Early and Late Complications of Pregnancy Flashcards
What is Hyperemesis Gravidarum?
it is extreme, persistent nausea and vomiting during pregnancy
what can Hyperemesis Gravidarum lead to in pregnant women?
1)
2)
3)
It can lead to;
dehydration
weight loss
electrolyte imbalances
what is morning sickness?
mild nausea and vomiting that occurs in early pregnancy
what is the most common time period morning sickness occurs?
Most common during the first 3 months of the pregnancy
causes of moring sickness
not fully understood
potentially caused by rapidly rising blood level of a hormone called human chorionic gonadotropin (HCG)
what is HCG released by?
released by the placenta
what pregnancies are considered high risk to developing Hyperemesis Gravidarum?
1)
2)
3)
4)
in twin pregnancies
molar pregnancies
hyperemesis in previous pregnancies
motion sickness history
Hyperemesis Gravidarum management plan?
1)
2)
3)
4)
Hydration
Antiemetics
Multivitamin supplements
severe cases - steroid use
Hyperemesis Gravidarum can cause weight loss of more than 5% of body weight. True or False?
True
Bleeding in early pregnancy causes (5)
Implantation bleeding ( physiological)
Miscarriage
Ectopic Pregnancy
Cervical causes – Ectropion/polyp, rarely cancer
Molar pregnancy
define miscarriage?
miscarriage is the loss of a pregnancy during the first 22 weeks
list 5 causes of miscarriage?
Unknown
Chromosomal
Placental problems
Uterine anomalies
Cervical incompetence
Autoimmune conditions
What percentage of pregnancies end in miscarriage?
15% (1 in 8)
miscarriage signs and symptoms and what you’ll find on examination?
Signs normal observations tachycardia low BP tender on abdominal examination (in suprapubic area)
Symptoms
Vaginal bleeding
Cramping + pain in lower abdomen
On Examination
Bleeding from the cervical os.
Cervical os can be open or closed
Products of conceptions might be seen on examination.
Name the types of Miscarriage
Threatened miscarriage -> pregnancy remains viable
Inevitable miscarriage
Incomplete miscarriage -> Products of conception partly expelled
Completed miscarriage ->Products of conception completely expelled
Missed miscarriage -> non-viable pregnancy
- Septic miscarriage - Recurrent miscarriage -> three or more consecutive miscarriages (1%)
what reduces the chances of miscarriage?
abstain from
Alcohol
Smoking
illegal drugs
Can long term health conditions impact pregnancies? if yes then how?
yes
Several long-term (chronic) health conditions can increase the risk of having a miscarriage in the second trimester especially if they’re not treated or well controlled
e.g diabetes, high blood pressure, lupus
How is a miscarriage diagnosed?
Early pregnancy
USS ( transvaginal)
blood test for HCG
Ultrasound?
Checking for foetus heartbeat?
how is a miscarriage managed?
Medications used
Mifepristone ( Anti progesterone ) and Misoprostal ( potent uterine stimulant) tablets
Surgical
Evacuation of the uterus by suction evacuation/ curettage
What does Resus Negative blood group mean?
???????
If the woman blood group is Rh-ve what is she administered?
Anti–D is administered
why is Anti –D administered to women with the blood group Rh-ve?
prevents haemolytic disease of the foetus and newborn
What is an Ectopic Pregnancy?
when a fertilised egg implants outside of the uterus, usually in one of the fallopian tubes.
what is the Risk of ectopic pregnancy in UK?
1%
what are the symptoms of an ectopic pregnancy?
Positive pregnancy test and othersigns of pregnancy
Lower abdominal pain, more on one side/localised
Vaginal bleedingor a brown watery discharge
Shoulder tip pain
Discomfort while micturating or opening bowels.
what are investigations and management for an ectopic pregnancy?
Investigations:
USS and blood test ( FBC and B-HCG)
Management:
Medical management with Methotrexate
Surgical management with salpingectomy
is missing an ectopic pregnancy dangerous?
yes - if missed or not managed appropriately can be life threatening
Miscarrige VS Ectopic pregnancy differences
Miscarriage Ectopic
Pregnancy WITHIN the uterine cavity Pregnancy OUTSIDE the uterine cavity
Pain is more in the suprapubic area Pain localized to one side
Bleeding can be moderate to heavy Bleeding is minimal
Pregnancy can continue and it’s safe Continuing pregnancy is unsafe
No adnexal tenderness on examination Adnexal tenderness positive
what is a Hydatiform mole?
