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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

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2
Q

What does early/late antepartum mean?

A

Early <24 weeks, late >24 weeks

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3
Q

What does intrapartum mean?

A

In labour – first and second stages

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4
Q

What does postpartum mean?

A

From delivery of foetus up to 6 weeks later

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5
Q

What is hyperemesis gravidarum?

A

Extreme nausea and vomiting in pregnancy

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6
Q

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

A

70-80%

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7
Q

How many % of pregnant women does HG affect?

A

0.3-2%

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8
Q

What are the dangers of HG?

A

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

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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.

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10
Q

How is HG managed?

A 
Dietary advice
IV fluids
Avoid dextrose
Thiamine
Antiemetics
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11
Q

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

A

25%

50% and 50%

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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

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13
Q

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

A

20-30%

60%

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14
Q

What are the six types of miscarriage?

A 
Threatened
Inevitable
Incomplete
Complete
Septic
Missed
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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%

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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

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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

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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

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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

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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
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21
Q

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

A

> 66%

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22
Q

What is the expectant management for miscarriage? (2)

A

Wait for resolution

Resuscitation and syntocinon/ergometrine

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23
Q

What is the medical management for miscarriage? (2)

A

Removal of foetal tissue (using prostaglandins)

Misoprostol

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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

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25
What defines a recurrent miscarriage? How many % of couples does this affect?
Three or more consecutive miscarriages 1% Infection e.g. bacterial vaginosis Others e.g. obesity, smoking, high maternal age, drug abuse
26
What are the causes of recurrent miscarriage?
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
What is an ectopic pregnancy? | How many pregnancies does it occur in?
Implantation of the fertilised ovum outside the endometrial cavity 1 in 60-100 (in the UK)
28
What two groups of people is ectopic pregnancy more common in?
Advanced maternal age | Lower social class
29
What are the risk factors for ectopic pregancy?
``` STI/PID Emergency contraception Assisted conception Pelvic surgery IUCD in situ Failed sterilisation Previous ectopic Congenital abnormalities of the tube e.g. diverticulum ```
30
How does an ectopic pregnancy present? (4)
Bleeding (scanty, dark) Lower abdominal pain Collapse Amenorrhoea for 4-10 weeks
31
What can be seen on examination with ectopic pregnancy? (6)
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
What surgery is done for ectopic pregnancies?
Laparoscopy and salpingectomy/salpingotomy (removal of ectopic from tube)
33
How is ectopic pregnancy treated medically?
Methotrexate
34
What is a molar pregnancy also called?
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
What is the difference between a partial mole and a complete mole?
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
GTD - what are the symptoms? (5)
Bleeding Hyperemesis gravidarum (excess HCG production) Passage of vesicles per vaginum Uterus is often large Early pre-eclampsia and hyperthyroidism may occur
37
What is antepartum haemorrhage? How many % of all pregnancies does this occur in?
Bleeding from the genital tract >24 weeks gestation but before the delivery of the baby. 3-5%
38
What are the causes of antepartum haemorrhage? (6)
``` Undetermined origin Placental abruption Placenta praevia Incidental genital tract pathology Uterine rupture Vasa praevia ```
39
Painful vaginal bleeding from a normally sited placenta - what is this called? How many % of pregancies does it affect after 24 weeks?
Placental abruption | 1.5%
40
What are the risk factors for placental abruption? (8)
``` Multiparity Gestational hypertension Polyhydramnios ECV Trauma Smoking Malnutrition Previous abruption ```
41
What are the clinical features of placental abruption? (8)
``` 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
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?
Steroids
43
How is placental abruption managed if there are signs of foetal distress?
Urgent C-section
44
How is placental abruption managed if there are no signs of foetal distress and the baby is >37 weeks gestation?
Induce labour with amniotomy
45
What is placenta praevia?
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
What is the difference between a major placenta praevia and a minor one?
Major covers the cervical os, minor doesn’t
47
What is placenta praevia associcated with? (4)
Twin pregnancies Multiparous women Older mothers Scarring of the uterus
48
Is the bleeding in placenta praevia painful?
Painless
49
What are the complications of placenta praevia? (6)
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
What is it called when the placenta implants in a previous Cesarean section scar?
Placenta accreta
51
What is particularly important to remember about the management of placenta praevia?
NO VAGINAL EXAMINATION (speculum safe)
52
What are 3 other causes of antepartum haemorrhage?
Vasa praevia Ruptured uterus Cervical carcinoma
53
What is pre-eclampsia characterised by?
Hypertension, renal impairment/proteinuria, fluid retention/oedema/weight gain and DIC
54
What is pre-eclampsia due to?
Abnormal maternal adaptation to trophoblast
55
What are the risk factors for pre-eclampsia? (5)
``` Primigravidity Genetic Multiple pregnancy Molar pregnancies Pre-existing hypertension or diabetes ```
56
Monozygotic twinning is a chance event. What predisposes to dizygotic twinning? (4)
Racial predisposition Fertility treatments Older ages Parity >5
57
If cleavage occurs on day 1-3, what type of twins?
Dichorionic/diamniotic
58
If cleavage occurs on day 4-8, what type of twins?
Monochorionic/diamniotic
59
If cleavage occurs on day 8-13, what type of twins?
Monochorionic/monoamniotic
60
If cleavage occurs on day 13-15, what type of twins?
Conjoined twins
61
What is TTTS? When do the majority of cases occur? | What type of twins does this affect?
Twin to twin transfusion syndrome - where there are vascular communications within the placenta 16-24 weeks
62
How does TTTS affect the babies? With laser treatment, what is the survival rate?
Discrepant growth and oligohydramnios or polyhydramnios | About 70%
63
What other complications is a multiple pregnancy at higher risk of? (7)
``` Anaemia Preeclampsia Congenital anomalies IUGR Polyhydramnios Malpresentation Miscarriage and preterm labour ```

HD 2 (25 decks)

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