Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

HD 2 > Placental Problems in Pregnancy > Flashcards

Placental Problems in Pregnancy Flashcards

1
Q

What four categories of ‘placental problems’ are talked about in this lecture?

A

Exaggerated symptoms of pregnancy
Bleeding disorders of pregnancy
Medical problems of pregnancy
Multiple pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does early/late antepartum mean?

A

Early <24 weeks, late >24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does intrapartum mean?

A

In labour – first and second stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does postpartum mean?

A

From delivery of foetus up to 6 weeks later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is hyperemesis gravidarum?

A

Extreme nausea and vomiting in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How many % of pregnant women does nausea and vomiting affect early on?

A

70-80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How many % of pregnant women does HG affect?

A

0.3-2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the dangers of HG?

A

Severe nausea/vomiting can cause electrolyte imbalance and weight loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What might cause HG?

A

It is poorly understood, but it might be due to beta-HCG stimulating the upper GI tract. It is similar to TSH and so also has effects on the TSH receptor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is HG managed?

A 
Dietary advice
IV fluids
Avoid dextrose
Thiamine
Antiemetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What % of pregnancies does early bleeding affect? How many % settle vs lead to miscarriage/ectopic/GTD?

A

25%

50% and 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the definition of a spontaneous miscarriage? When do the majority of these cases occur?

A

Foetus dies or delivers dead <24 weeks

Before 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How many % of pregnancies miscarry? How many % of these are isolated?

A

20-30%

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the six types of miscarriage?

A 
Threatened
Inevitable
Incomplete
Complete
Septic
Missed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Threatened miscarriage - describe the bleeding, the state of the cervical os, the size/health of the foetus and how many go on to miscarry.

A

Light and painless bleeding
Cervical os is closed
Foetus is alive and the size expected from dates
25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Inevitable miscarriage - what is the bleeding like? Is the cervical os open/closed? Is the foetus alive? Are there any other symptoms?

A

Bleeding normally heavier
Os is open
Foetus may be alive at this point
Pelvic pain/cramp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Incomplete miscarriage - what is this? Is the cervical os open/closed?

A

Only some of the fetal parts have been passed

Os is open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complete miscarriage - what is this? Describe the bleeding. Is the cervical os open/closed?

A

All foetal tissues have been passed
Bleeding has diminished/stopped
Os is closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Missed miscarriage - what is this? When is this recognised? Is the cervical os open/closed? Describe the uterus.

A

Foetus has not developed or has died in utero
Only recognised later (when bleeding occurs or do ultrasound)
Closed
Uterus is smaller than the expected dates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Septic miscarriage - what is this? What may it progress to? What can be said about the uterus?

A 
Contents of the uterus are infected causing endometritis
Pelvic infection (causing abdo pain and peritonism)
Tender uterus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How much does beta-HCG increase by in 48 hours in a viable pregnancy?

A

> 66%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the expectant management for miscarriage? (2)

A

Wait for resolution

Resuscitation and syntocinon/ergometrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the medical management for miscarriage? (2)

A

Removal of foetal tissue (using prostaglandins)

Misoprostol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the surgical management for miscarriage? (3)

A

Curettage or surgical aspiration
Infection swabs and broad spectrum antibiotics
Anti-D to rhesus –ve women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What defines a recurrent miscarriage? How many % of couples does this affect?

A

Three or more consecutive miscarriages
1%

Infection e.g. bacterial vaginosis
Others e.g. obesity, smoking, high maternal age, drug abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the causes of recurrent miscarriage?

A

Autoimmune disease e.g. antiphospholipid syndrome
Chromosomal defects in couple
Hormonal factors (e.g. PCOS, LH hypersecretion)
Anatomical factors (e.g. uterine septa, cervical incompetence)
Infection (e.g. bacterial vaginosis)
Others (e.g. obesity, smoking, high maternal age, drug abuse)

27
Q

What is an ectopic pregnancy?

How many pregnancies does it occur in?

A

Implantation of the fertilised ovum outside the endometrial cavity
1 in 60-100 (in the UK)

28
Q

What two groups of people is ectopic pregnancy more common in?

A

Advanced maternal age

Lower social class

29
Q

What are the risk factors for ectopic pregancy?

A 
STI/PID
Emergency contraception
Assisted conception
Pelvic surgery
IUCD in situ
Failed sterilisation 
Previous ectopic
Congenital abnormalities of the tube e.g. diverticulum
30
Q

How does an ectopic pregnancy present? (4)

A

Bleeding (scanty, dark)
Lower abdominal pain
Collapse
Amenorrhoea for 4-10 weeks

31
Q

What can be seen on examination with ectopic pregnancy? (6)

A

Tachycardia
Abdominal tenderness and rebound tenderness
Cervical motion tenderness
Adnexal tenderness on side with pathology
Uterus is smaller than the expected gestation
Cervical os is closed

32
Q

What surgery is done for ectopic pregnancies?

A

Laparoscopy and salpingectomy/salpingotomy (removal of ectopic from tube)

33
Q

How is ectopic pregnancy treated medically?

