

What are some of the other forms of management of postpartum haemorrhage?

A

Balloon tamponade
Surgical

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35
Q

List some of the factors associated with placental abruption.

A

Pre-eclampsia/ chronic hypertension
Multiple pregnancy
Polyhydramnios
Smoking
Increasing age
Previous abruption
Cocaine use

36
Q

Three types of placental abruption?

A

Revealed
Concealed
Mixed

->in revealed, see blood. In concealed, don’t see blood as inside

37
Q

Presentation of placenta abruptuon?

A

Severe abdominal pain
Vaginal bleeding
Increased uterine activity

->note bleeding may be minimal

38
Q

Management of antepartum haemorrhage?

A

Depends on amount of bleeding and the general condition of mother and baby, as well as the gestation.

However, may attempt vaginal delivery or go to an immediate C-section.

39
Q

Complications of placental abruption?

A

Maternal shock/collapse
Foetal distress, then potentially death
Maternal DIC
Renal failure
Postpartum haemorrhage

40
Q

Preterm labour?

A

Onset of labour before 37wks gestation

41
Q

Predisposing factors to preterm labour?

A

Multiple pregnancy
Polyhydramnios
APH- antepartum haemorrhage
Pre-eclampsia
Infection e.g. UTI
Prelabour premature rupture of membranes

->majority are idiopathic

42
Q

How is a diagnosis of preterm labour made?

A

Contractions with evidence of cervical change on vaginal examination
Test- foetal fibronectin

43
Q

Management of preterm delivery?

A

Consider tocolysis to allow steroids/transfer
Steroids unless contraindicated
Transfer to unit with NICU facilities
Aim for vaginal delivery

44
Q

List some of the potential neonatal morbidities resulting from prematurity.

A

Respiratory distress syndrome
Intraventricular haemorrhage
Cerebral palsy
Nutrition
Temperature control
Jaundice
Infections
Visual impairment
Gearing loss

45
Q

Hypertension can be common in pregnancy.

What are the systolic and diastolic cutoffs for mild HT in pregnancy?

A

140/90

Diastolic- 90-99
Systolic- 140-49

46
Q

Hypertension can be common in pregnancy.

What are the systolic and diastolic cutoffs for moderate HT in pregnancy?

A

150/100

Diastolic- 100-109
Systolic- 150-159

47
Q

Hypertension can be common in pregnancy.

What are the systolic and diastolic cutoffs for severe HT in pregnancy?

A

> 160/110

48
Q

What is meant by chronic hypertension in pregnancy?

A

Hypertension either pre-pregnancy or at booking (<20wks gestation)

49
Q

What is meant by gestational hypertension in pregnancy?

A

New hypertension which has developed in pregnancy, usually develops after 20wks

50
Q

What is the difference between gestational hypertension and pre-eclampsia?

A

Pre-eclampsia is new hypertension >20wks gestation AND significant proteinuria

51
Q

When in chronic hypertension in pregnancy more common?

A

In increased maternal age

->this makes sense as hypertension often occurs in older age anyways

52
Q

Describe the changes to anti-hypertensive drugs in pregnancy.

A

Women with pre-existing hypertension need to switch meds.

Stop ACEi, ARB’s, anti-diuretics

Aim to keep BP <150/100 using labetalol, nifedipine, methyldopa

53
Q

What needs to be monitored in women with chronic hypertension in pregnancy?

A

Monitor for superimposed pre-eclampsia
Monitor foetal growth

->bear in mind there is a higher risk of placental abruption

54
Q

As mentioned, pre-eclampsia is when there is hypertension and proteinuria.

Quantify this though.

A

HT on two occasions more than 4hrs apart
Proteinuria more than 300mgs/24hrs

55
Q

Risk factors for pre-eclampsia?

A

First pregnancy
Extremes of maternal age
Pre-eclampsia in previous pregnancy
Pregnancy interval >10yrs
FH of pre-eclampsia
Underlying medical disorders: chronic hypertension, renal disease, diabetes, autoimmune conditions

56
Q

Pre-eclampsia has mutisystem involvement. Which systems does it affect?

A

Renal
Liver
Vascular
Cerebral
Pulmonary

57
Q

Maternal complications of pre-eclampsia?

A

Eclampsia- seizures
Severe hypertension increasing risks of strokes or cerebral haemorrhage
Renal failure
Pulmonary oedema
Cardiac failure

58
Q

Foetal complications of pre-eclampsia?

A

Impaired placental perfusion which can lead to prematurity, foetal distress

59
Q

Symptoms/signs of severe pre-eclampsia?

A

Headache, blurring of vision
Severe hypertension and proteinuria
Reduced urine output
Convulsions (eclampsia)
Clonus/brisk reflexes

60
Q

Biochemical/haematological abnormalities in severe pre-eclampsia?

