Complications of Pregnancy

Question 1

How is abortion or spontaneous miscarriage defined?

Answer 1

Termination or loss of pregnancy before 24 weeks gestation with no evidence of life

Question 2

What are the different categories of spontaneous miscarriage?

Answer 2

Threatened 
Inevitable 
Incomplete 
Complete 
Septic 
Missed

Question 3

What is a threatened miscarriage?

Answer 3

Bleeding from the gravid uterus before 24 weeks gestation
Viable pregnancy
Closed cervix
Pain

Question 4

When does a miscarriage become inevitable?

Answer 4

Viable pregnancy

Open cervix with bleeding

Question 5

What is an incomplete miscarriage?

Answer 5

Partial expulsion of products of conception
Open cervix
Vaginal bleeding

Question 6

What is a complete miscarriage?

Answer 6

Passed all products of conception
Cervix closed
Bleeding stopped

Question 7

What is a septic miscarriage?

Answer 7

Following an incomplete miscarriage risk of ascending infection into the uterus which may spread throughout the pelvis

Question 8

What is a missed miscarriage?

Answer 8

Pregnancy in which the foetus has died but the uterus has made no attempt to expel products of conception
Empty gestational sac or foetal pole with no heart

Question 9

What are the different causes of miscarriage?

Answer 9

Chromosomal, genetic, structural 
Congenital uterine abnormality 
Fibroids 
Cervical incompetence 
Increased maternal age 
Maternal diabetes 
Unknown

Question 10

How is a threatened miscarriage managed?

Answer 10

Conservative treatment

Question 11

How is n inevitable miscarriage treated?

Answer 11

Evacuation of heavy bleeding

Question 12

How is a missed miscarriage treated?

Answer 12

Conservative treatment
Medical (prostaglandins)
Surgery

Question 13

How is a septic miscarriage managed?

Answer 13

Antibiotics

Evacuate uterus

Question 14

What is an ectopic pregnancy?

Answer 14

Pregnancy implanted outside the uterine cavity

Question 15

Where is the most common area for an ectopic pregnancy?

Answer 15

Ampullary part of the fallopian tube

Question 16

What are the risk factors for an ectopic pregnancy?

Answer 16

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception (IVF)

Question 17

How does an ectopic pregnancy present?

Answer 17

Period of amenorrhoea with positive pregnancy test
Vaginal bleeding
Abdominal pain
GI or urinary symptoms

Question 18

How should an ectopic pregnancy be investigated?

Answer 18

Ultrasound scan
Serum BHCG levels (will be sub optimal)
Serum progesterone levels (lower)

Question 19

How are ectopic pregnancies managed?

Answer 19

Methotrexate
Surgery (saplingectomy, salpingotomy)
Conservative

Question 20

How is antepartum haemorrhage defined?

Answer 20

Haemorrhage from the genital tract after the 24th week of pregnancy and before the birth of the baby

Question 21

What are the causes of antepartum haemorrhage?

Answer 21

Placenta praevia 
Placental abruption 
Unknown 
Local lesions of the genital tract 
Vasa praevia

Question 22

What is placenta praevia?

Answer 22

All or part of the placenta is attached to the lower segment of the uterus

Question 23

What are the risk factors for placenta praevia?

Answer 23

Multiparous woman
Previous C section
Multiple pregnancies

Question 24

What are the gradings for placenta praevia?

Answer 24

Grade 1 placenta encroaching on lower segment but not he internal cervical os
Grade 2 placenta reaches the internal os
Grade 3 placenta eccentrically overs os
Grade 4 central placenta praevia

Question 25

What is the presentation of placenta praevia?

Answer 25

Painless PV bleeding
Malpresentation of foetus
Incidental finding

Question 26

How is placenta praevia diagnosed?

Answer 26

Ultrasound scan

Question 27

How is placenta praevia managed?

Answer 27

C section

Question 28

What are the clinical features of placenta praevia?

Answer 28

Maternal condition correlates with mount of bleeding PV

Soft, non tender uterus

Question 29

What is a placental abruption?

Answer 29

Haemorrhage resulting from premature separation of the placenta before delivery

Question 30

What are the risk factors for placental abruption?

Answer 30

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

Question 31

What are the different types of placental abruption?

Answer 31

Revealed
Concealed
Mixed

Question 32

How does a placental abruption present?

Answer 32

Pain
Vaginal bleeding
Increased uterine activity

Question 33

What are the complications of placental abruption?

Answer 33

Maternal shock, collapse
Foetal death
Maternal DIC, renal failure
Postpartum haemorrhage

Question 34

What is the general management of antepartum haemorrhage?

Answer 34

Expectant treatment
Attempted vaginal delivery
Immediate C section

Question 35

How is preterm labour defined?

Answer 35

Onset of labour before 37 completed weeks gestation

Question 36

What are the predisposing factors for preterm labour?

Answer 36

Multiple pregnancy 
Polyhydramnios 
APH 
Pre-eclampsia 
Infection 
Prelabour premature rupture of membranes
Idiopathic (majority)

Question 37

What is the management of preterm delivery?

Answer 37

(<24-26 wks) Discuss with parents and neonatologists
Consider tocolysis to allow steroids/transfer
Steroids unless contraindicated
Transfer to unit with NICU facilities
Aim for vaginal delivery

Question 38

What are the neonatal moralities resulting from prematurity?

Answer 38

Respiratory distress syndrome 
Intraventricular haemorrhage 
Cerebral palsy 
Nutrition 
Temperature control 
Jaundice 
Infections 
Visual impairment 
Hearing Loss