Obstetric Complications (1) Flashcards
VTE:
When is this risk the highest?
What are its risk factors in pregnancy?
What investigations should be done?
→ Why aren’t D-dimer used here?
When should prophylaxis be given?
→ What is given?
→ What are other options if anti-coags are contraindicated?
➊ In the postpartum period
➋ Smoking, Parity 3+, Age 35+, Obesity, Reduced mobility, Multiple pregnancy, Pre-eclampsia, Thrombophilia, IVF Pregnancy
➌ • Doppler US if suspected DVT
• CXR and ECG if suspected PE
• CTPA/VQ scan for a definitive diagnosis
→ D-dimers are usually raised in pregnancy, therefore have little use here
➍ • 28 wks if 3 risk factors
• 1st trimester if 4+ risk factors
→ LMWH (Dalteparin, Enoxaparin)
→ Stockings or pneumatic compression
Pre-eclampsia:
What is this?
What are the triad of symptoms?
What are its risk factors?
What is its pathophysiology?
What other symptoms does it present with?
What is given to prevent it?
➊ HTN after 20 wks on 2 separate occasions at least 4 hours apart PLUS significant Proteinuria
➋ HTN, Proteinuria, Oedema
➌ Pre-existing HTN, DM, CKD, Previous hx or FHx of PET, 40+, BMI >35, 1st pregnancy, Multiple pregnancy
➍ • Disorder of Placentation - Failure of 2nd wave of Trophoblastic invasion around 15/16 weeks
• Systemic Vasospasm
• Systemic Microangiopathy - Endothelial dysfunction leads to Microthrombosis and Infarction of end-organs
• Increased Capillary permeability - Movement of fluid into extracellular space
• Multi-system disorder - Kidney, Liver, CNS, Coagulation system, Placenta
➎ Headache, Visual disturbance, N+V, Epigastric pain, Reduced urine output
➏ 75-100mg Aspirin prophylaxis from 12 wks in high-risk pts
How is it managed?
How are the eclampsia seizures prevented and treated?
What is done to definitively treat this?
What are the complications?
What is the most severe form of PET?
→ How does it present?
→ What is important to ask about here?
➊ • Labetalol 1st line – Nifedipine 2nd line
• Fluid restriction in severe cases to avoid fluid overload
➋ IV Magnesium Sulphate
➌ Deliver the placenta
➍ • Eclampsia – seizures due to cerebrovascular vasospasm
• Renal disorder - Glomerular dysfunction, Proteinuria = Oedema = Renal failure
• Vasospasm, HTN = Encephalopathy, Eclampsia, Cerebral Haemorrhage
• Microvascular damage, End-organ disease and Increased vascular permeability = Pulmonary oedema and Acute Respiratory Distress
• Foetal symptoms - Reduced placental transfer = Hypoxia, Malnourishment, Placental abruption, and Reduced foetal renal perfusion = Oligohydramnios
➎ HELLP Syndrome
→ Haemolysis (H), Elevated Liver enzymes (EL), and Low Platelets (LP)
→ Epigastric/RUQ pain
Amniotic Fluid Embolism:
What occurs here?
What are its risk factors?
How does it present?
➊ Amniotic fluid passes into mother’s blood during labour and delivery, therefore causing blockage and an immune reaction
➋ Increasing maternal age, Induction of labour, C-section, Multiple pregnancy
➌ Similar to sepsis, pe, or anaphylaxis
• SOB
• Hypoxia
• Hypotension
• Tachycardia
• Coagulopathy
Placenta Praevia:
What is it a huge cause of?
What are its risk factors?
How does it present?
What are its complications?
How is it managed?
➊ Antepartum haemorrhage
➋ Low-lying placenta, Previous hx, Previous c-sections, Older maternal age, Smoking, IVF pregnancy
➌ • Painless PV Bleeding, usually > 24 wks
• Bleeding may occur after sex
➍ Antepartum haemorrhage, Premature birth, Emergency c-section, Maternal anaemia and transfusions, Stillbirth
➎ • Corticosteroids to mature the foetal lungs as there’s risk of prematurity
• Planned/Emergency c-section
Vasa Praevia:
What is it a huge cause of?
What occurs here?
→ What’s the danger with this?
What are the 2 types?
What are its risk factors?
How does it present?
How is it managed?
➊ Antepartum haemorrhage
➋ Foetal vessels are exposed outside of the umbilical cord or placenta and pass across the internal os
→ Makes the vessels more likely to bleed during rupture of membranes as they’re unsupported by the umbilical cord or placental tissue – Can lead to severe foetal blood loss and death
➌ • Type 1 – Foetal vessels exposed as a velamentous umbilical cord
• Type 2 – Foetal vessels exposed as they travel to an accessory placental lobe
➍ Low lying placenta, IVF pregnancy, Multiple pregnancy
➎ • Painless PV Bleeding
• Rupture of membranes
• Foetal distress
➏ • Corticosteroids to mature the foetal lungs as there’s risk of prematurity
• Planned/Emergency c-section
Placental Abruption:
What is it a huge cause of?
Instead of bleeding out, what is another way it can present?
What are its risk factors?
How does it present?
How is it managed?
➊ Antepartum haemorrhage
➋ Concealed Abruption – Cervical os remains closed, so all bleeding remains in the uterus, therefore making one underestimate the extent of the bleeding
➌ Previous hx, PET, Trauma (consider domestic violence), Multiple pregnancy, Smoking, Cocaine/Amphetamine use
➍ • Sudden, severe abdominal pain that is continuous
• Antepartum haemorrhage
• PVB (or not if concealed)
• Foetal distress
• Shock
• O/E - Characteristic “woody” abdomen on palpation
➎ • Corticosteroids to mature the foetal lungs as there’s risk of prematurity
• Anti-D prophylaxis for Rh -ve women
• Emergency c-section if maternal/foetal compromise – Induction of labour if no compromise
