Lecture 14 Complications in Pregnancy Flashcards
The cervix in a threatened miscarriage is (closed/open)
Closed
The cervix in an inevitable miscarriage is (closed/open)
Open
What may be seen during a scan when a missed miscarriage is suspected
Empty gestational sac
Foetal pole with no foetal heart
What is an incomplete miscarriage
Most of pregnancy is expelled out
Some products of pregnancy remaining in the uterus
Open cervix
Heavy bleeding
What is a complete miscarriage
Passed all products of conception
Cervix closed
What abnormal conceptus causes of spontaneous miscarriage
Chromosomal
Genetic
Structural
What uterine abnormalities causes spontaneous miscarriages
Congenital
Fibroids
What maternal factors can cause a spontaneous miscarriage
Increasing age Diabetes Hormonal imbalance SLE Thyroid disease Infection
How is a threatened miscarriage managed
Conservative- just wait
How are inevitable miscarriages managed
If bleeding heavy may need evacuation
How are missed miscarriages managed
Conservative
Medical- Prostaglandins (misoprostol)
Surgical
How is a septic miscarriage managed
Antibiotics and evacuate uterus
What is an ectopic pregnancy
Pregnancy implants outside the uterine cavity
What’s the most common site in the Fallopian tube for an ectopic pregnancy
Ampullary
What are the risk factors for ectopic pregnancy
Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception
What is the clinical presentation of ectopic pregnancy
Period of ammenorhoea
Vaginal bleeding
Pain abdomen
GI or urinary symptoms
What are the investigations for an ectopic pregnancy
Scan
Serum BHCG
How is ectopic pregnancy managed
Methotrexate
Salpingectomy, Salpinotomy
What is Grade I Placenta Praaevia
Encroaching on the lower segment but not the internal cerivcal os
What is Grade II Placenta Praaevia
Placenta reaches the internal os
What is Grade III Placenta Praaevia
Eccentrically covers the os
What is Grade IV Placenta Praaevia
Central placenta praaevia
What are the clinical features of placenta praaevia
Soft, non-tender uterus
Foetal malpresentation
How is placental praaevia diagnosed
US scan to located placental site
NO VAGINAL EXAMINATION
How is Placental Praaevia managed?
C-section (watch for PPH)
Medical (oxytocin, ergometrine, crab-Prost, transgenic acid)
Balloon tamponade
Surgical (B lymph suture, ligation of uterine, iliac vessels, hysterectomy)
What factors are associated the placental abruption
Pre-eclampsia Chronic hypertension Polyhydramnios Smoking, increasing age, parity Previous abruption Cocaine use
What are the 3 clinical types of placental abruption
Revealed (see blood)
Concealed (bleeding but not visible)
Concealed
What is the clinical presentation of placental abruption
Pain
Vaginal bleeding (may be minimal)
Increased uterine activity
How are preterm deliveries managed
Test foetal fibronectin
Define mild hypertension
Diastolic BP 90-99
Systolic BP 140-49
Define moderate hypertension
Diastolic BP 100-109
Systolic BP 150-159
Define severe hypertension
Diastolic >110
Systolic BP>160
Define pre-eclampsia
Mild HT on two occasions more than 4 hours apart
Describe the clinical presentation of pre-eclampsia
Seizures Cerebral haemorrhage Stroke Haemolysis Elevated liver enzymes Low platelets DIC Renal failure Pulmonary oedema Cardiac failure
Name the symptoms and sign of severe PET
Headache Blurry vision Epigastric pain Pain below ribs Vomiting Swelling of hands and face Urine proteinuria Clonus Reduce urine output Convulsions
The only cure for PET is_____
delivery of the baby and placenta
How are seizures/impending seizures treated
Magnesium sulphate bolus + IV infusion
IV labetolo, hydralazine
