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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
Which types of miscarriage is the cervix closed
Threatened Missed Possibly Complete depending on stage Possibly Recurrent depending on typd
26
Septic miscarriage
Contents of uterus infected causing endometritis
27
Septic miscarriage symptoms
Purulent cervical discharge Tender uterus Passage of fetal tissue - may be incomplete Pelvic infection signs Systemic symptoms
28
Septic miscarriage causes
Unsafe abortion Cervical incompetence
29
Spontaneous miscarriage investigations
Ultrasound Serum beta hCG FBC Rhesus status - Rhesus disease
30
Miscarriage management
Await spontaneous resolution Treat excessive blood loss Prostaglandins - misoprostol Surgery Anti D to Rhesus negative women Support + counselling
31
Why is misoprostol used in miscarriage management
Prostaglandin analog Causes uterus to contract and expel products
32
Recurrent miscarriage causes
Genetic Anatomical Immunological
33
When can cervical incompetence cause miscarriage
2nd trimester
34
Cervical incompetence risks
Miscarriage Chorioamnionitis Preterm delivery
35
How is cervical incompetence managed
Cervix stitched, stitches removed at 36 wks
36
Ectopic pregnancy
Implantation of fertilised ovum outside endometrial cavity
37
Most common site of ectopic
Ampullary
38
Ectopic pregnancy risk factors
STIs PID IVF pelvis surgery Smoking IUCD Failed sterilisation Previous ectopic
39
Ectopic presentation
Female reproductive age Positive pregnancy test/amenorrhoea 4-10wks PV bleeding Low abdo pain Collapse Shoulder tip pain
40
Why is methotrexate given in ectopics
Causes miscarriage by Stopping placenta growth
41
Gestational trophoblastic disease
Trophoblastic tissue that forms part of the blastocyst proliferates more aggressively than normal - molar pregnancies
42
Gestational Trophoblastic disease symptoms
Vaginal bleeding Hyperemesis gravidarum Enlarged uterus Early pre eclampsia Hyperthyroidism symptoms
43
What causes a Complete molar pregnancy
Sperm fertilises egg with no maternal chromosomes Can be monospermic or dispermic
44
How is a molar pregnancy treated
Methotrexate removal of molar tissue - surgery, chemo
45
Which type of molar pregnancy may produce some fetal tissue
Partial molar pregnancy
46
What causes a partial molar pregnancy
2 sperm fertilise egg at once, embryo has 2 sets paternal chromosomes + 1 set maternal chromosomes
47
Antepartum haemorrhage
Bleeding from genital tract at 24+ wks
48
Antepartum haemorrhage causes
Placenta abruption Placenta praevia genital tract pathology Uterine rupture Vasa praevia
49
Placental abruption
Placenta comes away from uterine wall
50
Symptoms of placental abruption
PV bleeding Abdo pain Tense woody uterus from blood accumulation behind placenta Weak/ absent fetal heart rate
51
Placental abruption risk factors
Previous abruption High BP Trauma Smoking Idiopathic Multi parity Polyhydramnios
52
Placental abruption management
Deliver baby Resuscitate Steroids before delivery if <39wks Anti D
53
Placenta praevia
Placenta inserted into lower segment of uterus after 24wks
54
2 types of placenta praevia
Major - covers cervix and internal os Minor - <2cm from internal os
55
Placenta praevia risk factors
Prior praevia Multi parity Multiple pregnancy Incr maternal age Previous lower segment C section Smoking
56
Placenta praevia signs
Painless PV bleeding Uterus non tender Malpresentation of fetus
57
Placenta praevia management
Steroids after 39wks - pre term delivery common Lower segment C section
58
Placenta accreta, increta, and percreta
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
Placenta accreta/increta/percreta management
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
Pre eclampsia
Hypertension in pregnancy
61
What causes pre eclampsia
Abnormal maternal adaptation to trophoblasts
62
Pre eclampsia management
Stabilise BP - aspirin, calcium Monitor fetal growth Antihypertensives Anticonvulsants Timely delivery
63
What can unmanaged pre eclampsia lead to
Eclampsia
64
Twin to twin transfusion
Twins receive unequal shares of placental blood supply causing discrepant growth
65
Twin to twin transfusion treatment
Ablate anastomosing vessels with laser
66
Velamentous insertion of umbilical cord into placenta
Major umbilical vessels separate in the fetal membranes before reaching placental disk, leaving vessels exposed to trauma

HD2 (23 decks)

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