A

Raised LFTs
Raised urea, creatinine, urate
Low platelets
Low haemoglobin

61
Q

Management of pre-eclampsia?

A

Frequent BP checks and urinalysis
Check symptoms
Check for hyper-reflexia and tenderness over liver
Bloods

Foetal investigations- scan for growth, cardiotocography

62
Q

What is the only cure for pre-eclampsia?

A

Delivery of baby

->conservative management can be given if aiming for increased foetal maturity before delivery

63
Q

Although delivery of the baby is the only cure for pre-eclampsia, what needs to still be monitored after?

A

Monitoring of pre-eclampsia must continue after delivery as risks still continue and could still develop into eclampsia

64
Q

Treatment of seizures/impending seizures of eclampsia?

A

Magnesium sulphate bolus + IV infusion
Control of BP
Avoid fluid overload

65
Q

What is used for prophylaxis for pre-eclampsia in subsequent pregnancies?

A

Low does aspirin
Given from 12wks to delivery

66
Q

What are women with pre-eclampsia at increased risk of developing in later life?

A

Hypertension

67
Q

Gestational diabetes?

A

Diabetes in pregnancy- carbohydrate intolerance or abnormal glucose tolerance that reverts to normal after delivery

68
Q

What are mother’s with gestational diabetes at increased risks of developing in later life?

A

Type II diabetes

69
Q

What is the management of pre-existing diabetes in a pregnant mother?

A

Insulin requirements increases

Foetal hyper-insulinemia occurs

70
Q

What are some of the risks to the foetus after delivery to a mother with pre-existing diabetes?

A

Increased risk of neonatal hypoglycaemia
Increased risk of respiratory distress

71
Q

What effect does diabetes have on the foetus?

A

Increased risks of foetal congenital abnormalities e.g. cardiac abnormality, sacral agenesis

Impaired lung maturity
Neonatal hypoglycaemia
Jaundice

->especially if blood sugards high peri-conception

72
Q

What are some of the increased risks on the mother if she has diabetes in pregnancy?

A

Miscarriage
Foetal macrosomia
Shoulder dystocia
Stillbirth
Pre-eclampsia
Infections

73
Q

What are some pre-existing maternal issues which can worsen if there is diabetes in pregnancy?

A

Nephropathy
Retinopathy
Hypoglycaemia

74
Q

What makes up the preconception management of diabetes if the mother is wanting to become pregnant?

A

Better glycaemic control
Folic acid 5mg
Dietary advice
Retinal and renal assessment

75
Q

What is the management of diabetes during pregnancy?

A

Optimise glucose control- insulin requirements will increase
Can continue oral anti-diabetic meds e.g. metformin but may need to add insulin for tighter glucose control
Watch foetal growth
Watch for ketonuria/infections

76
Q

Why may Csection be considered in mothers with diabetes?

A

Baby may be bigger- macrosomia

77
Q

What are other aspects of management which need to be carried out in delivery of a baby when the mother has diabates?

A

Induction of pregnancy
Maintain blood sugar in labour with insulin-dextrose infusion
Continuous CTG foetal monitoring
Early feeding of baby to reduce neonatal hypoglycaemia

->mother can go back to pre-pregnancy regimen of insulin post delivery

78
Q

Risk factors for gestational diabetes?

A

Increased BMI > 30
Previous macrosomic baby (>4.5kg)
Previous GDM
FH of diabetes

79
Q

Management of gestational diabetes?

A

Control blood sugars- by diet, but metformin/insulin if sugars remain high
Annual check of HbA1C as higher risk of developing overt diabetes

80
Q

Venous thromboembolism is a lot more common in pregnancy because of Virchow’s triad. What makes up this?

A

Stasis of blood
Hypercoagulability
Vessel wall injury

->all of which occur in pregnancy

81
Q

What are some of the factors which increased risk of a thromboembolism in pregnancy?

A

Older mothers
Increased BMI
Smokers
IVDU
Pre-eclampsia
Dehydration
Decreased mobility
Infections
Prolonged delivery
Haemorrhage
Previous VTE
Sickle cell disease

82
Q

What can be used as prophylaxis for VTE in pregnancy?

A

TED stockings
Advise increased mobility, hydration
Prophylactic anti-coagulation with three or more risk factors

83
Q

Signs/symptoms of VTE?

A

Pain in calf
Swelling
Heat
Calf muscle tenderness
Breathlessness
Pain on breathing
Cough
Tachycardia
Hypoxic
Pleural rub

84
Q

Investigations if suspect VTE?

A

ECG
Blood gases
Doppler V/Q lung scam
CTPA- CT pulmonary angiogram

85
Q

Treatment of VTE?

A

Appropriate anticoagulation

86
Q
A

Year 3- Reproduction (33 decks)

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