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HD CC > Placental Problems > Flashcards

Placental Problems Flashcards

1
Q

Spontaneous miscarriage

A

Foetal death/delivery <24 weeks of gestation

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2
Q

Recurrent miscarriage

A

3 or more miscarriages in succession

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3
Q

Threatened miscarriage

A 
Light and painless bleed
Foetus is alive
Uterus size as expected for gestation
Cervical os closed
25% go on to miscarry
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4
Q

Inevitable miscarriage

A 
Miscarriage about to occur
Bleeding heavier
Foetus may still be alive
Cervical os open
Crampy pelvic pain
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5
Q

Incomplete miscarriage

A

Some, but not all foetal parts have been passed

Cervical os open

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6
Q

Complete miscarriage

A

Miscarriage has happened + finished
Bleeding has stopped/diminished
Uterus no longer enlarged
Cervical os closed

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7
Q

Septic miscarriage

A 
Contents of uterus infected- -endometritis
Vaginal loss is offensive
Tender uterus
Fever may be present
May progress to pelvic pain (abdo pain)
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8
Q

Missed miscarriage

A

Foetus has died/not developed in utero
Only recognised later when bleeding occurs or USS performed
Uterus smaller than expected for gestation
Cervical os closed
Maybe mild abdo pain + bleeding

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9
Q

Ectopic pregnancy

A

Implantation of a fertilised ovum outside the endometrial cavity

  • -> 70% will have subsequent successful pregnancy
  • ->10-15% ectopic again
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10
Q

Ectopic pregnancy sites

A 
Tubal (95%)
--> Isthmus (25%)
--> ampulla (55%)
--> fimbriae (17.4%)
Other- ovarian, interstitial, cornual, cervical, abdominal
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11
Q

Ectopic pregnancy RFs

A 
Previous ectopic
STI/PID
Prolapse
IUCD
Endometriosis
Assisted conception
Failed sterilisation
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12
Q

Ectopic pregnancy- Clinical features

A 
PV bleeding
Lower abdo pain
Collapse
Tachycardia
Abdominal tenderness
Unilateral adnexal tenderness
Cervical excitation
Small uterus
Cervical os closed
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13
Q

Ectopic pregnancy Investigations

A

Urine BetaHCG- to confirm pregnancy
Transvaginal USS- failure to localise in-utero suggests
–> gestation too early to visualise (<5 weeks)
–> complete miscarriage
–> ectopic pregnancy

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14
Q

Gestational trophoblastic disease (molar pregnancy)

A

When trophoblastic tissue that forms part of blastocyst proliferates more aggressively than usual

  • -> non-invasive- hydatidiform mole
  • -> locally invasive- invasive mole
  • -> metastatic- choriocarcinoma
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15
Q

Partial mole

A

Two sperms fertilise an egg
Results in triploid conceptus with 69 chromosomes
Foetal tissue present
Malignant change rare

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16
Q

Complete mole

A

Two types- monospermic and dispermic
Results in a conceptus with 46 chromosomes but all derived from father
No foetal tissue seen at histology, just swollen chorionic villi

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17
Q

Monospermic complete mole

A

Maternal chromosomes are lost AND paternal chromosomes double up

18
Q

Dispermic complete mole

A

Maternal chromosomes are lost AND fertilisation by 2 sperm

19
Q

Molar pregnancy clinical features

A

PV bleeding
Hyperemesis gravidarum- excess HCG production
Passage of vesicles PV

20
Q

Molar pregnancy examination

A

Large uterus

Early pre-eclampsia + hyperthyroidism

21
Q

Molar pregnancy investigation

A

USS- snowstorm appearance

22
Q

Molar pregnancy management

A

Evacuation of retained products of conception –> send tissue to histology for diagnosis
Serial bHCG levels- persistent or rising levels suggest malignancy
Pregnancy + COCP avoided until bHCG levels normal

23
Q

Molar pregnancy recurrence

A

1 in 60

24
Q

Antepartum haemorrhage (APH)

A

PV bleed > 24 weeks gestation but before delivery of baby

25
Q

APH examples

A 
Placental abruption
Placenta praevia
Placenta accrete
Vasa praevia
Uterine rupture
Incidental genital tract pathology
26
Q

Placental abruption

A

Part or all of placenta separates before delivery
Considerable amount of maternal bleeding- DIC, renal failure, maternal death
Acute foetal distress- foetal death in 30%

27
Q

Placental abruption RFs

A 
Previous history
IUGR
Pre-eclampsia
Autoimmune disease
Smoking
Multiparity
Polyhydramnios
28
Q

Placental abruption clinical features

A 
Tender and hard uterus
Foetal distress or absent heart sounds
Tachycardia
Hypotension
Abdominal pain
Vaginal bleeding
29
Q

Placental abruption investigations

A 
FBC
Urea
Creatinine
Coagulation screen
Cross-match blood 
USS to rule out placenta praevia
CTG
Catheterisation with hourly urine output
CVP monitoring to access blood loss + replacement
30
Q

Placental abruption management

A

Maternal/foetal distress- emergency C section
No foetal distress and >37 weeks- induction of labour
Dead baby- induction of labour

31
Q

Placenta praevia

A

Placenta implanted in lower segment of uterus >24 weeks

32
Q

Placenta praevia RFs

A

Multiple gestation
High parity
Increased maternal age
Scarred uterus- e.g. previous C section

33
Q

Placenta praevia issues

A

Placenta in lower segment obstructs engagement of head- necessitates C section
PPH likely as lower segment is less able to contract + constrict maternal haemorrhage

34
Q

Placenta accreta

A

Placenta attaches to site of previous scar- severe PPH risk

35
Q

Placenta perceta

A

Invasion completely through uterine wall, sometimes into nearby tissues e.g. bladder

36
Q

Placenta increta

A

Placenta invades at least halfway through uterine wall

37
Q

Vasa praevia

A

Membranous insertion of the cord- major vessel implanted into membrane, forms branches to placenta

38
Q

Vasa praevia effect

A

When membranes rupture, foetal bleeding + rapid exsanguination
Painless/moderate PV bleed at rupture or membranes/amniotomy accompanied by severe foetal distress
CS rarely fast enough to save baby

39
Q

Uterine rupture

A

Rarely occurs before labour
Either old C-section scar opening or de novo rupture of uterus
Foetus extruded
Uterus contracts down + bleeds from rupture site
Foetal hypoxia and maternal haemorrhage

40
Q

Miscellaneous gynaecological causes of APH

A

Lower genital tract neoplasms- vulval, vaginal, cervical
Cervical polyps
Genital infections

HD CC (22 decks)

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