Placental problems in pregnancy Flashcards
What is early vs late antepartum
Early is before 24 weeks
Late is after
What % of women are effected by nausea and vomiting in pregnancy
70-80%
What % of women are effected by hyperemesis gravidarum
0.3-2%
What does hyperemesis gravidarum refer to
Loss of 5% of body weight due to vomiting
What can can hyperemesis gravidarum lead to
Electrolyte imbalance
Weight loss
Hospital
How should hyperemesis gravidarum be managed
- Give IV fluids
- Replace lost potassium
- Replace thiamine with pabrinex IV
- Increase folic acids
- Steroids to suppress nausea
Why should dextrose not be used to replace potassium in HG patients
Leads to encephalopathy
In what % of early pregnancies does bleeding occur? How many of these settle
25%
50%
Define spontaneous miscarriage
Foetus dies or delivers dead <24 weeks. Majority <12 weeks
What % of miscarriages are isolated, non recurring chromosomal abnormalities
60
Name 6 ways of categorising miscarriage
- Threatened
- Inevitable
- Incomplete
- Complete
- Septic
- Missed
What are the features of a threatened miscarriage
Light and painless PV bleeding Foetus alive Uterus size expected from dates Cervical os closed 25% of women with this bleed go on to miscarry
What are the features of an inevitable miscarriage
Heavy bleeding Foetus MAY be alive Os open Crampy pelvic pain Miscarriage about to occur
What are the features of an incomplete miscarriage
Only some foetal parts have been passed
Os open
PV bleeding continues
What are the features of a complete miscarriage
All foetal tissues passed
Bleeding has dimished/ stopped
Uterus no longer enlarged
Os is clsoed
What are the features of a missed miscarriage
Foetus died in utero
Only recognised later when bleeding occurs/ ultrasound
Uterus smaller than expected
Os closed
Abdominal pain and vaginal bleeding minimal
What are the features of a septic miscarriage
Contents of the uterus is infected causing endometritis
Offensive vaginal loss
Tender uterus
How do serum bHCG levels change is pregnancy is progressing normally
Normally increases by 66% in 48 hour with viable pregnancy
How to manage an expectant miscarriage
Wait for spontaneous resolutions
Resus and syntocinon/ ergometrine if blood loss is substantial
How is foetal tissue removed
Using prostaglandins
Define recurrent miscarriage
Three or more consecutive miscarriages
Name some causes of recurrent miscarriage
- Autoimmune disease
- Chromosomal defect
- Hormonal factors
- Anatomical factors
- Infection
What is cervical incompetence
Cervix fails to retain the pregnancy
Define ectopic pregnancy
Embryo that implants outside the uterine cavity
What % of women who have had an ectopic pregnancy have a succesful pregnancy subsequently
70
Risk factors for ectopic pregnancy
STI Emergency contraception Assisted conception Pelvic surgery Previous ectopic
Describe the clinical presentation of ectopic pregnancy
Women of reproductive age PV bleeding Lower abdo pain Collapse (shoulder tip pain) Amenorrhoea
What is the purpose of a trans vaginal ultrasound in investigating ectopic pregnancy
Visualisation of intrauterine pregnancy/ adnexal mass free fluid in pouch of douglas
If you can’t located foetus what 3 things can it suggest
Gestation <5 weeks
Complete miscarriage
Ectopic pregnancy
How to manage acute presentations of ectopic pregnancy
- IV access, cross match blood
- Uregent laparotomy is haemodynamically unstable
Surgical treatment for subacute presentation of ectopic pregnancy
Laparoscopy and salpingectomy (removal of ectopic from tube)
Medical treatment for sabacute presentation of ectopic pregnancy
Single dose methotrexate and keep checking bHCG levels
Define gestational trophoblastic disease
When trophoblastic tissue that normally forms part of the blastocyst proliferates more aggresively than normal
What is a partial mole
Foetal tissue is present
2 sperm fertilise an egg resulting in triploid conceptus with 69 chromosomes
What is a complete mole
All chromosomes from father
No foetal tissue present
Clinical features of gestational trophoblastic disease
PV bleeding
HG due to excess hcg production
Passage of vesicles per vaginum
What can be seen when examining somebody with GTD
Uterus is often large
Early pre-eclampsia and hyperthyroidism
What is placental abruption
The early separation of the placenta and the uterus
Painful vaginal bleeding
Risk factors for placental abruption
Multiparity Polyhydramnios Trauma Smoking Malnutrition Previous abruption Idiopathic
Clinical features of placental abruption
Intense constant abdo pain Profound shock Tense tender uterus Foetal parts not easily felt Foetal heart weak/ absent
What is the purpose of ultrasound in placenta abruption
To check that it is not placenta plaevia
When can steroids be given to mother with placental abruption
<34 weeks gestation
What should be done is there is foetal distress in placental abruption
Urgent C section
What should be done in mothers with placental abruption if there is not foetal distress and >37 weeks gestation
Induction of labour with amniotomy
What should be done is baby has died due to placental abruption
Coagulopathy likely so give blood products and induce labour
Conservative management for placental abruption
If no distress, preterm and minor degree of abruption… give steroids and monitor on ward
Define placenta praevia
When the placenta is inserted into the lower segment of the uterus after 24 weeks
What is placenta praevia associated with
Twins
Multiparous women
Older mothers
Uterus scarring
Difference between minor and major placenta praevia
Major covers the os, minor doesn’t
What complications are likely to occur with placenta praevia
- Obstructs head enlargement
- Malpresentation of baby
- Postpartum haemorrhage
- Pre term delivery
- Increased incidence of IUGR
- Placenta accrete
What is placenta accreta
Placenta implants in previous c section scar which may present normal separation
How is pre-eclampsia characterised
Hypertension Renal impairment Proteinuria Fluid retention Oedema Weight gain
Risk factors for pre-eclampsia
Primigravidity
Genetic
Multiple pregnancy
Diabetes
What happens in stage 1 of pre-eclampsia
Defective placental implantation
Placental ischaemia
Placental factors and systemic haemodynamic adaptation
What happens in stage 2 of pre-eclampsia
Endothelial dysfunction
Reduced perfusion of affected organs
Clinical manifestation
What are monochorionic/ monoamniotic twins
Share a placenta and a sac
When should monochorionic/ monoamniotic twins be delivered
32 weeks because worry that cords will tangle
What is twin to twin transufions
Vascular communications within the placenta of monochorionic twins
Discrepant growth- one twin gets more fluid and one gets none
