Complications of pregnancy

Question 1

what are the 6 main types of spontaneous miscarriage?

Answer 1

threatened

inevitable

incomplete

complete

septic

missed

Question 2

what is a threatened miscarriage?

Answer 2

bleeding from the gravid uterus before 24 weeks when there is a viable fetus and no cervical dilation

Question 3

what is an inevitable miscarriage?

Answer 3

abortion is inevitable if the cervix has begun to dilate

Question 4

what is a complete miscarriage?

Answer 4

complete expulsion of products of conception

Question 5

what is a septic miscarriage?

Answer 5

risk of infection following an incomplete abortion/ expulsion of products of conception

Question 6

what is a missed miscarriage?

Answer 6

the fetus has died but there is no attempt to expel the products of conception

Question 7

an early viable pregnancy can be detected with what?

Answer 7

US transducer

in the vaginal canal

Question 8

a missed miscarriage is also known as what?

Answer 8

early fetal demise

Question 9

in which miscarriage types is the fetus still viable?

Answer 9

inevitable

threatened

Question 10

causes of spontaneous miscarriage

Answer 10

chromosomal, genetic, structural

uterine abnormalities (fibroids, congenital)

cervical incontinence (primary, secondary)

maternal (increasing age, diabetes)

Question 11

how do you manage a threatened miscarriage?

Answer 11

conservatively

Question 12

how do you manage an inevitable miscarriage?

Answer 12

if bleeding is heavy - the baby may need evacuted

Question 13

a threatened miscarriage is literally just:

Answer 13

bleeding before 24 weeks

Question 14

risk factors for an ectopic pregnancy

Answer 14

(remember it is anything that can cause the slowing of the ovum travelling to the uterus)

PID

previous tubal surgery

previous ectopic

endometriosis

smoking

Question 15

How does an ectopic present?

Answer 15

period of amenorrhoea/ asymptomatic

+/- abdominal pain

+/- bleeding

+/- fainting/ diarrhoea and vomiting

Question 16

investigating an ectopic pregnancy

Answer 16

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

Question 17

how do you manage an ectopic pregnancy?

Answer 17

medically - methotrexate

surgically - laparoscopic which will either be a salpingostomy or a salpingectomy

conservative

Question 18

salpingostomy

Answer 18

removal of the fallopian tube

Question 19

salpingectomy

Answer 19

removal of the ectopic pregnancy through tubal incision (should be used more commonly than salpingostomy)

Question 20

when does an antepartum haemorrhage occur?

Answer 20

after the 24th week but before the delivery of the baby

Question 21

what are the main causes of antepartum haemorrhage?

Answer 21

placenta praevia

placental abruption

APH of unknown origin

local lesions of the genital tract

vasa praevia (rare - blood loss from fetus)

Question 22

placenta praevia

Answer 22

when the placenta is attached to the lower part of the uterus (just above the cervix)

Question 23

placental abruption

Answer 23

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

Question 24

what are the 3 types of placental abruption?

Answer 24

concealed

revealed

mixed

Question 25

what is a revealed placental abruption?

Answer 25

major haemorrhage is apparent externally due to blood from the placenta escaping from the cervical os

Question 26

what is a concealed placental abruption?

Answer 26

haemorrhage occurs between the placenta and the uterine wall

Question 27

what is a mixed placental abruption?

Answer 27

both concealed and revealed

Question 28

risk factors for placenta praevia:

Answer 28

multiparous women

multiple pregnancies (twins, triplets)

previous c section

Question 29

how does placenta praevia present?

Answer 29

PV bleeding

malpresentation of the baby

can be an incidental finding

Question 30

how do you investigate placenta praevia?

Answer 30

USS

to see the site of the placenta
Vaginal exam must NOT be done in this case

Question 31

risk factors associated with placental abruption

Answer 31

pre-eclampsia/ chronic hypertension

multiple pregnancy

polyhydraminos

smoking, increased age, parity

previous abruption

cocaine

Question 32

what is polyhydraminos?

Answer 32

excess amniotic fluid in sac

Question 33

when is preterm labour?

Answer 33

before 37 weeks

Question 34

how do you manage and APH?

Answer 34

depends on the condition of the mother and baby but usually

vaginal birth or C section

Question 35

what factors predispose a preterm delivery?

Answer 35

multiple pregnancies

polyhydraminos

APH

pre eclampsia

infection

premature rupture in membrane

Question 36

how would you manage a post partum haemorrhage?

PPH

Answer 36

medically: oxytocin, ergometrine or balloon tamponade
surgically: B-lynch suture, ligation of uterus, hysterectomy

Question 37

what is hypermeresis gravidarum?

Answer 37

morning sickness

Question 38

what is early fetal demise?

Answer 38

miss miscarriage

Question 39

how do you treat a missed miscarriage?

Answer 39

prostaglandins (medical)

surgical management of miscarriage (Surgical)

Question 40

how do you manage a septic miscarriage?

Answer 40

antibiotics