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Obstetrics > Obstetric complications > Flashcards

Obstetric complications Flashcards

1
Q

What are the four causes of antepartum haemorrhage?

A

Placental abruption
Uterine rupture
Cord prolapse
Placenta praevia

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2
Q

What is placenta praevia?

A

The placenta is attached to the lower uterine segment

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3
Q

What are the two types of placenta praevia?

A

Minor: low lying placenta, but not covering the internal cervical os
Major: placenta lies over the internal cervical os

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4
Q

What are the RF for placenta praevia?

A 
BIGGEST: previous C-section 
Previous placenta praevia
Maternal age 40+
Multiple pregnancy
PID
Curettage to endometrium
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5
Q

How might placenta praevia present?

A

Painless vaginal bleeding (from spotting to massive haemorrhage)

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6
Q

How is placenta praevia diagnosed?

A

USS

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7
Q

How is placenta praevia managed?

A

C-section delivery recommended

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8
Q

How is placenta praevia monitored?

A

Once discovered - repeat scan at 32 and 36 weeks and assess if has moved superiorly. If not - plan for delivery

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9
Q

What is placental abruption?

A

A portion/all of the placenta separates from the wall of the uterus prematurey, causing rapid foetal compromise

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10
Q

What are the risk factors for placental abruption?

A 
Previous placental abruption
Pre-eclampsia or gestational hypertension
Abnormal lie
Polyhydramnios
Abdominal trauma
Cocaine use
Multiple pregnancy
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11
Q

How would placental abruption present?

A

Antepartum haemorrhage
Abdominal pain
Woody and tender abdomen

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12
Q

How is placental abruption managed?

A

USS, FBC, clotting screen

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13
Q

How is placental abruption managed?

A

If foetal compromise or unwell mother: emergency C-section

If mother and foetus well: induce labour

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14
Q

What are the two types of uterine rupture?

A

Complete: peritoneum torn, uterine contents can enter the uterine cavity
Incomplete: peritoneum intact, uterine contents remain in the uterus

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15
Q

What are the RF for uterine rupture?

A 
Previous C-section
Previous uterine surgery
Induction or augmentation of labour
Obstruction of labour
Multiple pregnancy
Multiparity
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16
Q

How might a woman with uterine rupture present?

A 
Sudden severe abdominal pain, persisting between contractions
Shoulder tip pain
Vaginal bleeding
Signs of hypovolaemic shock
Collapse
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17
Q

How is uterine rupture diagnosed?

A

USS

CTG: shows foetal bradycardia and decelerations

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18
Q

How is uterine rupture managed?

A

Group and save and crossmatch
ABCDE approach
C-section delivery
Uterine repair OR hysterectomy

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19
Q

When should women be risk assessed for VTE risk?

A

At booking visit
At all intrapartum midwife visits
Post-natally

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20
Q

When is VTE prophylaxis given?

A

4 RF in first 2 trimester
3 RF in 3rd trimester
2 RF n post partum period

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21
Q

Should VTE prophylaxis be continue post-partum?

A

Yes, until at least 6wks PP

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22
Q

What VTE prophylaxis should be given to women who have had a C-section?

A

10 day course of LMWH

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23
Q

What single factor indicates that a woman should be given VTE prophylaxis?

A

Previous VTE

24
Q

What are the RF which decide if VTE prophylaxis is given?

A 
Obesity (BMI 30+)
Age 35+
Parity 3+
Smoker
Varicose veins
Pre-eclampsia
Immobility
1st degree FH of VTE
Low risk thrombophila
Multiple pregnancy
IVF
25
Q

What three LMWH are used in pregnancy as VTE prophylaxis?

A

Enoxaparin
Dalteparin
Tinzaparin

26
Q

Describe 1st, 2nd, 3rd and 4th degree tears

A

1st: skin graze
2nd: perineal muscle involvement
3a: less than 50% of anal sphincter torn
3b: more than 50% of anal sphincter torn
4th: rectal muscle involvement

27
Q

Define miscarriage?

A

Loss of pregnancy before viability (pre-24wks)

28
Q

What are the causes of miscarriage?

A 
Chromosomal abnormalities
Structural malformation
Acute pyrexial illness
Uterine malformation
Chronic maternal disease
29
Q

How might a miscarriage present?

A

Vaginal bleeding
Abdominal pain
Regression of pregnancy symptoms
May be an incidental finding at a routine antenatal appointment

30
Q

How is a miscarriage diagnosed?

A 
Pregnancy test (urinary and serum)
USS + doppler + foetal HR
Speculum
31
Q

What are the types of miscarrage and status of the cervical os?

A 
Threatened: closed os
Inevitable: open os
Complete: closed os
Incomplete: open os
Missed: closed os
32
Q

Define a threatened miscarriage

A

Any PV bleeding pre-24wks

33
Q

How is a threatened miscarriage managed?

A

Nil required

34
Q

Define an inevitable miscarriage?

A

Symptoms of bleeding and pain presenting in the process of miscarriage with an open cervical os

35
Q

How is an inevitable miscarriage managed?

A

Watchful wait - ensure no retained products

36
Q

Does a threatened miscarriage have implications for the rest of the pregnancy?

A

No

37
Q

Define complete miscarriage

A

Bleeding and foetal loss which has now lessened or resolved

38
Q

How is a complete miscarriage managed?

A

Nil required, check for ectopic

39
Q

Define incomplete miscarriage

A

Heavy and increased vaginal bleeding with lower abdominal pain. There are some retained products.

40
Q

How is incomplete miscarriage managed?

A

Medical or surgical management to complete miscarriage

41
Q

What is a missed or delayed miscarriage?

A

Retention of the entire gestation sac with no foetal heartbeat or further foetal growth.

42
Q

What bleeding pattern is there in missed or delayed miscarriage?

A

Minimal bleeding

43
Q

How is missed/delayed miscarriage managed?

A

Medical or surgical termination of pregnancy

44
Q

Describe an expectant approach to managing miscarriage

A

Allow the body to miscarriage naturally. This is unpredictable and can take weeks

45
Q

Describe a surgical approach to miscarriage

A

Vacuum aspiration OR dilation and evacuation

46
Q

Describe a medical approach to miscarriage

A

Misoprostol to induce contractions to expel remaining products

47
Q

What is molar pregnancy?

A

Aka hydatidiform mole; gestational trophoblastic disease

48
Q

What is the cause of a molar pregnancy

A

Imbalance of chromosomes from each gamete

49
Q

What are the types of molar pregnancy?

A

Complete: all genetic material comes from the father. There is no foetus, only placenta.
Incomplete: the foetus develops with 3 sets of chromosomes and there is an abnormal placenta

50
Q

How might a molar pregnancy present?

A

Usually positive pregnancy test and pregnancy symptoms

51
Q

How might a molar pregnancy appear on examination of the abdomen?

A

Uterus may be large for dates and be boggy in consistency

52
Q

What are the risk factors for molar pregnancy?

A

Previous molar pregnancy
OCP use
Maternal age under 20 or above 35

53
Q

What tests are diagnostic for a molar pregnancy and how might they appear?

A

USS: snowstorm appearance

Histology shows trophoblastic disease

54
Q

How is a molar pregnancy managed?

A

Surgical: manual vacuuum aspiration or dilation and evacuation

55
Q

What are the complications of a molar pregnancy

A

Distress
Malignant potential
Haemorrhage

Obstetrics (5 decks)

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