Placental problems in pregnancy Flashcards by Alice Scholfield

What is early vs late antepartum

Early is before 24 weeks

Late is after

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What % of women are effected by nausea and vomiting in pregnancy

70-80%

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What % of women are effected by hyperemesis gravidarum

0.3-2%

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What does hyperemesis gravidarum refer to

Loss of 5% of body weight due to vomiting

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What can can hyperemesis gravidarum lead to

Electrolyte imbalance
Weight loss
Hospital

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How should hyperemesis gravidarum be managed

Give IV fluids
Replace lost potassium
Replace thiamine with pabrinex IV
Increase folic acids
Steroids to suppress nausea

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Why should dextrose not be used to replace potassium in HG patients

Leads to encephalopathy

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In what % of early pregnancies does bleeding occur? How many of these settle

25%

50%

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Define spontaneous miscarriage

Foetus dies or delivers dead <24 weeks. Majority <12 weeks

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What % of miscarriages are isolated, non recurring chromosomal abnormalities

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Name 6 ways of categorising miscarriage

Threatened
Inevitable
Incomplete
Complete
Septic
Missed

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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

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What are the features of an inevitable miscarriage

Heavy bleeding
Foetus MAY be alive
Os open
Crampy pelvic pain
Miscarriage about to occur

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What are the features of an incomplete miscarriage

Only some foetal parts have been passed
Os open
PV bleeding continues

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What are the features of a complete miscarriage

All foetal tissues passed
Bleeding has dimished/ stopped
Uterus no longer enlarged
Os is clsoed

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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

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What are the features of a septic miscarriage

Contents of the uterus is infected causing endometritis
Offensive vaginal loss
Tender uterus

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How do serum bHCG levels change is pregnancy is progressing normally

Normally increases by 66% in 48 hour with viable pregnancy

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How to manage an expectant miscarriage

Wait for spontaneous resolutions

Resus and syntocinon/ ergometrine if blood loss is substantial

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How is foetal tissue removed

Using prostaglandins

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Define recurrent miscarriage

Three or more consecutive miscarriages

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Name some causes of recurrent miscarriage

Autoimmune disease
Chromosomal defect
Hormonal factors
Anatomical factors
Infection

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What is cervical incompetence

Cervix fails to retain the pregnancy

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Define ectopic pregnancy

Embryo that implants outside the uterine cavity

What % of women who have had an ectopic pregnancy have a succesful pregnancy subsequently

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