Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

HD > Placental problems in pregnancy > Flashcards

Placental problems in pregnancy Flashcards

1
Q

Describe the different stages of pregnancy.

A

Antepartum: Early (<24 wks) and Late (>24 wks)
Intrapartum: in labour - 1st and 2nd stages
Postpartum: delivery of foetus + 6 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is hyperemesis gravidarum (HG)?

A

Severe, electrolyte imbalance, causing weight loss and requiring hospital admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is HG managed?

A

Dietary fluids
IV fluids (avoid dextrose)
Thiamine
Antiemetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is spontaneous miscarriage?

A

Foetus dies or delivers dead <24 weeks

majority of these occur <12 weeks, mother is usually older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What % of pregnancies miscarry? What is the biggest reason for this?

A

20-30%

60% of miscarriages are isolated, non-recurring chromosomal abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name the different types of miscarriages.

A
  1. Threatened
  2. Inevitable
  3. Incomplete
  4. Complete
  5. Missed
  6. Septic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the signs of threatened miscarriage, the state of the foetus and the state of the cervical os.

A

Signs: light and painless bleeding
Foetus: is still alive
Uterus size: expected from the dates
Cervical os: closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the signs of inevtiable miscarriage, the state of the foetus and the state of the cervical os.

A

Signs: heavy bleeding, pelvic pain
Foetus: may still be alive
Os: open
*Miscarriage is about to occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the signs of incomplete miscarriage, the state of the foetus and the state of the cervical os.

A

Signs: PV (vaginal) bleeding
Foetus: only some foetal parts have been passed
Os: open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the signs of complete miscarriage, the state of the foetus and the state of the cervical os.

A

Signs: PV bleeding diminished/stopped
Foetus: all foetal tissues have been passed
Uterus: no longer enlarged
Os: closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the signs of missed miscarriage, the state of the foetus and the state of the cervical os.

A

Signs: abdo pain and bleeding minimal
Foetus: has not developed or died in utero - only recognised when bleeding occurs as US performed
Uterus: smaller than expected
Os: closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the signs of septic miscarriage.

A

Signs: contents of uterus infected causing endometriosis may have fever
tender uterus
pelvic infection - abdo pain and peritonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What investigations are carried to out to determine whether a foetus has been/is about to be miscarried?

A

USS: detects location + viability; may show retained foetal tissue; if any doubt - repeat scan in 1 week
Serum bHCG: normally an increase >66% in 48 h with a VIABLE pregnancy
Bloods: FBC, Rhesus group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should a (potential) miscarriage be managed?

A

Expectant: wait for spontaneous resolution
Resuscitation + syntocinon/ergometrine if blood loss is substantial

Pharma: removal of foetal tissue via prostaglandins -(misoprostol)

Surgical: curettage or surgical aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is considered to be a recurrent miscarriage?

A

3+ consecutive miscarriages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the causes of recurrent miscarriages?

A

Autoimmune disease = antiphospholipid syndrome
Chromosomal defects in couple
Anatomical factors = uterine septa, cervical incompetence
Infection = bacterial vaginosis
Obesity, age, smoking, drug abuse

17
Q

What is an ectopic pregnancy? How common is it in the UK?

A

Embryo that implants outside the uterine cavity

1 in 60-100 pregnancies

18
Q

What are the risk factors for an ectopic pregnancy?

A 
STIs
PID
Emergency contraception
Pelvic surgery 
IUCD in situ
Failed sterilisation
Previous ectopic
Congenital abnormalities of tube
19
Q

What is the typical clinical presentation of a woman with an ectopic pregnancy?

A 
PV bleeding (scanty + dark)
Lower abdo pain (initially colicky, but becoming constant)
Collapse
Amenorrhea for 4-10 weeks (if pt does not know they are pregnant)
20
Q

What is usually found on examination of a woman with an ectopic pregnancy?

A 
tachycardia
abdo tenderness/rebound tenderness
cervical tenderness
adnexal tenderness
uterus smaller than expected 
cervical os is closed
21
Q

What investigation should be carried out if a woman is suspected of having an ectopic pregnancy?

