complications of pregnancy Flashcards
what is miscarriage ?
loss of pregnancy before 24 weeks
what is the incidence of spontaneous miscarriage ?
15%
what are the different types of miscarriage ?
threatened inevitable incomplete complete septic missed
what is a threatened miscarriage ?
vaginal bleeding +/- pain
viable pregnancy
closed cervix on speculum exam
what is an inevitable miscarriage ?
open cervix with bleeding
bleeding heavy +/- clots
what is a missed miscarriage ?
no symptoms, could have bleeding
gestational sac seen on scan, no fetus or fetal pole
what is an incomplete miscarriage ?
most of pregnancy expelled, some products may remain
open cervix
vaginal bleeding may be heavy
what is complete miscarriage ?
passed all products of conception
cervix closed
bleeding stopped
when do you get septic miscarriage ?
cases of incomplete miscarriage
what is the aetiology of spontaneous miscarriage ?
abnormal conceptus - chromosomal, genetic, structural
uterine abnormality - congenital, fibroids
cervical incompetence
maternal - increased age, DM
how do you manage miscarriage ?
threatened - conservative
inevitable - if heavy bleeding may need evacuation
missed - prostaglandin, surgical
septic - Abx and evacuate uterus
what is the most common site for ectopic pregnancy ?
ampullarf section of fallopian tube
what are risk factors for ectopic pregnancies ?
pelvic inflammatory disease
previous tubal surgery
previous ectopic
assisted conception
how do ectopic pregnancies present ?
period of amenorrhoea, +ve urine test
vaginal bleeding
abdominal pain
GI/urinary symptoms
how do you investigate ectopic pregnancy ?
serum B-hCG levels
USS - no intrauterine gestational sac, adnexal mass, fluid in pouch of Douglas
serum progesterone - if IU pregnancy may be high
how do you manage ectopic pregnancy ?
methotrexate
surgical - salphnectomy
what is antepartum haemorrhage ?
haemorrhage from genital tract after 24th week but before delivery
what causes antepartum haemorrhage ?
placenta praevia placental abruption APH of unknown origin local lesions of the genital tract vasa praevia - bad, small volume of blood from fetal vessel rupture
what is placenta praaevia ?
all or part of the placenta implants in the lower uterine segment
what are risk factors for placenta praaevia ?
multiparous women
multiple pregnancies
previous Caesarean section
what are the classifications of placenta praaevia ?
grade 1 - placenta encroaching on lower segment but not internal os
grade 2 - placenta reaches internal os
grade 3 - placental eccentrically covers os
grade 4 - central placenta praaevia
how does placenta praevia present ?
painless PV bleeding
malpresentation of fetus
soft non-tender uterus
how do you investigate placenta praaevia ?
USS
DO NOT DO VAGINAL EXAM
how do you manage placenta praaevia ?
gestation
Caesarean section
what is a maternal complication of placenta praaevia ?
post partum haemorrhage
how do you manage post partum haemorrhage ?
medical - oxytocin, ergometrine, carbaprost, tranexamic acid
balloon tamponade
surgical ligation of vessels
hysterectomy
what are factors associated with placental abruption ?
pre-eclampsia/chronic hypertension multiple pregnancy polyhydramnios smoking, increased age, parity previous abruption cocaine use
what are the three types of placental abruption ?
revealed
concealed
mixed
what is the presentation of placental abruption ?
pain ++
vaginal bleeding
increased uterine activity
what are complications of placental abruption ?
maternal shock, collapse
fetal death
maternal DIC, renal failure
postpartum haemorrhage
what are predisposing factors to preterm labour ?
multiple pregnancy polyhydramnios APH pre-eclampsia infection - UTI prelabour premature membrane rupture
what are neonatal morbidities resulting from prematurity ?
RDS intraventricular haemorrhage cerebral palsy nutrition temperature control jaundice infections visual impairment hearing loss
