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HD2 > Placental Problems In Preganancy > Flashcards

Placental Problems In Preganancy Flashcards

1
Q

3 stages of pregnancy

A

Antepartum
Intrapartum
Postpartum

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2
Q

Early and late Antepartum

A

Early = <24 wks
Late = >24 wks

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3
Q

Intrapartum

A

1st and 2nd stages of labour

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4
Q

Postpartum

A

6wks after delivery of baby

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5
Q

Hyperemesis gravidarum

A

nausea and vomiting - severe morning sickness

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6
Q

When does morning sickness/hyperemesis gravidarum occur

A

Begins 6-8wks, subsides 16-20 wks

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7
Q

Why causes morning sickness to end at 16-20 wks

A

Placenta well established so hCG decreases

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8
Q

What increases chance of hyperemesis gravidarum

A

Young mother
1st pregnancy

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9
Q

What may cause morning sickness

A

hCG
Oestrogen
Beta hCG
GDF15
Progesterone
Vit B deficiency

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10
Q

Morning sickness treatment

A

Dietary and lifestyle changes
Medications
Enteral/Parenteral nutrition
IV fluids

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11
Q

When does bleeding in early pregnancy occur

A

1st 20 wks gestation

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12
Q

Outcomes of bleeding in early pregnancy

A

Settle - 50%
Miscarry
Ectopic
Trophoblastic disease
Problems in late pregnancy

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13
Q

Causes of bleeding in early pregnancy

A

Cervical sensitivity
Infection
Molar pregnancy
Subchorionic haemorrhage
Implantation bleeding

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14
Q

Spontaneous miscarriage

A

Fetus does or is delivered dead <24 wks

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15
Q

What is the most common cause of spontaneous miscarriage

A

Chromosomal abnormalities - fetus unviable

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16
Q

When do the majority of spontaneous miscarriages occur

A

Before 16wks

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17
Q

8 types of miscarriage

A

Complete
Incomplete
Threatened
Missed
Recurrent
Incebitable
Septic
Therapeutic

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18
Q

Complete miscarriage

A

Bleeding and complete passage of products of conception

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19
Q

Incomplete miscarriage

A

Heavy bleeding and passage of some products of conception

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20
Q

Threatened miscarriage

A

Slight vaginal bleeding, possible abdominal pain
Intact membranes and fetal cardiac activity

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21
Q

Missed miscarriage

A

Often asymptomatic
No fetal cardiac activity

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22
Q

Recurrent miscarriage

A

3+ consecutive spontaneous abortions before 20wks

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23
Q

Inevitable miscarriage

A

Vaginal bleeding and abdo pain
Membranes may/may not be ruptured
Products of conception not attached and being removed, may be seen/felt above/at cervical os

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24
Q

Which types of miscarriage is the cervix dilated

A

Incomplete
Inevitable
Possibly recurrent depending on type
Possibly complete depending on stage

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25
Q

Which types of miscarriage is the cervix closed

A

Threatened
Missed
Possibly Complete depending on stage
Possibly Recurrent depending on typd

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26
Q

Septic miscarriage

A

Contents of uterus infected causing endometritis

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27
Q

Septic miscarriage symptoms

A

Purulent cervical discharge
Tender uterus
Passage of fetal tissue - may be incomplete
Pelvic infection signs
Systemic symptoms

28
Q

Septic miscarriage causes

A

Unsafe abortion
Cervical incompetence

29
Q

Spontaneous miscarriage investigations

A

Ultrasound
Serum beta hCG
FBC
Rhesus status - Rhesus disease

30
Q

Miscarriage management

A

Await spontaneous resolution
Treat excessive blood loss
Prostaglandins - misoprostol
Surgery
Anti D to Rhesus negative women
Support + counselling

