Early Pregnancy Complications Flashcards
define a miscarriage
removal of products of conception prior to 24 weeks gestation
what is the most common cause of early bleeding in pregnancy
miscarriage
outline some of the causes of miscarriage
infection
abnormal conceptus - chromosomal
uterine abnormalities - incompetent uterus
toxins - smoking, alcohol, drugs, infection
immune diseases
trauma - amniocentesis, coitus
IUCD
describe the features of a threatened miscarriage
pregnancy test positive cervix is closed pain and bleeding uterus = gestational age foetal heart beat present + foetal pole present
how is a threatened miscarriage managed
reassurance and rest
avoid coitus
what is an inevitable miscarriage
pregnancy test positive cervical os open foetal heart beat present pain and bleeding choice of management is up to woman between conservative, medical or surgical
what is an incomplete miscarriage
some of the products of conception have passed whilst others remain in the uterus
cervical os open - products may be visible
woman usually in cervical shock with heavy bleeding
no foetal heartbeat
how does cervical shock present
occurs when there is incomplete emptying of conceptus
severe abdo pain
nausea/vomiting
sweating, faint, tachycardia
manage with fluids, uterotonics and remove products of conception
how is an incomplete miscarriage managed
blood transfusion if in shock
oxytocic
remove POCs
bimanual compression
what are the features of a complete miscarriage
all POC have passed
uterus is empty and small for gestational age
no foetal heart beat
may have pain, amenorrhoea
how is a septic miscarriage managed
antibiotics, resuscitation and evacuation of uterus
how many miscarriage must a woman have had before they are classified as recurrent
3 or more
how is a miscarriage managed conservatively
allow the pregnancy to run its natural course
how is a miscarriage managed medically
administration of misoprostol
how is a miscarriage managed surgically
evacuation of uterus
if a woman with recurrent miscarriage is found to have antiphospholipid syndrome or thrombophilia, what drugs can help her pregnancy
low dose aspiring and daily fragmin injections
what is a molar pregnancy
a non-viable fertilised egg is made with overgrowth of placental tissue - swollen fluid appearing with grape like clusters
describe a partial molar pregnancy
one set of DNA from the egg and 2 from the sperm - fertilised egg causes triploidy
foetus may be present
describe a complete molar pregnancy
no DNA from the egg and 2 sets from the sperm causing diploidy
no foetus is present, just overgrowth of placental tissue
a complete mole carries a small risk of what cancer
choriocarcinoma
how does a molar pregnancy present
extreme hyperemesis
fundus is large for dates
heavy bleeding which may appear like frogspawn
describe the HCG and USS findings seen with molar pregnancy
HCG - unusually high for dates hence hyperemesis
USS - snow storm appearance
how is a molar pregnancy managed
surgical evacuation irrespective of type, tissue is sent to histology to determine type of mole
women are followed up at specialist centres
what is hyperemesis
excessive and prolonged vomiting
list some complications of hyperemesis
dehydration ketosis electrolyte disturbance nutritional imbalance weight loss altered LFTs
how is hyperemesis managed
IV fluids and anti-emetic (oral if possible)
state the first and second line antiemetics used for hyperemesis
first line - cyclizine and prochlorperazine
second line - ondansetron and metaclopramide
give some examples of sensitising events requiring Anti-D immunisation
placental abruption abdo trauma amniocentesis/CVS foetal death vaginal bleeding from 12 weeks TOP ectopic pregnancy delivery of Rh+ve baby
outline some of the risk factors for developing hypertension in pregnancy
increasing maternal age BMI >30 FH of hypertension parity previous hypertension African origin medical conditions such as renal disease, diabetes, connective tissue diseases and thrombophilia
what BP measurements warrant hospital admission
> 170/110 mmHg
>140/90 with significant proteinuria
what are the 3 types of hypertension to be aware of during pregnancy
pre-existing hypertension
pregnancy induced hypertension
pre-eclampsia
what are the features of pregnancy induced hypertension
usually develops in second trimester
resolves within 6 weeks postnatally
no additional features such as proteinuria and headache
what is the blood pressure target for someone with hypertension in pregnancy
140/90mmHg
which antihypertensives are safe to use in pregnancy
labetolol
nifedipine
hydralazine
methyldopa
which antihypertensive is contraindicated in asthma
labetolol
