Complications Of Pregnancy Flashcards
What are the types of miscarriage?
Spontaneous: loss of pregnancy <24wk gestation
Threatened: vaginal bleeding +/- pain, viable pregnancy, closed cervix on speculum examination
Inevitable: open cervix with bleeding that could be heavy +/- clots, viable pregnancy
Missed: no symptoms, possible bleeding/ brown loss vaginally. Gestational sac on scan, no clear foetus or foetal pole with no heart
Incomplete: most of pregnancy expelled out, some products remaining in uterus
Complete: passed all products of conception, cervix closed and bleeding has stopped
Septic: especially in cases of incomplete miscarriage
How are miscarriages initially managed?
Threatened: conservatively
Inevitable: may need evacuation if bleeding is heavy
Missed: conservative, medically with prostaglandins, surgically
Septic: antibiotics and evacuate uterus
What is antepartum haemorrhage?
Haemorrhage from genital tract >24 weeks of pregnancy but before delivery of baby
Causes: placenta praevia, placental abruption, unknown origin, local lesions, vasa praevia
Placenta praevia presents with painless PV bleeding, malpresentation or incidentally. Diagnose with USS. Management depends on gestation and severity. Birth via CS.
Placental abruption can be revealed, concealed or mixed. Presents with pain, vaginal bleeding, increased uterine activity
How is APH initially managed?
Varies from expectant treatment to attempting vaginal delivery to immediate CS depending on: amount of bleeding, general condition of mother and baby, gestation
What hypertensive disorders can occur in pregnancy and how are they initially managed?
Chronic - prepregnancy or at booking <20wk. Older mothers. Should have pre pregnancy care. Asses drugs and change/stop. Monitor for: superimposed pre-eclampsia, foetal growth.
Gestational - new HTN develops >20wk.
Pre-eclampsia - new HTN >20wk, associated with significant proteinuria. Mild HTN x2>4hr apart OR moderate to severe HTN + proteinuria. Risk factors include: 1st pregnancy, extremes of age, previous history, >35 BMI, pregnancy interval of >10y, multiple pregnancy, FH, underlying medical conditions.
Management:
-conservative: close obs, anti HTN, steroid for foetal lung maturity. Consider induction,CS if condition deteriorates. Monitor post delivery.
-seizures: magnesium sulphate bolus + IV infusion. Control BP via IV labetolol, hydrallazine. Avoid fluid overload.
What are the complications of hypertensive disorders in pregnancy?
Pre-eclampsia: seizures, of severe then cerebral haemorrhage, stroke, HELLP (haemolysis, elevated liver enzymes, low platelets), DIC, renal failure, pulmonary oedema, cardiac failure, impaired placenta perfusion (IUGR, foetal distress, prematurity, increases PN mortality)
What are the complications associated with diabetes in pregnancy?
Increased risk of: foetal congenital abnormalities eg cardiac, sacral agenesis; miscarriage; foetal macrosomnia, polyhydramnios; operative delivery, shoulder dystocia; stillbirth, increased perinatal mortality; pre eclampsia; worsening maternal nephropathy, retinopathy, hypoglycaemia, reduces awareness of hypoglycaemia; infections
Neonatal: impaired lung maturity, neonatal hypoglycaemia, jaundice
When should you suspect thrombosis in pregnancy?
Risk factors: increase in age, increase number of pregnancies, increased BMI, smoker, IV drug user, PET, dehydration, decreased mobility, infections, operative delivery, prolonged labour, haemorrhage, previous VTE, thrombophilia, FH, sickle cell
Signs/symptoms: calf pain, increased birth, muscle tenderness, SOB, pain on breathing, cough, tachycardia, hypoxia, pleural rub etc
Investigations: ECG, VQ scan, blood gases, Doppler
Can confirm dismally with a Doppler
Management:
- prophylaxis: TED stockings, advice re mobility, hydration. If >3 risks then prophylactic ant coagulation.
- acute: full dose anticoagulation
When do you suspect someone has severe PET?
Symptoms/signs of: headache, blurred vision, epigastric pain, vomiting, sudden swelling of face, hands, legs. Severe HTN, >3+ urine proteinuria. Clonus/brisk reflexes, papilloedema, epigastric tenderness. Reduced urine output. Convulsions.
Biochemistry: raised liver enzymes, bilirubin. Raised urea and creatinine, raised urate.
Haematological: low platelets, low Hb, signs of haemolysis, feature of DIC
What is the management of diabetes in pregnancy?
Preconception: improve glycemic control, folic acid, dietary advice, retinal and renal assessment
During: optimise glucose control, be aware of risk of hypoglycaemia, watch for ketonuria/infections, repeat retinal assessments, watch total growth, observe for PET, induce labour plans, consider elective, maintain blood sugar in labour, continuous CTG, early feeding of baby
Post baby: pre pregnancy regime of insulin
