High risk pregnancies Flashcards
What problems during gestation can make the pregnancy high risk?
- Multiple pregnancy
- SGA/IUGR
- Placenta praevia
- Gestational diabetes
- Pre-eclampsia
What problems during labour can make the pregnancy high risk?
- Meconium/blood stained liquor
- Lack of progress
- Need for Oxytocin infusion
- Worrying features on CTG
What previous obstetric conditions can make the pregnancy high risk?
- C-Section
- Preterm delivery
- Recurrent miscarriage
- Stillbirth
- 3rd degree tear
- Prev gestational diabetes
What maternal conditions can make the pregnancy high risk?
- DM
- VTE
- Obesity
- Infections
- Chronic disease (renal, autoimmune)
- Hypertension
What social factors can make the pregnancy high risk?
- Teenage pregnancy
- Maternal age >40
- Poor socioeconomic conditions
- High parity/low inter pregnancy interval
What causes perinatal mortality?
Placental problems/fetal growth restriction: Diabetes, pre-eclampsia & obesity increase the risk of placental issues
Infection: Group B Strep, E.Coli, Chlamydia
Prematurity
Congenital abnormalities
What are the risks associated with multiple pregnancy?
- Prematurity
- Congenital abnormalities
- Cardiac, bowel atresia, neural tube defects
- Intrauterine death
- Fetal growth restriction
- Twin-twin transfusion syndrome
In what type of pregnancy is twin-twin transfusion syndrome seen?
Monochorionic pregnancies
What are the maternal complications of a multiple pregnancy?
1) Hyperemesis gravidarum
2) Anaemia
3) Miscarriage
4) Preterm labour & delivery
5) Gestational diabetes
6) Pre-eclampsia
7) Antepartum/postpartum haemorrhage
8) Postnatal depression
Which high risk pregnancies should be prescribed a higher dose of Folic acid? How much?
Twins & Diabetics
5mg
What are the 3 different ways twins can line in utero?
Dichorionic diamniotic
Monochorionic diamniotc
Monochorionic monoamniotic
What signs can be seen on twin USS?
T sign: Only one placenta
𝛌 sign: 2 placentas/ 1 egg has split very early (identical twins)
What are the causes of maternal mortality?
Thrombosis-LEADING CAUSE Eclampsia Sepsis Cardiac-largest single cause of indirect maternal deaths Psychiatric
You are working as a junior doctor on the delivery suite. A midwife alerts you that a 37-year-old female is having a postpartum haemorrhage (PPH) after delivering her baby four hours ago. You perform an ABCDE assessment, contact a senior for help and start appropriate management. What is the most likely cause of this patient’s postpartum haemorrhage?
Uterine Atony most common cause of postpartum haemorrhage
What are the main causes of postpartum haemorrhage?
Tone (uterine atony, distended bladder)
Trauma (lacerations of uterus, cervix, vagina)
Tissue (retained placenta or clots)
Thrombin (pre-existing or acquire coagulopathy)
When can IM steroids be given?
Birth within 7 days at 24-36weeks
2doses of Betamethasone 12mg IM 24hours apart
In what condition does IM steroids need to be noted in particular?
Diabetes
Not a contraindication
Insulin therapy needs adjusting accordingly
What factors are more likely to cause PTSD after birth?
Long and painful labour Assisted birth with ventouse or forceps Emergency c-section Baby was born with a disability Baby spent time in special care You feared for your, or your baby's life or health, during or after the birth. Helplessness during birth Traumatic event in your past
How is a late miscarriage defined?
Loss between 14-24weeks
What causes a mid-trimester loss?
Chromosomal abnormalities Structural defects Genetic abnormalities Antiphospholipid syndrome Infection
What infections can cause mid-trimester loss?
Parvovirus
Cytomegalovirus
Toxoplasmosis
Bacterial vaginosis
What are the predisposing factors for malpresentation?
Prematurity Multiple pregnancy Abnormalities of the uterus - fibroids Partial septate uterus Abnormal fetus Placenta praevia Primiparity
What is the most common malpresentation?
Breech
What is the most common malposition?
Occipito-posterior
What is the difference between malpresentation & malposition?
Presentation: Baby fully in the wrong position
Position: Baby’s head in the wrong position
What is the difference in constituents between dizygotic & monozygotic pregnancies?
D: Own placenta (separate or fused), amnion, chorion
M: Depends on division of the ovum-
Split at 3days: 2chorion & 2 amnion
Split at 4-7days: 1 placenta, 1chorion, 2 amnion
Split at 8-12days: 1 placenta, 1chorion, 1amnion RARE
What ‘chorion’ can triplet pregnancies be?
Monochorionic
Dichorionic
Trichorionic
What should expectant multiple pregnancy mothers be warned about at booking?
Higher likelihood of positive screening result and therefore invasive treatment
When should the first USS scan be offered in multiple pregnancy? Why?
11-13weeks
- Estimate gestational age
- Determine chronicity (no. of placental masses, lambda/T sign, membrane thickness)
- Screen for Down’s
What is antepartum haemorrhage?
Vaginal bleeding from 24-40weeks
What are the causes of APH?
Obstetric: PP, abruption, vasa praevia, uterine rupture (IOL related), fetal vessel rupture, bloody show
Non-obstetric: Cervical, medical conditions, vaginal/vulval
What are the signs & symptoms of APH?
Bleeding: Clots= larger bleed, bright red- PP, darker/brown- abruption
Pain: PP- no pain, abruption pain
What are the risk factors for APH?
Hypertension
PP
What are the investigations for APH?
Bloods: Cross match, FBC, Clotting, Rhesus test
USS
CTG & doppler
How is APH managed?
Large bleed: Resus, Left lateral position, consider delivery
In APH which conditions are/aren’t associated with pain?
Are: Rupture, abruption, bloody show (related to labour)
Aren’t: PP, Vasa praevia,
