Complications of pregnancy Flashcards
what are the 6 main types of spontaneous miscarriage?
threatened
inevitable
incomplete
complete
septic
missed
what is a threatened miscarriage?
bleeding from the gravid uterus before 24 weeks when there is a viable fetus and no cervical dilation
what is an inevitable miscarriage?
abortion is inevitable if the cervix has begun to dilate
what is a complete miscarriage?
complete expulsion of products of conception
what is a septic miscarriage?
risk of infection following an incomplete abortion/ expulsion of products of conception
what is a missed miscarriage?
the fetus has died but there is no attempt to expel the products of conception
an early viable pregnancy can be detected with what?
US transducer
in the vaginal canal
a missed miscarriage is also known as what?
early fetal demise
in which miscarriage types is the fetus still viable?
inevitable
threatened
causes of spontaneous miscarriage
chromosomal, genetic, structural
uterine abnormalities (fibroids, congenital)
cervical incontinence (primary, secondary)
maternal (increasing age, diabetes)
how do you manage a threatened miscarriage?
conservatively
how do you manage an inevitable miscarriage?
if bleeding is heavy - the baby may need evacuted
a threatened miscarriage is literally just:
bleeding before 24 weeks
risk factors for an ectopic pregnancy
(remember it is anything that can cause the slowing of the ovum travelling to the uterus)
PID
previous tubal surgery
previous ectopic
endometriosis
smoking
How does an ectopic present?
period of amenorrhoea/ asymptomatic
+/- abdominal pain
+/- bleeding
+/- fainting/ diarrhoea and vomiting
investigating an ectopic pregnancy
scan (no intrauterine sac - may see adnexal mass/ fluid in the pouch of douglas) - transvaginal USS
serum BHCG levels (may need to track) - if pregnancy is normal though would increase
Urine HCG
serum progesterone
FBC
how do you manage an ectopic pregnancy?
medically - methotrexate
surgically - laparoscopic which will either be a salpingostomy or a salpingectomy
conservative
salpingostomy
removal of the fallopian tube
salpingectomy
removal of the ectopic pregnancy through tubal incision (should be used more commonly than salpingostomy)
when does an antepartum haemorrhage occur?
after the 24th week but before the delivery of the baby
what are the main causes of antepartum haemorrhage?
placenta praevia
placental abruption
APH of unknown origin
local lesions of the genital tract
vasa praevia (rare - blood loss from fetus)
placenta praevia
when the placenta is attached to the lower part of the uterus (just above the cervix)
placental abruption
the placenta has started to separate from the uterine wall before the birth of the baby
a collection of blood (haematoma) forms behind the placenta
what are the 3 types of placental abruption?
concealed
revealed
mixed
what is a revealed placental abruption?
major haemorrhage is apparent externally due to blood from the placenta escaping from the cervical os
what is a concealed placental abruption?
haemorrhage occurs between the placenta and the uterine wall
what is a mixed placental abruption?
both concealed and revealed
risk factors for placenta praevia:
multiparous women
multiple pregnancies (twins, triplets)
previous c section
how does placenta praevia present?
PV bleeding
malpresentation of the baby
can be an incidental finding
how do you investigate placenta praevia?
USS
to see the site of the placenta
Vaginal exam must NOT be done in this case
risk factors associated with placental abruption
pre-eclampsia/ chronic hypertension
multiple pregnancy
polyhydraminos
smoking, increased age, parity
previous abruption
cocaine
what is polyhydraminos?
excess amniotic fluid in sac
when is preterm labour?
before 37 weeks
how do you manage and APH?
depends on the condition of the mother and baby but usually
vaginal birth or C section
what factors predispose a preterm delivery?
multiple pregnancies
polyhydraminos
APH
pre eclampsia
infection
premature rupture in membrane
how would you manage a post partum haemorrhage?
PPH
medically: oxytocin, ergometrine or balloon tamponade
surgically: B-lynch suture, ligation of uterus, hysterectomy
what is hypermeresis gravidarum?
morning sickness
what is early fetal demise?
miss miscarriage
how do you treat a missed miscarriage?
prostaglandins (medical)
surgical management of miscarriage (Surgical)
how do you manage a septic miscarriage?
antibiotics