A hydatidiform mole is a growing mass of tissue inside your womb (uterus) that will not develop into a baby.
It may cause bleeding in early pregnancy and is usually picked up in an early pregnancy ultrasound scan
what are Hydatiform mole pregnancy symptoms?
nausea and vomiting can be occasionally profound
how is Hydatiform mole pregnancy diagnosed and confirmed?
how is it treated?
Diagnosis: USS and high levels of beta- HCG
Confirmed by histology
Treatment: surgical evacuation
Notify molar pregnancy register
Biochemical follow up – till B HCG is negative
Avoid COCP as it delays the return of B- HCG
basic causes of abdominal pain?
Heart burn Constipation Musculo- Skeletal Appendicities Cholecystitis Renal colic IBS Ovarian cyst accidents
what are the physiological changes in pregnancy in the urogenital tract?
Bladder volume increases and detrusor tone decreases.
Ureteric dilatation due to combination of progestogenic relaxation of ureteric smooth muscle and pressure from the expanding uterus.
Relative sparing of the left ureter because of protection from the sigmoid colon and upper rectum.
The net effect - is increased urinary stasis, compromised ureteric valves and vesicoureteric reflux.
Facilitates bacterial colonisation and ascending infection
are UTI’s common in pregnancy?
are they asymptomatic or symptomatic?
how is it diagnosed?
yes
can be either
Mid stream sample (MSU) is sent for culture and sensitivity (C/S) at booking
In pregnancy -the overall incidence of UTI is approximately…….%
The incidence of asymptomatic bacteriuria in pregnant women is ……%
Escherichia coli accounts for ——–% of infections
…..8%
……2-5%
……80-90%
what is Asymptomatic Bacteriuria associated with?
Preterm delivery and low birthweight
Increased risks of preeclampsia
Anaemia
Chorioamnionitis
Postpartum endometritis
Fetal growth restriction
Asymptomatic Bacteriuria treatment?
appropriate antibiotics for 7 days based on C/S
what are the symptoms and treatment for Acute Cystities?
Symptoms: are dysuria, frequency, urgency and suprapubic pain in the absence of systemic illness.
Treatment is hydration and antibiotics
what % of women does acute cystitis affect?
Affects approximately 1% of all pregnant women.
what % of women with asymptomatic bacteriuria develop acute cystitis during their pregnancy.
30% of women
what is Pyelonephritis?
how serious is in in pregnancy?
is an infection of a renal papilla, which if untreated can spread to multiple papillae and occasionally to the renal cortex
Serious type of urinary infection in pregnancy
what are the symptoms, investigations and treatment for Pyelonephritis in pregnancy?
Symptoms:
sepsis ( tachycardia, tachyapnoea, pyrexia)
loin pain
urinary symptoms
Investigation: MSU,USS of the renal tract, FBC Renal function tests blood culture CRP
Treatment: Antibiotics for 10-14 days.
when do most of the cases of pyelonephritis occur during pregnancy?
last two trimesters
what are the risks of developing Recurrent Urinary Tract infection during pregnancy?
The risks of developing pyelonephritis and its potential consequences are the same as for the primary infection.
what is the treatment for Recurrent Urinary Tract infection during pregnancy?
Long-term, low dose antimicrobial cover or single postcoital doses for the remainder of the pregnancy.
what is anaemia?
Anaemia is having lower than normal Haemoglobin.
what are the Haemoglobin cut offs in each trimester before being considered anaemic?
1st and 2nd trimester – minimum of 110g/dl
3rd trimester it is 105g/dl
what are the symptoms of anaemia during pregnancy?
what are the investigations and treatment?
Symptoms:
Feeling tired and exhausted
Palpitations
Breatlessness
Investigation: FBC, Ferritin, Folic acid and Vit B12 levels
Treatment:
oral /injectable iron
&/or Vit B12
&/or Folic acid
what is Antepartum Haemorrhage?
Is defined as bleeding from the genital tract after the 22nd week of pregnancy
Extras
Complicates 2-5% of all pregnancies.
Associated with fetal and maternal morbidity and mortality.
what are the causes of Antepartum Haemorrhage?
placental abruption placenta previa vasa previa cervicitis trauma vulvo-vaginal varicosities genital tumors infection
what is the management for Antepartum Haemorrhage?
Depends on the cause, severity and gestational weeks
Admit to hospital
Cannula and take bloods (FBC, G&S U&Es coagulation profile)
Resuscitation (iv fluids, blood transfusion)
Examination
Ultrasound
Rh –ve women needs anti D and Kleihauer test
define Placenta Praevia?
