Complications of Pregnancy

Question 1

What are the main complications of pregnancy?

Answer 1

Spontaneous miscarriage
Ectopic pregnancy
Antepartum haemorrhage
Preterm labour

Question 2

What is abortion/spontaneous miscarriage?

Answer 2

Termination/loss of pregnancy before 24 weeks gestation

Question 3

What are the types of spontaneous miscarriage?

Answer 3

Threatened
Inevitable
Incomplete
Complete
Septic
Missed

Question 4

What is a threatened miscarriage?

Answer 4

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

Question 5

What is an inevitable miscarriage?

Answer 5

Abortion becomes inevitable if the cervix has already begun to dilate

Question 6

What is an incomplete abortion?

Answer 6

When there is only partial expulsion of the products of conception

Question 7

What is complete abortion?

Answer 7

Complete expulsion of the products of conception

Question 8

What is a septic abortion?

Answer 8

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

Question 9

What is a missed abortion?

Answer 9

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

Question 10

Signed/symptoms of threatened miscarriage

Answer 10

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

Question 11

Signs/symptoms of inevitable pregnancy

Answer 11

Open cervix with bleeding

that could be heavy (+/-clots)

Question 12

Signs/symptoms of missed miscarriage

Answer 12

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

Question 13

Aetiology of spontaneous miscarriage

Answer 13

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

Question 14

Management of threatened miscarriage

Answer 14

Conservative

Question 15

Management of inevitable miscarriage

Answer 15

If bleeding heavy may need evacuation

Question 16

Management of missed miscarriage

Answer 16

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

Question 17

Management of septic miscarriage

Answer 17

Antibiotics and evacuate uterus

Question 18

What is an ectopic pregnancy?

Answer 18

Pregnancy implanted outside the uterine cavity

Question 19

Risk factors of ectopic pregnancy

Answer 19

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

Question 20

Presentation of ectopic pregnancy

Answer 20

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

Question 21

Management of ectopic pregnancy

Answer 21

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

Question 22

What is antepartum haemorrhage?

Answer 22

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

Question 23

Causes of APH

Answer 23

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

Question 24

What is placenta praevia?

Answer 24

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

Question 25

What is placental abruption?

Answer 25

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

Question 26

Clinical features of placenta praevia

Answer 26

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

Question 27

Diagnosis of placenta praevia

Answer 27

Ultrasound scan to locate placental site

Vaginal examination must not be done with suspected placenta praevia

Question 28

Management of placenta praevia

Answer 28

C section

Watch for PPH

Question 29

Management of PPH

Answer 29

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

Question 30

Factors associated with placental abruption

Answer 30

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

Question 31

Presentation of placental abruption

Answer 31

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

Question 32

Complications of placental abruption

Answer 32

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

Question 33

What is preterm labour?

Answer 33

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

Question 34

Neonatal morbidity resulting from prematurity

Answer 34

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