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HD 2 > Placental problems in pregnancy > Flashcards

Placental problems in pregnancy Flashcards

1
Q

What is early vs late antepartum

A

Early is before 24 weeks

Late is after

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2
Q

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

A

70-80%

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3
Q

What % of women are effected by hyperemesis gravidarum

A

0.3-2%

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4
Q

What does hyperemesis gravidarum refer to

A

Loss of 5% of body weight due to vomiting

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5
Q

What can can hyperemesis gravidarum lead to

A

Electrolyte imbalance
Weight loss
Hospital

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6
Q

How should hyperemesis gravidarum be managed

A
  • Give IV fluids
  • Replace lost potassium
  • Replace thiamine with pabrinex IV
  • Increase folic acids
  • Steroids to suppress nausea
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7
Q

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

A

Leads to encephalopathy

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8
Q

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

A

25%

50%

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9
Q

Define spontaneous miscarriage

A

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

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10
Q

What % of miscarriages are isolated, non recurring chromosomal abnormalities

A

60

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11
Q

Name 6 ways of categorising miscarriage

A
  • Threatened
  • Inevitable
  • Incomplete
  • Complete
  • Septic
  • Missed
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12
Q

What are the features of a threatened miscarriage

A 
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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13
Q

What are the features of an inevitable miscarriage

A 
Heavy bleeding
Foetus MAY be alive
Os open
Crampy pelvic pain
Miscarriage about to occur
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14
Q

What are the features of an incomplete miscarriage

A

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

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15
Q

What are the features of a complete miscarriage

A

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

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16
Q

What are the features of a missed miscarriage

A

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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17
Q

What are the features of a septic miscarriage

A

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

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18
Q

How do serum bHCG levels change is pregnancy is progressing normally

A

Normally increases by 66% in 48 hour with viable pregnancy

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19
Q

How to manage an expectant miscarriage

A

Wait for spontaneous resolutions

Resus and syntocinon/ ergometrine if blood loss is substantial

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20
Q

How is foetal tissue removed

A

Using prostaglandins

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21
Q

Define recurrent miscarriage

A

Three or more consecutive miscarriages

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22
Q

Name some causes of recurrent miscarriage

A
  • Autoimmune disease
  • Chromosomal defect
  • Hormonal factors
  • Anatomical factors
  • Infection
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23
Q

What is cervical incompetence

A

Cervix fails to retain the pregnancy

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24
Q

Define ectopic pregnancy

A

Embryo that implants outside the uterine cavity

25
Q

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

A

70

26
Q

Risk factors for ectopic pregnancy

A 
STI
Emergency contraception
Assisted conception
Pelvic surgery
Previous ectopic
27
Q

Describe the clinical presentation of ectopic pregnancy

A 
Women of reproductive age
PV bleeding
Lower abdo pain
Collapse (shoulder tip pain)
Amenorrhoea
28
Q

What is the purpose of a trans vaginal ultrasound in investigating ectopic pregnancy

A

Visualisation of intrauterine pregnancy/ adnexal mass free fluid in pouch of douglas

29
Q

If you can’t located foetus what 3 things can it suggest

A

Gestation <5 weeks
Complete miscarriage
Ectopic pregnancy

30
Q

How to manage acute presentations of ectopic pregnancy

A
  • IV access, cross match blood

- Uregent laparotomy is haemodynamically unstable

31
Q

Surgical treatment for subacute presentation of ectopic pregnancy

A

Laparoscopy and salpingectomy (removal of ectopic from tube)

32
Q

Medical treatment for sabacute presentation of ectopic pregnancy

A

Single dose methotrexate and keep checking bHCG levels

33
Q

Define gestational trophoblastic disease

A

When trophoblastic tissue that normally forms part of the blastocyst proliferates more aggresively than normal

34
Q

What is a partial mole

A

Foetal tissue is present

2 sperm fertilise an egg resulting in triploid conceptus with 69 chromosomes

35
Q

What is a complete mole

A

All chromosomes from father

No foetal tissue present

36
Q

Clinical features of gestational trophoblastic disease

A

PV bleeding
HG due to excess hcg production
Passage of vesicles per vaginum

37
Q

What can be seen when examining somebody with GTD

A

Uterus is often large

Early pre-eclampsia and hyperthyroidism

38
Q

What is placental abruption

A

The early separation of the placenta and the uterus

Painful vaginal bleeding

39
Q

Risk factors for placental abruption

A 
Multiparity
Polyhydramnios
Trauma
Smoking
Malnutrition
Previous abruption
Idiopathic
40
Q

Clinical features of placental abruption

A 
Intense constant abdo pain
Profound shock
Tense tender uterus
Foetal parts not easily felt
Foetal heart weak/ absent
41
Q

What is the purpose of ultrasound in placenta abruption

A

To check that it is not placenta plaevia

42
Q

When can steroids be given to mother with placental abruption

A

<34 weeks gestation

43
Q

What should be done is there is foetal distress in placental abruption

A

Urgent C section

44
Q

What should be done in mothers with placental abruption if there is not foetal distress and >37 weeks gestation

A

Induction of labour with amniotomy

45
Q

What should be done is baby has died due to placental abruption

A

Coagulopathy likely so give blood products and induce labour

46
Q

Conservative management for placental abruption

A

If no distress, preterm and minor degree of abruption… give steroids and monitor on ward

47
Q

Define placenta praevia

A

When the placenta is inserted into the lower segment of the uterus after 24 weeks

48
Q

What is placenta praevia associated with

A

Twins
Multiparous women
Older mothers
Uterus scarring

49
Q

Difference between minor and major placenta praevia

A

Major covers the os, minor doesn’t

50
Q

What complications are likely to occur with placenta praevia

A
  • Obstructs head enlargement
  • Malpresentation of baby
  • Postpartum haemorrhage
  • Pre term delivery
  • Increased incidence of IUGR
  • Placenta accrete
51
Q

What is placenta accreta

A

Placenta implants in previous c section scar which may present normal separation

52
Q

How is pre-eclampsia characterised

A 
Hypertension
Renal impairment
Proteinuria
Fluid retention
Oedema
Weight gain
53
Q

Risk factors for pre-eclampsia

A

Primigravidity
Genetic
Multiple pregnancy
Diabetes

54
Q

What happens in stage 1 of pre-eclampsia

A

Defective placental implantation
Placental ischaemia
Placental factors and systemic haemodynamic adaptation

55
Q

What happens in stage 2 of pre-eclampsia

A

Endothelial dysfunction
Reduced perfusion of affected organs
Clinical manifestation

56
Q

What are monochorionic/ monoamniotic twins

A

Share a placenta and a sac

57
Q

When should monochorionic/ monoamniotic twins be delivered

A

32 weeks because worry that cords will tangle

58
Q

What is twin to twin transufions

A

Vascular communications within the placenta of monochorionic twins
Discrepant growth- one twin gets more fluid and one gets none

HD 2 (26 decks)

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