Complications of Pregnancy Flashcards
How is abortion or spontaneous miscarriage defined?
Termination or loss of pregnancy before 24 weeks gestation with no evidence of life
What are the different categories of spontaneous miscarriage?
Threatened Inevitable Incomplete Complete Septic Missed
What is a threatened miscarriage?
Bleeding from the gravid uterus before 24 weeks gestation
Viable pregnancy
Closed cervix
Pain
When does a miscarriage become inevitable?
Viable pregnancy
Open cervix with bleeding
What is an incomplete miscarriage?
Partial expulsion of products of conception
Open cervix
Vaginal bleeding
What is a complete miscarriage?
Passed all products of conception
Cervix closed
Bleeding stopped
What is a septic miscarriage?
Following an incomplete miscarriage risk of ascending infection into the uterus which may spread throughout the pelvis
What is a missed miscarriage?
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
What are the different causes of miscarriage?
Chromosomal, genetic, structural Congenital uterine abnormality Fibroids Cervical incompetence Increased maternal age Maternal diabetes Unknown
How is a threatened miscarriage managed?
Conservative treatment
How is n inevitable miscarriage treated?
Evacuation of heavy bleeding
How is a missed miscarriage treated?
Conservative treatment
Medical (prostaglandins)
Surgery
How is a septic miscarriage managed?
Antibiotics
Evacuate uterus
What is an ectopic pregnancy?
Pregnancy implanted outside the uterine cavity
Where is the most common area for an ectopic pregnancy?
Ampullary part of the fallopian tube
What are the risk factors for an ectopic pregnancy?
Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception (IVF)
How does an ectopic pregnancy present?
Period of amenorrhoea with positive pregnancy test
Vaginal bleeding
Abdominal pain
GI or urinary symptoms
How should an ectopic pregnancy be investigated?
Ultrasound scan
Serum BHCG levels (will be sub optimal)
Serum progesterone levels (lower)
How are ectopic pregnancies managed?
Methotrexate
Surgery (saplingectomy, salpingotomy)
Conservative
How is antepartum haemorrhage defined?
Haemorrhage from the genital tract after the 24th week of pregnancy and before the birth of the baby
What are the causes of antepartum haemorrhage?
Placenta praevia Placental abruption Unknown Local lesions of the genital tract Vasa praevia
What is placenta praevia?
All or part of the placenta is attached to the lower segment of the uterus
What are the risk factors for placenta praevia?
Multiparous woman
Previous C section
Multiple pregnancies
What are the gradings for placenta praevia?
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
What is the presentation of placenta praevia?
Painless PV bleeding
Malpresentation of foetus
Incidental finding
How is placenta praevia diagnosed?
Ultrasound scan
How is placenta praevia managed?
C section
What are the clinical features of placenta praevia?
Maternal condition correlates with mount of bleeding PV
Soft, non tender uterus
What is a placental abruption?
Haemorrhage resulting from premature separation of the placenta before delivery
What are the risk factors for placental abruption?
Pre-eclampsia/ chronic hypertension Multiple pregnancy Polyhydramnios Smoking Increasing age Parity Previous abruption Cocaine use
What are the different types of placental abruption?
Revealed
Concealed
Mixed
How does a placental abruption present?
Pain
Vaginal bleeding
Increased uterine activity
What are the complications of placental abruption?
Maternal shock, collapse
Foetal death
Maternal DIC, renal failure
Postpartum haemorrhage
What is the general management of antepartum haemorrhage?
Expectant treatment
Attempted vaginal delivery
Immediate C section
How is preterm labour defined?
Onset of labour before 37 completed weeks gestation
What are the predisposing factors for preterm labour?
Multiple pregnancy Polyhydramnios APH Pre-eclampsia Infection Prelabour premature rupture of membranes Idiopathic (majority)
What is the management of preterm delivery?
(<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
What are the neonatal moralities resulting from prematurity?
Respiratory distress syndrome Intraventricular haemorrhage Cerebral palsy Nutrition Temperature control Jaundice Infections Visual impairment Hearing Loss