Defined as Placenta partly or completely inserted in the lower uterine segment
define and explain the different grades of placenta pravia?
insert picture????????????????
define placental abruption
It is bleeding following premature separation of normally situated placenta
it can be Revealed or concealed??
what are the causes of placental abruption?
Majority of the cases the cause is unknown
trauma
polyhydramnios
hypertension
define placental abruption diagnosis and management
Diagnosis – clinical presentation and examination, ultrasound
Management depends on severity, gestational age, maternal and fetal condition
define preterm labour
the onset of labour before 37 completed weeks of gestation
list pre-term labour risk factors
Multiple pregnancies
History of preterm labour
Polyhydramnios
Infectio
explain how pre-term labour diagnosis takes place
Diagnosis on clinical grounds, fetal fibronectin test and ultrasound
what is metal fibronectin (fFN)
it is a fibronectin protein produced by foetal cells.
It is found at the interface of the chorion and the decidua (between the foetal sac and the uterine lining).
It is like an adhesive/ biological glue that binds the foetal sac to the uterine lining.
how is pre-term labour managed?
Tocolysis – to slow labour for administration of steroids and in-utero transfer if needed
Steroids – for fetal lung maturation
Magnesium sulphate- for neuro protection till 34 weeks of gestation
define Preterm Pre-labour rupture of membranes (PPROM)
who is more at risk of PPROM?
Spontaneous rupture of membranes before 37 weeks of gestation in the absence of regular painful uterine contractions.
Polyhydramnios
previous history of PPROM
uterine anomalies
infections
what is the diagnosis and management of Preterm Pre-labour rupture of membranes (PPROM)
Diagnosis
Examination swabs
USS
Management tocolysis antibiotics steroids delivery
Define Intra uterine growth Retardation (IUGR)
Failure of the foetus to achieve the expected weight for a given gestational age
define small for gestational age (SGA)
how is it diagnosed and managed
Refers to fetus estimated birth weight (EFW) on USS is below the 10th centile for the given population.
SGA : Constitutionally small or growth restricted.
Diagnosis: Regular SFH, use of customized growth charts, USS
Management: careful monitoring and appropriate intervention .
intra uterine growth retardation causes
chromosomal
uteroplacental
environmental
define Obstetric Choestasis
It is a multifactorial condition of pregnancy characterised by pruritus in the absence of a skin rash with abnormal liver function tests (LFTs),neither of which has an alternative cause and both of which resolve after birth.
Explain what the diagnosis, complications and treatment of Obstetric Choestasis are
Diagnosis:
unexplained pruritus and abnormal liver function tests (LFTs) and/or raised bile acids occur in the pregnant woman and both resolve after delivery.
usually involves palms and soles of the feet
Postnatal resolution of symptoms and of biochemical abnormalities is required to secure the diagnosis.
LFTS should be deferred 10 days following delivery
Complications:
meconium passage, small risk of stillbirth, premature birth (iatrogenic)
Treatment:
symptomatic management
what is pre-eclampsia?
Pre-eclampsia is a condition that typically occurs after 20 weeks of pregnancy. (6%)
It is a combination of raised blood pressure (hypertension) and protein in urine (proteinuria)
what are the symptoms of pre-ecalmpsia?
asymptomatic
headaches
visual disturbance
pain the right hypochondriac region
edema
what are the risk factors of pre-ecalmpsia?
diabetes
high blood pressure orkidney disease before starting pregnancy
lupus or antiphospholipid syndrome
personnel or FH of pre-eclampsia
1st pregnancy
maternal age more than 40
High BMI
PCOS
multiple pregnancies
how is pre-eclampsia diagnosed and investigated?
The earlier the pre-eclampsia is diagnosed and monitored, the better the outlook for mother and baby.
Investigations: Bloods for FBC, U and Es Uric acid coagulation profile fetal monitoring urine ACR
how is pre-eclampsia monitored?
what are the complications?
Management
Regular BP monitoring and anti hypertensives
Fetal growth monitoring
Delivery
Complication Eclampsia- seizures – Magnesium sulphate Intracranial Haemorrhage Pulmonary edema HELLP syndrome Placental abruption Stillbirth IUGR
why should caution be maintained when prescribing NSAID’s for pregnant women during the third trimester?
NSAIDs – in third trimester can lead to premature closure of ductus arteriosus)
