Placental Problems In Preganancy Flashcards
3 stages of pregnancy
Antepartum
Intrapartum
Postpartum
Early and late Antepartum
Early = <24 wks
Late = >24 wks
Intrapartum
1st and 2nd stages of labour
Postpartum
6wks after delivery of baby
Hyperemesis gravidarum
nausea and vomiting - severe morning sickness
When does morning sickness/hyperemesis gravidarum occur
Begins 6-8wks, subsides 16-20 wks
Why causes morning sickness to end at 16-20 wks
Placenta well established so hCG decreases
What increases chance of hyperemesis gravidarum
Young mother
1st pregnancy
What may cause morning sickness
hCG
Oestrogen
Beta hCG
GDF15
Progesterone
Vit B deficiency
Morning sickness treatment
Dietary and lifestyle changes
Medications
Enteral/Parenteral nutrition
IV fluids
When does bleeding in early pregnancy occur
1st 20 wks gestation
Outcomes of bleeding in early pregnancy
Settle - 50%
Miscarry
Ectopic
Trophoblastic disease
Problems in late pregnancy
Causes of bleeding in early pregnancy
Cervical sensitivity
Infection
Molar pregnancy
Subchorionic haemorrhage
Implantation bleeding
Spontaneous miscarriage
Fetus does or is delivered dead <24 wks
What is the most common cause of spontaneous miscarriage
Chromosomal abnormalities - fetus unviable
When do the majority of spontaneous miscarriages occur
Before 16wks
8 types of miscarriage
Complete
Incomplete
Threatened
Missed
Recurrent
Incebitable
Septic
Therapeutic
Complete miscarriage
Bleeding and complete passage of products of conception
Incomplete miscarriage
Heavy bleeding and passage of some products of conception
Threatened miscarriage
Slight vaginal bleeding, possible abdominal pain
Intact membranes and fetal cardiac activity
Missed miscarriage
Often asymptomatic
No fetal cardiac activity
Recurrent miscarriage
3+ consecutive spontaneous abortions before 20wks
Inevitable miscarriage
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
Which types of miscarriage is the cervix dilated
Incomplete
Inevitable
Possibly recurrent depending on type
Possibly complete depending on stage
Which types of miscarriage is the cervix closed
Threatened
Missed
Possibly Complete depending on stage
Possibly Recurrent depending on typd
Septic miscarriage
Contents of uterus infected causing endometritis
Septic miscarriage symptoms
Purulent cervical discharge
Tender uterus
Passage of fetal tissue - may be incomplete
Pelvic infection signs
Systemic symptoms
Septic miscarriage causes
Unsafe abortion
Cervical incompetence
Spontaneous miscarriage investigations
Ultrasound
Serum beta hCG
FBC
Rhesus status - Rhesus disease
Miscarriage management
Await spontaneous resolution
Treat excessive blood loss
Prostaglandins - misoprostol
Surgery
Anti D to Rhesus negative women
Support + counselling
Why is misoprostol used in miscarriage management
Prostaglandin analog
Causes uterus to contract and expel products
Recurrent miscarriage causes
Genetic
Anatomical
Immunological
When can cervical incompetence cause miscarriage
2nd trimester
Cervical incompetence risks
Miscarriage
Chorioamnionitis
Preterm delivery
How is cervical incompetence managed
Cervix stitched, stitches removed at 36 wks
Ectopic pregnancy
Implantation of fertilised ovum outside endometrial cavity
Most common site of ectopic
Ampullary
Ectopic pregnancy risk factors
STIs
PID
IVF
pelvis surgery
Smoking
IUCD
Failed sterilisation
Previous ectopic
Ectopic presentation
Female reproductive age
Positive pregnancy test/amenorrhoea 4-10wks
PV bleeding
Low abdo pain
Collapse
Shoulder tip pain
Why is methotrexate given in ectopics
Causes miscarriage by Stopping placenta growth
Gestational trophoblastic disease
Trophoblastic tissue that forms part of the blastocyst proliferates more aggressively than normal
- molar pregnancies
Gestational Trophoblastic disease symptoms
Vaginal bleeding
Hyperemesis gravidarum
Enlarged uterus
Early pre eclampsia
Hyperthyroidism symptoms
What causes a Complete molar pregnancy
Sperm fertilises egg with no maternal chromosomes
Can be monospermic or dispermic
How is a molar pregnancy treated
Methotrexate
removal of molar tissue - surgery, chemo
Which type of molar pregnancy may produce some fetal tissue
Partial molar pregnancy
What causes a partial molar pregnancy
2 sperm fertilise egg at once, embryo has 2 sets paternal chromosomes + 1 set maternal chromosomes
Antepartum haemorrhage
Bleeding from genital tract at 24+ wks
Antepartum haemorrhage causes
Placenta abruption
Placenta praevia
genital tract pathology
Uterine rupture
Vasa praevia
Placental abruption
Placenta comes away from uterine wall
Symptoms of placental abruption
PV bleeding
Abdo pain
Tense woody uterus from blood accumulation behind placenta
Weak/ absent fetal heart rate
Placental abruption risk factors
Previous abruption
High BP
Trauma
Smoking
Idiopathic
Multi parity
Polyhydramnios
Placental abruption management
Deliver baby
Resuscitate
Steroids before delivery if <39wks
Anti D
Placenta praevia
Placenta inserted into lower segment of uterus after 24wks
2 types of placenta praevia
Major - covers cervix and internal os
Minor - <2cm from internal os
Placenta praevia risk factors
Prior praevia
Multi parity
Multiple pregnancy
Incr maternal age
Previous lower segment C section
Smoking
Placenta praevia signs
Painless PV bleeding
Uterus non tender
Malpresentation of fetus
Placenta praevia management
Steroids after 39wks - pre term delivery common
Lower segment C section
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
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
Pre eclampsia
Hypertension in pregnancy
What causes pre eclampsia
Abnormal maternal adaptation to trophoblasts
Pre eclampsia management
Stabilise BP - aspirin, calcium
Monitor fetal growth
Antihypertensives
Anticonvulsants
Timely delivery
What can unmanaged pre eclampsia lead to
Eclampsia
Twin to twin transfusion
Twins receive unequal shares of placental blood supply causing discrepant growth
Twin to twin transfusion treatment
Ablate anastomosing vessels with laser
Velamentous insertion of umbilical cord into placenta
Major umbilical vessels separate in the fetal membranes before reaching placental disk, leaving vessels exposed to trauma
