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Reproductive system > Complications of pregnancy > Flashcards

Complications of pregnancy Flashcards

1
Q

what is a spontaneous miscarriage?

A

loss of pregnancy before 24 weeks gestation

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2
Q

what is a threatened miscarriage?

A

painful bleeding but cervix are closed

the pregnancy is still viable

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3
Q

what is an inevitable miscarriage?

A

there is bleeding and the cervix is dilated

abortion then becomes inevitable

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4
Q

what is a missed miscarriage?

A

the foetus dies in the uterus but the uterus has made no attempt to expel the products of conception

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5
Q

what is a septic miscarriage?

A

incomplete miscarriage leaves some products behind in the uterus which can become infected

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6
Q

what is an incomplete miscarriage?

A

most of the pregnancy is expelled out but some products remain in the uterus
open cervix and heavy vaginal bleeding

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7
Q

what is a complete miscarriage?

A

passing of all products of conception

cervix is closed and the bleeding has stopped

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8
Q

what are the different types of spontaneous miscarriage?

A 
threatened 
complete 
inevitable
incomplete 
missed 
septic
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9
Q

what are the causes of a spontaneous miscarriage?

A

abnormal conceptus i.e. chromosomal
uterine abnormality i.e. double uterus, septum in uterus
cervical incompetence i.e. primary or secondary (after surgery)
maternal causes i.e. age, diabetes
unknown

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10
Q

what maternal infections can increase risk of miscarriage?

A
  • Pyelitis and Appendicitis

by causing toxic illness with high temperatures which can stimulate uterine activity and loss of pregnancy

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11
Q

what uterine abnormalities can increase risk of miscarriage?

A

fibroids (particularly sub mucous)

congenital abnormalities i.e. double uterus, septum in uterus

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12
Q

how is a septic miscarriage managed?

A 
antibiotics
evacuate uterus (hysterectomy)
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13
Q

how is a missed miscarriage managed?

A

conservative
medical (prostaglandins - misoprostol)
surgical management of miscarriage

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14
Q

what is an ectopic pregnancy?

A

pregnancy implanted outside the uterine cavity

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15
Q

what are the risk factors for an ectopic?

A 
previous sterilisation reversed
pelvic inflammatory disease (STI's)
assisted conception
previous ectopic 
smoking
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16
Q

what is the presentation of ectopic pregnancy?

A

period of amenorrhoea (+ve pregnancy test)
bleeding
abdo pain
GI or urinary symptoms

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17
Q

at what level should progesterone rise to if it is a viable pregnancy?

A

> 25ng/ml

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18
Q

by how much should HCG levels increase over 48 hours in a viable pregnancy?

A

66%

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19
Q

how is an ectopic pregnancy managed?

A

methotrexate

surgical - salpingectomy or salpingotomy

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20
Q

what is antepartum haemorrhage?

A

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

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21
Q

what are the causes of antepartum haemorrhage?

A 
placenta praevia
placenta abruption
unknown origin
local lesions of the genital tract
vasa praevia
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22
Q

what is vasa praevia and how does it cause antepartum haemorrhage?

A

blood loss due to rupture of a foetal vessel within the foetal membranes
blood loss is fatal and nor maternal and therefore has catastrophic consequences for the foetus

23
Q

what is placenta praaevia?

A

all or part of the placenta implants in the lower uterine segment

24
Q

placenta praaevia is more common in?

A

multiparous women
previous c-section
multiple pregnancies (more placenta)

25
Q

what are the different grades of placenta praaevia?

A

grade I: placenta near the lower segment but not the internal cervical os

grade II: placenta reaches the internal os

grade III: placenta covers the os

grade IV: central placenta praevia

26
Q

what is the presentation of placenta praaevia?

A

painless bleeding
malpresentation of foetus (placenta prevents longitudinal life)
may be incidental at the 20 week scan

27
Q

what is the most accurate way of diagnosing placenta praaevia?

A

MRI
as it allows identification of the internal cervical os

  • isn’t widely accessible so USS is used more
28
Q

what are the clinical features of placenta praaevia?

