Complications of pregnancy

Question 1

what is a spontaneous miscarriage?

Answer 1

loss of pregnancy before 24 weeks gestation

Question 2

what is a threatened miscarriage?

Answer 2

painful bleeding but cervix are closed

the pregnancy is still viable

Question 3

what is an inevitable miscarriage?

Answer 3

there is bleeding and the cervix is dilated

abortion then becomes inevitable

Question 4

what is a missed miscarriage?

Answer 4

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

Question 5

what is a septic miscarriage?

Answer 5

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

Question 6

what is an incomplete miscarriage?

Answer 6

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

Question 7

what is a complete miscarriage?

Answer 7

passing of all products of conception

cervix is closed and the bleeding has stopped

Question 8

what are the different types of spontaneous miscarriage?

Answer 8

threatened 
complete 
inevitable
incomplete 
missed 
septic

Question 9

what are the causes of a spontaneous miscarriage?

Answer 9

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

Question 10

what maternal infections can increase risk of miscarriage?

Answer 10

• Pyelitis and Appendicitis

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

Question 11

what uterine abnormalities can increase risk of miscarriage?

Answer 11

fibroids (particularly sub mucous)

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

Question 12

how is a septic miscarriage managed?

Answer 12

antibiotics
evacuate uterus (hysterectomy)

Question 13

how is a missed miscarriage managed?

Answer 13

conservative
medical (prostaglandins - misoprostol)
surgical management of miscarriage

Question 14

what is an ectopic pregnancy?

Answer 14

pregnancy implanted outside the uterine cavity

Question 15

what are the risk factors for an ectopic?

Answer 15

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

Question 16

what is the presentation of ectopic pregnancy?

Answer 16

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

Question 17

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

Answer 17

> 25ng/ml

Question 18

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

Answer 18

66%

Question 19

how is an ectopic pregnancy managed?

Answer 19

methotrexate

surgical - salpingectomy or salpingotomy

Question 20

what is antepartum haemorrhage?

Answer 20

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

Question 21

what are the causes of antepartum haemorrhage?

Answer 21

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

Question 22

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

Answer 22

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

Question 23

what is placenta praaevia?

Answer 23

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

Question 24

placenta praaevia is more common in?

Answer 24

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

Question 25

what are the different grades of placenta praaevia?

Answer 25

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

Question 26

what is the presentation of placenta praaevia?

Answer 26

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

Question 27

what is the most accurate way of diagnosing placenta praaevia?

Answer 27

MRI as it allows identification of the internal cervical os - isn't widely accessible so USS is used more

Question 28

what are the clinical features of placenta praaevia?

Answer 28

soft, non-tender uterus | maternal clinical features correlate to the mount of blood loss

Question 29

what is the main complication of placenta praaevia?

Answer 29

post partum haemorrhage

Question 30

how is post party haemorrhage managed?

Answer 30

medical: - ocytoxin - ergometrine - carbaprost - tranexemic acid surgical: - balloon tamponade - hysterectomy - ligation of uterine, lilac vessels

Question 31

what is a placental abruption?

Answer 31

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

Question 32

what is placental abruption associated with?

Answer 32

retroplacental clot

Question 33

what factors are associated with placental abruption?

Answer 33

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

Question 34

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

Answer 34

over distended uterus

Question 35

what is the presentation of placental abruption?

Answer 35

``` severe abdo pain vaginal bleeding (may be minimal) contractions (increased uterine activity) ```

Question 36

what are the different types of placental abruption?

Answer 36

revealed - blood released from placenta escapes through cervical os concealed- bleeding occurs between placenta and uterine wall mixed

Question 37

what is Couvelaire uterus?

Answer 37

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

Question 38

how is abrupt placental haemorrhage managed?

Answer 38

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

Question 39

what are the complications of placental abruption?

Answer 39

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

Question 40

at what gestation is pre term labour?

Answer 40

delivery before 37 weeks

Question 41

at what gestation is.. 1) mildly preterm 2) very preterm 3) extremely preterm

Answer 41

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

Question 42

what are the pre disposing factors to pre term labour?

Answer 42

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

Question 43

how is pre term delivery managed?

Answer 43

tocolysis to slow down labour | steroids for lung development

Question 44

what are the neonatal morbidities associated with pre term labour?

Answer 44

``` respiratory distress intraventricular haemorrhage cerebral palsy nutrition temp control jaundice infections visual impairement hearing loss ```

Question 45

what foetal complications can occur if the mother is diabetic?

Answer 45

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

Question 46

how does foetal macrosomia occur if mum is diabetic?

Answer 46

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

Question 47

what is acute chorioamnionitis and what cell type is found?

Answer 47

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

Question 48

what is the presentation of chorioamniontis?

Answer 48

fever and presence of neutrophils in blood | or mother may be well

Question 49

what are the complications of chorioamnionitis?

Answer 49

intrauterine death | cerebral palsy

Question 50

how does chorioamnionitis cause cerebral palsy (brain damage) ?

Answer 50

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

Question 51

what maternal conditions can increase risk of miscarriage?

Answer 51

``` diabetes thyroid disease SLE uterine abnormalities cervical incompetencies ```

Question 52

how is downs syndrome detected?

Answer 52

nuchal translucency thickening on USS | raised PAAP-A

Question 53

what test is used to confirm down syndrome?

Answer 53

amniocentesis