which antihypertensive is contraindicated in depression
methyldopa
are ACEi/ARBs safe in pregnancy
no as can causes renal agesis
what is pre-eclampsia
pregnancy induced hypertension with proteinuria and oedema
what causes pre-eclampsia to develop
failure of trophoblastic invasion of spinal arteries leaving them vasoactive
hypertension is a compensatory mechanism
what are the risk factors for developing pre-eclampsia
increasing maternal age BMI >35 CKD autoimmune disease diabetes existing hypertension or previous pre-eclampsia pregnancy interval >10 years first pregnancy
how is pre-eclampsia screened for
uterine artery doppler
outline some of the clinical features of pre-eclampsia
hypertension headache - cerebral oedema Hyperreflexia and clonus proteinuria visual disturbance
what is one of the complications of pre-eclampsia
HELLP syndrome
what is eclampsia
pre-eclampsia + tonic clonic seizures
when is the highest change that eclampsia will develop
post-partum
what are the effects on the foetus with eclampsia
bradycardia
reduced variability on CTG
what drug is given to prevent seizures with eclampsia
IV magnesium sulphate
what is HELLP syndrome
haemolysis
elevated liver enzymes
low platelets
what are the clinical features of HELLP syndrome
nausea/vomiting
fatigue
RUQ pain
what is the HbA1C target for pregnancy and what level should pregnancy be avoided
target - 48 mmol/l
avoid - >86 mmol/l
outline several parts of the antenatal care plan that differ for women with existing diabetes
high dose folic acid low dose aspirin regular eye checks for retinopathy growth scans every 4 weeks from 28 weeks safety advice about hypos
what is the main change in diabetes medication for women with existing diabetes
switch any oral hypoglycaemic agents to metformin and insulin
when should delivery be planned for in a woman with existing diabetes
aim for 38 weeks, opt for c-section if foetal weight >4.5kg
what are some of the complications of a child with maternal diabetes
macrosomia shoulder dystocia polyhydramnios still birth vaginal trauma in labour
what is the screening tests for gestational diabetes
high risk women screened at booking
oral glucose tolerance test - fasting and then 2 hour after 75g of glucose
what are the diagnostic values for GDM
fasting - >5.1mmol/l
2 hour - >8.5mmol/l
what is pre-term pre-labour rupture of membranes
breakage of the amniotic sac before the onset of labour
what causes PPROM
infection - weakens the tensile strength of membranes
cervical incompetence
over-distention eg multiple pregnancy and polyhydramnios
placental abruption
list some of the adverse effects of baby’s born before 26 weeks
risk of cerebral palsy walking problems blindness profound deafness reduced IQ
how is PPROM managed
monitor for chorioamnionitis
give antibiotics to prevent ascending infection - erythromycin first line
tocolytics to prevent contraction such as nifedipine
what is the most severe complication of anti-D crossing to the baby
hydros fetalis
what are the features of a foetus with hydros fetalis
extensive oedema causing ascites, pleural or pericardial effusion hepatosplenomegaly progressive anaemia CNS signs jaundice
list some pre-existing causes for VTE in pregnancy
previous VTE BMI >30 smoking age >35 varicose veins thrombophilia
list some obstetric causes for VTE in pregnancy
multiple pregnancy c-section pre-eclampsia prolonged labour PPH
list some transient causes for VTE in pregnancy
hyperemesis ART/IVF systemic infection admission and immobility wound infection
what investigation is carried out if suspicion of DVT is high
duplex ultrasound
state the findings for PE on ECG
sinus tachycardia T wave inversion right axis deviation right bundle branch block atrial arrhythmias
what are the advantages and disadvantages of CTPA and V/Q in pregnancy
CTPA is preferred but increases breast cancer risk
V/Q slight risk of childhood cancer in foetus
mother must be informed of the risks
how is VTE in pregnancy managed
LMWH until 3 days postnatally, then can be swapped for warfarin due to teratogenicity risks and PPH risk until 3 days post party
must be continued until 6 weeks postnatally
what are the 3 types of breech presentation
complete - legs folded to level of bum
footling - one of both legs hanging down so feet emerge first
frank - legs above bum so bum is delivered first
what are the risk factors for a breech baby
idiopathic uterine abnormalities prematurity oligohydramnios foetal abnormalities placenta praevia
how is breech position swapped to cephalic
external cephalic version - manually turn the baby into cephalic presentation if vaginal delivery is planned
what must a breech baby be screened for after birth
hip dislocation at 6 weeks
Klumpkes palsy