A

soft, non-tender uterus

maternal clinical features correlate to the mount of blood loss

29
Q

what is the main complication of placenta praaevia?

A

post partum haemorrhage

30
Q

how is post party haemorrhage managed?

A

medical:

  • ocytoxin
  • ergometrine
  • carbaprost
  • tranexemic acid

surgical:

  • balloon tamponade
  • hysterectomy
  • ligation of uterine, lilac vessels
31
Q

what is a placental abruption?

A

haemorrhage resulting from the premature separation of the placenta before the birth of the baby

32
Q

what is placental abruption associated with?

A

retroplacental clot

33
Q

what factors are associated with placental abruption?

A 
pre eclampsia / chronic hypertension
multiple pregnancy
polyhydramnios
smoking
increasing age
previous abruption
parity
cocaine use
34
Q

why does polyhydramnios and multiple pregnancies increase risk of placental abruption?

A

over distended uterus

35
Q

what is the presentation of placental abruption?

A 
severe abdo pain
vaginal bleeding (may be minimal)
contractions (increased uterine activity)
36
Q

what are the different types of placental abruption?

A

revealed - blood released from placenta escapes through cervical os

concealed- bleeding occurs between placenta and uterine wall

mixed

37
Q

what is Couvelaire uterus?

A

in a concealed placenta abruption the bleeding occurs between the placenta and uterine wall
blood may penetrate the walls of the uterus making it appear bruised known as Couvelaire uterus

38
Q

how is abrupt placental haemorrhage managed?

A

management will vary from vaginal delivery to C-section depending on amount of bleeding, condition of both mother and baby and gestation

39
Q

what are the complications of placental abruption?

A

maternal shock, collapse
fetal death
maternal disseminated intravascular coagulation
maternal renal failure
post partum haemorrhage (couvelaire uterus)

40
Q

at what gestation is pre term labour?

A

delivery before 37 weeks

41
Q

at what gestation is..

1) mildly preterm
2) very preterm
3) extremely preterm

A

1) 32-37
2) 28-32
3) 24-28

42
Q

what are the pre disposing factors to pre term labour?

A 
multiple pregnancies
polyhydraminos 
abrupt placental haemorrhage
pre eclampsia
infection i.e. UTI
prelabour premature rupture of membranes 
idiopathic
43
Q

how is pre term delivery managed?

A

tocolysis to slow down labour

steroids for lung development

44
Q

what are the neonatal morbidities associated with pre term labour?

A 
respiratory distress
intraventricular haemorrhage
cerebral palsy
nutrition
temp control
jaundice
infections
visual impairement
hearing loss
45
Q

what foetal complications can occur if the mother is diabetic?

A

increased risk of still birth and miscarriage
macrosomia
hyperinsulinaemia, hyperglycaemia
heart and brain abnormalities

46
Q

how does foetal macrosomia occur if mum is diabetic?

A

too much glucose in mothers blood
glucose crosses the placenta causing babies BG to increase
this causes overstimulation of babies pancreas to produce more insulin
= hyperglycaemia and hyperinsulinaemia
the baby isn’t able to decrease BG levels as mother keeps sending more glucose across the placenta
long term high insulin and glucose = massive growth

47
Q

what is acute chorioamnionitis and what cell type is found?

A

acute inflammation of the foetal membranes due to a bacterial infection
neutrophils are present within the membranes, cord and foetal plate of placenta

48
Q

what is the presentation of chorioamniontis?

A

fever and presence of neutrophils in blood

or mother may be well

49
Q

what are the complications of chorioamnionitis?

A

intrauterine death

cerebral palsy

50
Q

how does chorioamnionitis cause cerebral palsy (brain damage) ?

A

the neutrophils produce a cytokine ‘storm’ which activates some brain cells with get damaged during the normal hypoxia of labour

51
Q

what maternal conditions can increase risk of miscarriage?

A 
diabetes
thyroid disease
SLE 
uterine abnormalities 
cervical incompetencies
52
Q

how is downs syndrome detected?

A

nuchal translucency thickening on USS

raised PAAP-A

53
Q

what test is used to confirm down syndrome?

A

amniocentesis

Reproductive system (31 decks)

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