Pathological Issues Flashcards
Post-partum haemorrhage
Primary; blood loss >500ml within 24 hours of delivery
TONE TRAUMA TISSUE THROMBIN
Secondary; blood loss >500ml from 24 hours to 6wks post-partum
NB lochia normal for 3-4 weeks postnatal “should be a period or less”
Thromboembolic disease
Pregnant woman 6-10x as likely to develop thromboembolism (DVT or PE)
high quality risk assessment and appropriate thromboprophylaxis required to reduce risk
D-dimer unreliable in pregnancy
Investigate;
- ECG
- leg dopplers
- CXR +/- VQ scan
Treat with LMWH
Maternal sepsis
Leading cause of maternal death in UK
May present atypically
In any woman you suspect; prompt IV AB administration
Perform full septic screen; blood cultures, LVS, MSSU, wound swabs
antipyretic measures, IV fluids, referral to hospital if concerned about sepsis
Describe postnatal depression
Can continue from baby blues or start sometime later
Has classical ‘depressive’ symptoms
Affects functioning, bonding and often requires treatment
Increased risk in women with personal or FH of affective disorder
Describe puerperal psychosis
Rare but serious psychotic illness of postnatal period
Women can be a danger to themselves and their babies
Requires inpatient psychiatric care
Much more common in women with personal or FH of affective disorder, bipolar disorder or psychosis
Describe postnatal hypertensive disorders
Most eclamptic seizures occur in postnatal period
Pre-eclampsia can develop post-natally or may worsen several days following delivery
Describe how a case may present with a miscarriage
Woman misses period and has positive pregnancy test
Vaginal bleeding X weeks after missed period
US shows no foetus but membranes and decidua lining uterus are there
What are some causes of miscarriage?
Chromosomal abnormality
Infection
Maternal issues; ill-health, trauma, hormonal problems
How may an ectopic pregnancy present?
Woman misses period; X weeks pregnant, small amount bleeding per vaginum
B-hCG raised
US shows thickened lining of endometrial cavity, expanded fallopian tube on one side
Describe how a ruptured ectopic pregnancy may present
Women with sudden severe abdo pain
May collapse
Admission to A&E with fast pulse, low BP
Blood given and emergency laparotomy; several litres of blood in abdomen flowing from fallopian tube area
Microscopy; blood, fragments of fallopian, occasional chorionic villi
What is an ectopic pregnancy?
A pregnancy in the wrong anatomical site
Most common in fallopian tube
Lack of proper decidual layer and small size of tube predispose to haemorrhage and rupture
What is a molar pregnancy?
Abnormal form of pregnancy in which a non-viable fertilised egg implants and fails to come to term
This is a gestational trophoblastic disease and will have chorionic villi clusters, presenting like bunches of grapes
It is a form of precancer of trophoblast cells
If it persists it can (rarely) give rise to a malignant tumour called choriocarcinoma
Describe normal fertilisation with altered genes
Mum to be switches off certain genes in ova (eggs) by methylating them
Dad to be switches off different genes in sperm by methylating them
If BOTH have changes; Changes in mum promote early baby growth
Changes in dad promote early placenta growth via trophoblast proliferation
They will balance out
What are causes of molar pregnancy?
Various but most often caused by 2 sperm fertilising one egg with NO chromosomes
This results in an imbalance in methylated (switched off) genes
What is the treatment for molar pregnancy?
If B-cHG returns to normal then no further treatment
If B-cHG stays high then cure by methotrexate
What is maternal mortality?
The death of a woman while pregnant or within 42 days of termination of pregnancy
Irrespective of duration and site of pregnancy
From any cause related to or aggravated by the pregnancy or its management, but not accidental or incidental causes
What is maternal morbidity?
Severe health complications occurring in pregnancy and delivery not resulting in death
What is the maternal mortality ratio?
Number of maternal deaths during given time period per 100,000 live births during same time period
REPRESENTS RISK ASSOCIATED WITH EACH PREGNANCY
What is the maternal mortality rate?
Number of maternal deaths in given time period per 100,000 women of reproductive age, or women-years fo risk exposure, in same time period
What is the lifetime risk of maternal death?
Probability of maternal death during a woman’s reproductive life, usually expressed in terms of odds
A MEASURE FO THE RISK OF BECOMING PREGNANCY AS WELL AS RISK OF DYING WHILE PREGNANT
What is the proportionate mortality ratio?
Maternal deaths as proportion of all female deaths of those of reproductive age - usually defined as 15-49 years - in a given time period
What are some facility based methods for measuring maternal death?
- Health information systems
- Registries
- Confidential enquiries
- Maternal death review
- Audit; critical incident audit, criterion based clinical audit
What are some community/population based methods for measuring maternal death?
- notification by law
- vital registration
- census
- surveys or surveillance; sisterhood method, verbal autopsy
Why do mothers die?
Direct deaths; those related to obstetric complications or resulting from treatment received
Indirect deaths; those associated with a disorder, the effect of which is exacerbated by pregnancy e.g. malaria
Late deaths occur ≥ 42 days after end of pregnancy but within one year
