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HD2 > Placental Problems in Pregnancy > Flashcards

Placental Problems in Pregnancy Flashcards

1
Q

What are the stages of pregnancy?

A

Antepartum
Intrapartum (in labour)
Postpartum (delivery of fetus up to 6 weeks later)

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2
Q

How long is antepartum?

A

24 weeks
< 24 weeks = early pregnancy
> 24 weeks = late pregnancy

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3
Q

What is hyperemesis Gravidarum?

A
  • poorly understood

- hCG effects

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4
Q

What are the symptoms of hyperemesis Gravidarum?

A
  • severe nausea/vomiting
  • electrolyte imbalance
  • weight loss
  • hospital admission
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5
Q

What usually happens when there is bleeding in pregnancy?

A
  • 50% will settle

- 50% miscarry, ectopic, gestational trophoblastic disease

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6
Q

What is the definition of a spontaneous miscarriage?

A

Fetus dies/delivers dead < 24 weeks

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7
Q

What are the types of miscarriage?

A
  • threatened
  • inevitable
  • incomplete
  • complete
  • septic
  • missed
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8
Q

What is threatened miscarriage?

A
  • light/painless bleeding from vagina
  • fetus alive
  • cervical os closed
  • 25% go on to miscarry
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9
Q

What is an inevitable miscarriage?

A
  • bleeding heavier than threatened
  • fetus may be alive
  • cervical os open
  • miscarriage about to occur
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10
Q

What is an incomplete miscarriage?

A
  • only some fetal parts passed
  • cervical os open
  • PV bleeding continues
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11
Q

What is a complete miscarriage?

A
  • all fetal tissue passed
  • bleeding diminished
  • uterus no longer enlarged
  • cervical os closed
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12
Q

What is a septic miscarriage?

A
  • uterus contents infected = endometritis
  • tender uterus
  • fever may be absent
  • may progress to pelvic infection
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13
Q

What is a missed miscarriage?

A
  • fetus not developed and died in utero

- cervical os closed

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14
Q

What investigations do you do in a miscarriage?

A
  • US scan (location/viability, restrained fetal tissue)
  • serum bHCG (increases >66% in 48hrs if pregnancy viable)
  • bloods (FBC and Rhesus)
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15
Q

How do you manage a miscarriage when it is expectant?

A
  • wait for spontaneous resolution

- resuscitation if substantial blood loss

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16
Q

How do you medically manage a miscarriage?

A
  • removal of fetal tissue

- use PG

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17
Q

How do you surgically manage a miscarriage?

A

Curettage

- scraping instrument/surgical aspiration

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18
Q

What is a recurrent miscarriage?

A

3 or more consecutive

in 1% of couples

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19
Q

What are the causes of miscarriage?

A
  • autoimmune disease
  • chromosomal defects
  • hormonal factors
  • anatomic factors
  • infection
  • others - obesity, smoking, maternal age, drug abuse
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20
Q

How do you investigate causes of recurrent miscarriage?

A

Autoimmune and thrombophilia screen

Karyotyping (parents and products of conception)

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21
Q

How do you manage recurrent miscarriages?

A

Depends on cause:

  • anticoagulation therapy
  • genetic counselling
  • metformin
  • cervical cerclage
22
Q

What is an ectopic pregnancy?

A

Implantation of fertilised ovum outside endometrial cavity

- 70% of women have successful pregnancy if ectopic

23
Q

What are the risk factors of EP?

A 
STIs
Emergency Contraception
Assisted conception
Pelvic surgery
Failed sterilisation
24
Q

What is the clinical presentation of EP?

A
  • women of reproductive age with PV bleeding
  • lower abdominal pain
  • collapse
  • amenorrhoea (4-10 weeks)
  • tachycardia
  • uterus smaller than expected gestation
  • cervical os closed
25
Q

How is EP investigated?

A
  • uterine bHCG (confirms pregnancy)
  • trans-vaginal USS (allows visualisation)
  • quantitative spectrum (bHCG if uterus is empty)
  • diagnostic laparoscopy
26
Q

How is EP managed if there is acute presentation?

A
  • patient haemodynamically unstable:
  • urgent laparotomy
  • salpingectomy (removal of fallopian tube)
27
Q

How is EP managed if there is subacute presentation?

A
  • surgical (laparoscopy and salpingectomy)
  • medical
  • conservative
28
Q

What is molar pregnancy/gestational trophoblastic disease?

A
  • trophoblastic tissue forms part of blastocyst proliferates more aggressively than normal
  • hydatiform mole or partial hydatiform
29
Q

What is a hydatiform mole?

A

No fetus
Only placenta forms
Cells diploid but all chromosomes derived from father

30
Q

What is a partial hydatiform?

A

Some evidence of embryonic development can be found

31
Q

What are the clinical features of molar pregnancy?

A
  • PV bleeding
  • Excess hCG production as secreted by syncytiotrophoblast
  • passage of vesicles per vaginum
32
Q

How does molar pregnancy present?

A
  • large uterus

- early pre-eclampsia and hyperthyroidism

33
Q

How is molar pregnancy investigated?

A
  • ultrasound = snowstorm appearance
34
Q

How is molar pregnancy managed?

A
  • tissue histology analysis
  • serial bHCG levels
  • pregnancy/COCP avoided until bHCG normal
35
Q

What are the causes of bleeding in early pregnancy?

A
  • spontaneous miscarriage
  • recurrent miscarriage
  • ectopic pregnancy
  • molar pregnancy
36
Q

What are the causes of bleeding in late pregnancy?

A
  • placental abruption
  • placenta praevia
  • hypertension in pregnancy
  • multiple pregnancy
37
Q

How does bleeding in late pregnancy present?

A

> 24 weeks gestation but before delivery

38
Q

What is placental abruption?

A

Painful vaginal bleeding normally sites placenta due to placenta partially/completely separating from uterus before baby is born

39
Q

What are the risk factors of placental abruption?

A

Trauma, smoking, malnutrition, previous abruption, idiopathic

40
Q

What are the clinical features of placental abruption?

A

Intense constant abdominal pain

  • with or without vaginal bleeding
  • tense, tender uterus
  • fetal parts not easily felt
  • fetal heart weak/absent
41
Q

What is placenta praevia?

A
  • placenta inserted into lower segment of uterus after 24 weeks
  • can block cervix
42
Q

What is placenta praevia associated with?

A

Twin pregnancies
Multiparous women
Older mothers
Scarring of uterus

43
Q

What is the difference between major and minor placenta praevia?

A

Major covers os minor does not

44
Q

What are the clinical features of PP?

A
  • painless vaginal bleeding
  • all/part of placenta lies lower than fetal presenting part
  • uterus soft and non-tender
45
Q

What are the complications of PP?

A
  • C section necessary as obstructed womb
  • malpresentation of baby
  • postpartum haemorrhage as lower part less able to constrict
46
Q

How is PP examined?

A

Cannot do vaginal exam!

47
Q

What is pre-eclampsia?

A

Hypertension in pregnancy

48
Q

How does pre-eclampsia present?

A
  • maternal hypertension
  • renal impairment = proteinuria
  • fluid retention = oedema
  • weight gain
49
Q

What causes pre-eclampsia?

A

abnormal maternal adaptation to trophoblasts and formation of placental blood vessels

50
Q

How is pre-eclampsia managed?

A
  • antihypertensives

- anticonvulsants

51
Q

What is twin to twin transfusion?

A

Disproportionate blood supply

  • affects monochorionic multiples
  • laser treatment
  • all complications more common

HD2 (22 decks)

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