A 
Urine bHCG (confirm pregnancy)
Transvaginal USS - allows visualisation of intrauterine pregnancy/adnexal mass/ free fluid in pouch of douglas
Quantitative serum (bHCG)
Diagnostic laparoscopy
22
Q

What are the management methods for an ectopic pregnancy?

A 
surgical = laparoscopy + salpingectomy/salpingotomy 
medical = single dose of methotrexate (IM - 50 mg/m2) + serial bHCG levels 
conservative = if small, unruptured ecptopic with reduced bHCG levels
23
Q

What is gestational trophoblastic disease (GTD)?

A

when the trophoblastic tissue that forms part of the blastocyst proliferates more aggressively than normal
(results in molar pregnancy)

24
Q

What is a hydatiform mole?

A

mother’s chromosomes are lost
only the paternal chromosomes will remain and duplicate (if monospermic fertilisation) or stay at 46 (if dispermic fertilisation)
Complete mole will just appear as chorionic villi and there will be no foetal tissue

25
Q

What is a partial mole?

A

1 egg + 2 sperm = 69 chromosomes

Some foetal tissue is present

26
Q

What are the clinical features of GTD?

A

PV bleeding
hyperemesis gravidarum
passage of vesicles per vaginum

27
Q

What will clinical examination and US of a woman with GTD show?

A

Clinical examination: uterus often large, early pre-eclampsia; hyperthryoidism
USS: snowstorm appearance

28
Q

How is a woman with GTD managed?

A

Evacuation of retained products of conception (ERPC) + send tissue for histology diagnosis
serial bHCG levels (persistent rising nHCG levels suggest malignancy)

29
Q

What is antepartum haemorrhage and what are the causes?

A

Bleeding from the genital tract >24 weeks but before delivery of baby
Common causes: undetermined origin, placental abruption, placental praevia
Rare causes: incidental genital tract pathology –> uterine rupture, vasa praevia

30
Q

What is placental abruption? What are the risk factors?

A 
Painful vaginal bleeding from a normally sited placenta 
Risk factors: multiparity 
PIH 
polyhydramnios
ECV
trauma 
smoking 
malnutrition
31
Q

What are the clinical features of placental abruption? What investigations should be carried out?

A

Clinical features: intense abdo pain, tense/tender uterus, foetal parts not easily felt
Investigations: FBC, urea, creatinine, coagulation screen, cross-match blood
USS to rule out placental praevia
CTG (cardiotocography)

32
Q

What is placental praevia? What are the S+S? What are the different types? What are the risk factors?

A 
= placenta is inserted into lower segment of uterus after 24 weeks
S+S:
- painless vaginal bleeding
- soft non-tender uterus 
Types:
- minor, not covering os
- minor, covering os
- major, not covering os
- major, covering os 
Risk factors:
- twin pregnancies
- multiparous 
- older mothers
- scarring of uterus
33
Q

What are the signs of pre-eclampsia? Why does it occur? What are the risk factors?

A

Signs: HTN, proteinuria, fluid retention, weight gain
Due to abnormal adaptation to trophoblasts
Risk factors: primigravidity, genetic, multiparous, diabetes

34
Q

How is hypertension managed?

A

Mainly: timely delivery of baby
Also: antihypertensives, anticonvulsants
4 hrly BP, daily urinalysis, FBCs, LFTs, CTG etc

35
Q

What is the chance of having twins/triplets/quadruplets?

A

Twin: 1 in 80
Triplets: 1 in 6400
Quadruplets: 1 in 512000

36
Q

What are the different types of twins (in terms of amniotic sac etc) and how do they arise?

A

Dichorionic/Diamniotic (cleavage of morula at days 1-3)
- either separate/fused placenta

Monochorionic/Diamniotic (cleavage of blastocyst at days 4-8)

Monochorionic/Monoamniotic (cleavage of implanted blastocyst at day 8-13)

Conjoined twins (cleavage of formed embryonic disc at days 13-15)

37
Q

What complications can arise with twins?

A

Congenital anomalies
IUGR
Polyhydramnios
Malpresentation
Miscarriage
Preterm labour
Twin to twin transfusion
- vascular communication within placenta (monochorionic pregnancies)
- majority occur 16-24 weeks
- discrepant growth and either oligo/polyhydramnios
- can try to treat with later (70% survival rate)

HD (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions