Complications of Pregnancy Flashcards
What are the main complications of pregnancy?
Spontaneous miscarriage
Ectopic pregnancy
Antepartum haemorrhage
Preterm labour
What is abortion/spontaneous miscarriage?
Termination/loss of pregnancy before 24 weeks gestation
What are the types of spontaneous miscarriage?
Threatened Inevitable Incomplete Complete Septic Missed
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
What is an inevitable miscarriage?
Abortion becomes inevitable if the cervix has already begun to dilate
What is an incomplete abortion?
When there is only partial expulsion of the products of conception
What is complete abortion?
Complete expulsion of the products of conception
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
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
Signed/symptoms of threatened miscarriage
Vaginal bleeding+/- pain
Viable pregnancy
Closed cervix on speculum examination
Signs/symptoms of inevitable pregnancy
Open cervix with bleeding
that could be heavy (+/-clots)
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
Aetiology of spontaneous miscarriage
Abnormal conceptus Uterine abnormality Cervical incompetence Maternal (increasing age, diabetes) Unknown
Management of threatened miscarriage
Conservative
Management of inevitable miscarriage
If bleeding heavy may need evacuation
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