31
Q

Why is misoprostol used in miscarriage management

A

Prostaglandin analog
Causes uterus to contract and expel products

32
Q

Recurrent miscarriage causes

A

Genetic
Anatomical
Immunological

33
Q

When can cervical incompetence cause miscarriage

A

2nd trimester

34
Q

Cervical incompetence risks

A

Miscarriage
Chorioamnionitis
Preterm delivery

35
Q

How is cervical incompetence managed

A

Cervix stitched, stitches removed at 36 wks

36
Q

Ectopic pregnancy

A

Implantation of fertilised ovum outside endometrial cavity

37
Q

Most common site of ectopic

A

Ampullary

38
Q

Ectopic pregnancy risk factors

A

STIs
PID
IVF
pelvis surgery
Smoking
IUCD
Failed sterilisation
Previous ectopic

39
Q

Ectopic presentation

A

Female reproductive age
Positive pregnancy test/amenorrhoea 4-10wks
PV bleeding
Low abdo pain
Collapse
Shoulder tip pain

40
Q

Why is methotrexate given in ectopics

A

Causes miscarriage by Stopping placenta growth

41
Q

Gestational trophoblastic disease

A

Trophoblastic tissue that forms part of the blastocyst proliferates more aggressively than normal
- molar pregnancies

42
Q

Gestational Trophoblastic disease symptoms

A

Vaginal bleeding
Hyperemesis gravidarum
Enlarged uterus
Early pre eclampsia
Hyperthyroidism symptoms

43
Q

What causes a Complete molar pregnancy

A

Sperm fertilises egg with no maternal chromosomes
Can be monospermic or dispermic

44
Q

How is a molar pregnancy treated

A

Methotrexate
removal of molar tissue - surgery, chemo

45
Q

Which type of molar pregnancy may produce some fetal tissue

A

Partial molar pregnancy

46
Q

What causes a partial molar pregnancy

A

2 sperm fertilise egg at once, embryo has 2 sets paternal chromosomes + 1 set maternal chromosomes

47
Q

Antepartum haemorrhage

A

Bleeding from genital tract at 24+ wks

48
Q

Antepartum haemorrhage causes

A

Placenta abruption
Placenta praevia
genital tract pathology
Uterine rupture
Vasa praevia

49
Q

Placental abruption

A

Placenta comes away from uterine wall

50
Q

Symptoms of placental abruption

A

PV bleeding
Abdo pain
Tense woody uterus from blood accumulation behind placenta
Weak/ absent fetal heart rate

51
Q

Placental abruption risk factors

A

Previous abruption
High BP
Trauma
Smoking
Idiopathic
Multi parity
Polyhydramnios

52
Q

Placental abruption management

A

Deliver baby
Resuscitate
Steroids before delivery if <39wks
Anti D

53
Q

Placenta praevia

A

Placenta inserted into lower segment of uterus after 24wks

54
Q

2 types of placenta praevia

A

Major - covers cervix and internal os
Minor - <2cm from internal os

55
Q

Placenta praevia risk factors

A

Prior praevia
Multi parity
Multiple pregnancy
Incr maternal age
Previous lower segment C section
Smoking

56
Q

Placenta praevia signs

A

Painless PV bleeding
Uterus non tender
Malpresentation of fetus

57
Q

Placenta praevia management

A

Steroids after 39wks - pre term delivery common
Lower segment C section

58
Q

Placenta accreta, increta, and percreta

A

Placenta grows too far into wall
Accreta - placenta attaches to myometrium
Increta - placenta grows into myometrium
Percreta - placenta grows through entire uterine wall and can invade other organs

59
Q

Placenta accreta/increta/percreta management

A

Stable - manage expectantly
Bleeding - admit, cross match blood, anti D, antenatal steroids
Maternal/fetal compromise 37+wks - emergency C section, hysterectomy, methotrexate, close pelvic vessels

60
Q

Pre eclampsia

A

Hypertension in pregnancy

61
Q

What causes pre eclampsia

A

Abnormal maternal adaptation to trophoblasts

62
Q

Pre eclampsia management

A

Stabilise BP - aspirin, calcium
Monitor fetal growth
Antihypertensives
Anticonvulsants
Timely delivery

63
Q

What can unmanaged pre eclampsia lead to

A

Eclampsia

64
Q

Twin to twin transfusion

A

Twins receive unequal shares of placental blood supply causing discrepant growth

65
Q

Twin to twin transfusion treatment

A

Ablate anastomosing vessels with laser

66
Q

Velamentous insertion of umbilical cord into placenta

A

Major umbilical vessels separate in the fetal membranes before reaching placental disk, leaving vessels exposed to trauma

HD2 (23 decks)

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