A

Methotrexate

34
Q

What is a molar pregnancy also called?

A

Gestational trophoblastic disease

When the trophoblastic tissue that forms part of the blastocyst proliferates more aggressively than normal
1 in 500-1000 pregnancies affected
Non-invasive (hydatidiform mole), locally invasive (invasive mole), metastatic (choriocarinoma)

35
Q

What is the difference between a partial mole and a complete mole?

A

Partial mole – foetal tissue is present, malignant change in this type of mole is more rare.
Complete mole – entirely paternal in origin and no foetal tissue is seen at histology (just swollen chorionic villi). 5-10% turn malignant.

36
Q

GTD - what are the symptoms? (5)

A

Bleeding
Hyperemesis gravidarum (excess HCG production)
Passage of vesicles per vaginum
Uterus is often large
Early pre-eclampsia and hyperthyroidism may occur

37
Q

What is antepartum haemorrhage? How many % of all pregnancies does this occur in?

A

Bleeding from the genital tract >24 weeks gestation but before the delivery of the baby.
3-5%

38
Q

What are the causes of antepartum haemorrhage? (6)

A 
Undetermined origin
Placental abruption
Placenta praevia
Incidental genital tract pathology
Uterine rupture
Vasa praevia
39
Q

Painful vaginal bleeding from a normally sited placenta - what is this called? How many % of pregancies does it affect after 24 weeks?

A

Placental abruption

1.5%

40
Q

What are the risk factors for placental abruption? (8)

A 
Multiparity
Gestational hypertension
Polyhydramnios
ECV
Trauma
Smoking
Malnutrition
Previous abruption
41
Q

What are the clinical features of placental abruption? (8)

A 
Intense constant abdominal pain (+/- vaginal bleeding)
Profound shock, oliguria/anuria, DIC
Tense, tender (woody) uterus
Foetal parts not easily felt
Foetal heart weak or absent 
Pallor
Hypotension
Tachycardia
42
Q

How is placental abruption managed if there is no signs of foetal distress and only a minor degree of abruption, and the baby is less than 34 weeks gestation?

A

Steroids

43
Q

How is placental abruption managed if there are signs of foetal distress?

A

Urgent C-section

44
Q

How is placental abruption managed if there are no signs of foetal distress and the baby is >37 weeks gestation?

A

Induce labour with amniotomy

45
Q

What is placenta praevia?

A

When the placenta is inserted into the lower segment of the uterus after 24 weeks. There is bleeding most commonly between 32-37 weeks.

46
Q

What is the difference between a major placenta praevia and a minor one?

A

Major covers the cervical os, minor doesn’t

47
Q

What is placenta praevia associcated with? (4)

A

Twin pregnancies
Multiparous women
Older mothers
Scarring of the uterus

48
Q

Is the bleeding in placenta praevia painful?

A

Painless

49
Q

What are the complications of placenta praevia? (6)

A

Obstructs engagement of head so need c-section
Malpresentation of baby
Postpartum haemorrhage
Preterm delivery
Increased incidence of IUGR, congenital malformations, foetal anaemia, cord complications and perinatal mortality
Placenta accreta

50
Q

What is it called when the placenta implants in a previous Cesarean section scar?

A

Placenta accreta

51
Q

What is particularly important to remember about the management of placenta praevia?

A

NO VAGINAL EXAMINATION (speculum safe)

52
Q

What are 3 other causes of antepartum haemorrhage?

A

Vasa praevia
Ruptured uterus
Cervical carcinoma

53
Q

What is pre-eclampsia characterised by?

A

Hypertension, renal impairment/proteinuria, fluid retention/oedema/weight gain and DIC

54
Q

What is pre-eclampsia due to?

A

Abnormal maternal adaptation to trophoblast

55
Q

What are the risk factors for pre-eclampsia? (5)

A 
Primigravidity
Genetic
Multiple pregnancy
Molar pregnancies
Pre-existing hypertension or diabetes
56
Q

Monozygotic twinning is a chance event. What predisposes to dizygotic twinning? (4)

A

Racial predisposition
Fertility treatments
Older ages
Parity >5

57
Q

If cleavage occurs on day 1-3, what type of twins?

A

Dichorionic/diamniotic

58
Q

If cleavage occurs on day 4-8, what type of twins?

A

Monochorionic/diamniotic

59
Q

If cleavage occurs on day 8-13, what type of twins?

A

Monochorionic/monoamniotic

60
Q

If cleavage occurs on day 13-15, what type of twins?

A

Conjoined twins

61
Q

What is TTTS? When do the majority of cases occur?

What type of twins does this affect?

A

Twin to twin transfusion syndrome - where there are vascular communications within the placenta
16-24 weeks

62
Q

How does TTTS affect the babies? With laser treatment, what is the survival rate?

A

Discrepant growth and oligohydramnios or polyhydramnios

About 70%

63
Q

What other complications is a multiple pregnancy at higher risk of? (7)

A 
Anaemia
Preeclampsia
Congenital anomalies
IUGR
Polyhydramnios
Malpresentation
Miscarriage and preterm labour

HD 2 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions