Complications of pregnancy Flashcards
what is a spontaneous miscarriage?
loss of pregnancy before 24 weeks gestation
what is a threatened miscarriage?
painful bleeding but cervix are closed
the pregnancy is still viable
what is an inevitable miscarriage?
there is bleeding and the cervix is dilated
abortion then becomes inevitable
what is a missed miscarriage?
the foetus dies in the uterus but the uterus has made no attempt to expel the products of conception
what is a septic miscarriage?
incomplete miscarriage leaves some products behind in the uterus which can become infected
what is an incomplete miscarriage?
most of the pregnancy is expelled out but some products remain in the uterus
open cervix and heavy vaginal bleeding
what is a complete miscarriage?
passing of all products of conception
cervix is closed and the bleeding has stopped
what are the different types of spontaneous miscarriage?
threatened complete inevitable incomplete missed septic
what are the causes of a spontaneous miscarriage?
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
what maternal infections can increase risk of miscarriage?
- Pyelitis and Appendicitis
by causing toxic illness with high temperatures which can stimulate uterine activity and loss of pregnancy
what uterine abnormalities can increase risk of miscarriage?
fibroids (particularly sub mucous)
congenital abnormalities i.e. double uterus, septum in uterus
how is a septic miscarriage managed?
antibiotics evacuate uterus (hysterectomy)
how is a missed miscarriage managed?
conservative
medical (prostaglandins - misoprostol)
surgical management of miscarriage
what is an ectopic pregnancy?
pregnancy implanted outside the uterine cavity
what are the risk factors for an ectopic?
previous sterilisation reversed pelvic inflammatory disease (STI's) assisted conception previous ectopic smoking
what is the presentation of ectopic pregnancy?
period of amenorrhoea (+ve pregnancy test)
bleeding
abdo pain
GI or urinary symptoms
at what level should progesterone rise to if it is a viable pregnancy?
> 25ng/ml
by how much should HCG levels increase over 48 hours in a viable pregnancy?
66%
how is an ectopic pregnancy managed?
methotrexate
surgical - salpingectomy or salpingotomy
what is antepartum haemorrhage?
haemorrhage from genital tract after 24th week of pregnancy but before delivery of the baby
what are the causes of antepartum haemorrhage?
placenta praevia placenta abruption unknown origin local lesions of the genital tract vasa praevia
what is vasa praevia and how does it cause antepartum haemorrhage?
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
what is placenta praaevia?
all or part of the placenta implants in the lower uterine segment
placenta praaevia is more common in?
multiparous women
previous c-section
multiple pregnancies (more placenta)
what are the different grades of placenta praaevia?
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
what is the presentation of placenta praaevia?
painless bleeding
malpresentation of foetus (placenta prevents longitudinal life)
may be incidental at the 20 week scan
what is the most accurate way of diagnosing placenta praaevia?
MRI
as it allows identification of the internal cervical os
- isn’t widely accessible so USS is used more
what are the clinical features of placenta praaevia?
soft, non-tender uterus
maternal clinical features correlate to the mount of blood loss
what is the main complication of placenta praaevia?
post partum haemorrhage
how is post party haemorrhage managed?
medical:
- ocytoxin
- ergometrine
- carbaprost
- tranexemic acid
surgical:
- balloon tamponade
- hysterectomy
- ligation of uterine, lilac vessels
what is a placental abruption?
haemorrhage resulting from the premature separation of the placenta before the birth of the baby
what is placental abruption associated with?
retroplacental clot
what factors are associated with placental abruption?
pre eclampsia / chronic hypertension multiple pregnancy polyhydramnios smoking increasing age previous abruption parity cocaine use
why does polyhydramnios and multiple pregnancies increase risk of placental abruption?
over distended uterus
what is the presentation of placental abruption?
severe abdo pain vaginal bleeding (may be minimal) contractions (increased uterine activity)
what are the different types of placental abruption?
revealed - blood released from placenta escapes through cervical os
concealed- bleeding occurs between placenta and uterine wall
mixed
what is Couvelaire uterus?
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
how is abrupt placental haemorrhage managed?
management will vary from vaginal delivery to C-section depending on amount of bleeding, condition of both mother and baby and gestation
what are the complications of placental abruption?
maternal shock, collapse
fetal death
maternal disseminated intravascular coagulation
maternal renal failure
post partum haemorrhage (couvelaire uterus)
at what gestation is pre term labour?
delivery before 37 weeks
at what gestation is..
1) mildly preterm
2) very preterm
3) extremely preterm
1) 32-37
2) 28-32
3) 24-28
what are the pre disposing factors to pre term labour?
multiple pregnancies polyhydraminos abrupt placental haemorrhage pre eclampsia infection i.e. UTI prelabour premature rupture of membranes idiopathic
how is pre term delivery managed?
tocolysis to slow down labour
steroids for lung development
what are the neonatal morbidities associated with pre term labour?
respiratory distress intraventricular haemorrhage cerebral palsy nutrition temp control jaundice infections visual impairement hearing loss
what foetal complications can occur if the mother is diabetic?
increased risk of still birth and miscarriage
macrosomia
hyperinsulinaemia, hyperglycaemia
heart and brain abnormalities
how does foetal macrosomia occur if mum is diabetic?
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
what is acute chorioamnionitis and what cell type is found?
acute inflammation of the foetal membranes due to a bacterial infection
neutrophils are present within the membranes, cord and foetal plate of placenta
what is the presentation of chorioamniontis?
fever and presence of neutrophils in blood
or mother may be well
what are the complications of chorioamnionitis?
intrauterine death
cerebral palsy
how does chorioamnionitis cause cerebral palsy (brain damage) ?
the neutrophils produce a cytokine ‘storm’ which activates some brain cells with get damaged during the normal hypoxia of labour
what maternal conditions can increase risk of miscarriage?
diabetes thyroid disease SLE uterine abnormalities cervical incompetencies
how is downs syndrome detected?
nuchal translucency thickening on USS
raised PAAP-A
what test is used to confirm down syndrome?
amniocentesis