Complications of Pregnancy Flashcards by Laura M

What are the main complications of pregnancy?

Spontaneous miscarriage
Ectopic pregnancy
Antepartum haemorrhage
Preterm labour

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What is abortion/spontaneous miscarriage?

Termination/loss of pregnancy before 24 weeks gestation

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What are the types of spontaneous miscarriage?

Threatened
Inevitable
Incomplete
Complete
Septic
Missed

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What is a threatened miscarriage?

Bleeding from the gravid uterus before 24 weeks gestation when there is a viable fetus and no evidence of cervical dilatation

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What is an inevitable miscarriage?

Abortion becomes inevitable if the cervix has already begun to dilate

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What is an incomplete abortion?

When there is only partial expulsion of the products of conception

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What is complete abortion?

Complete expulsion of the products of conception

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What is a septic abortion?

Following an incomplete abortion there is always a risk of ascending infection into the uterus which can spread throughout the pelvis

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What is a missed abortion?

A pregnancy in which the fetus has died but the uterus has made no attempt to expel the products of conception

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Signed/symptoms of threatened miscarriage

Vaginal bleeding+/- pain
Viable pregnancy
Closed cervix on speculum examination

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Signs/symptoms of inevitable pregnancy

Open cervix with bleeding

that could be heavy (+/-clots)

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Signs/symptoms of missed miscarriage

No symptoms, or could have bleeding/ brown loss vaginally
Gestational sac seen on scan
No clear fetus (empty gestational sac) or a fetal pole with no fetal heart seen in the gestational sac

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Aetiology of spontaneous miscarriage

Abnormal conceptus
Uterine abnormality
Cervical incompetence
Maternal (increasing age, diabetes)
Unknown

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Management of threatened miscarriage

Conservative

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Management of inevitable miscarriage

If bleeding heavy may need evacuation

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Management of missed miscarriage

conservative
medical (prostaglandins)
surgical (surgical management of miscarriage)

Management of septic miscarriage

Antibiotics and evacuate uterus

What is an ectopic pregnancy?

Pregnancy implanted outside the uterine cavity

Risk factors of ectopic pregnancy

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

Presentation of ectopic pregnancy

Period of ammenorhoea (with +ve urine pregnancy test)
+/- Vaginal bleeding
+/- Pain abdomen
+/- GI or urinary symptoms

Management of ectopic pregnancy

Medical (methotrexate)
Surgical (mostly laparosciopical – salpingectomy, salpingotomy for few indications)
Conservative

What is antepartum haemorrhage?

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

Causes of APH

Placenta praevia
Placental abruption
APH of unknown origin
Local lesions of the genital tract
Vasa praevia

What is placenta praevia?

Where the placenta is attached to the lower segment of the uterus

What is placental abruption?

Where the placenta has started to separate from the uterine wall before the birth of the baby and is associated with a retroplacental clot

Clinical features of placenta praevia

Maternal condition correlates with amount of bleeding PV Soft, non tender uterus +/- fetal malpresentation

Diagnosis of placenta praevia

Ultrasound scan to locate placental site | Vaginal examination must not be done with suspected placenta praevia

Management of placenta praevia

C section | Watch for PPH

Management of PPH

``` Medical management (oxytocin, ergometrine, carbaprost, tranexemic acid) Balloon tamponade (surgical) ```

Factors associated with placental abruption

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

Presentation of placental abruption

Pain Vaginal bleeding (may be minimal bleeding) Increased uterine activity

Complications of placental abruption

Maternal shock, collapse (may be disproportionate to the amount of bleeding seen) Fetal death Maternal DIC, renal failure Postpartum haemorrhage

What is preterm labour?

Onset of labour before 37 completed weeks gestation (259 days)

Neonatal morbidity resulting from prematurity

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