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Human Development 2 > Placental problems in Pregnancy > Flashcards

Placental problems in Pregnancy Flashcards

1
Q

what does antepartum mean

A

occurring not long before childbirth.

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2
Q

what are the weak defining early and late antepartum

A
  • Early<24 weeks

- Late>24 weeks

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3
Q

what does intrapartum mean

A

In labour- first and second stages

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4
Q

what does postpartum mean

A

From delivery of the fetus until 6 weeks later

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5
Q

what happens in the 3rd stage of labour

A
  • placenta has been exepelled
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6
Q

what is hypermesis agravidarum

A

this is severe nausea and vomiting

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7
Q

how many women are affected by nausea and vomiting in pregnancy

A

affects 70-80% of women in early pregnancy

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8
Q

what can happen in severe hyeremesis gravidarium

A

Electrolyte imbalance
Weight loss
Hospital admission

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9
Q

what do people with hyperemesis gravidarium tend to have

A
  • High amounts of beta HCG

- high placenta weight

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10
Q

what is thought to cause hyperemesis gravidarium

A

bHCG: Stimulating affects in upper GI tract

Reduced stomach motility and gastric emptying

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11
Q

How do you manage hyperemsis gravidarium

A
  • correction of dehydration and electrolyte imbalance
  • prophylaxis against complications
  • provision of symptom release

admit if

  • symptoms severe despite 24 hours of medication
  • evidence of dehydration and ketosis
  • coexisting conditions such as diabetes
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12
Q

what percentage does bleeding effect pregnancies

A
  • complicates 25% of all pregnancies
  • 50% will settle
  • 50% will miscarry, ectopic, trophoblastic disease or have problems in late pregnancy
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13
Q

what is the definition of a spontaneous miscarriage

A

Fetus dies or delivers dead < 24 weeks

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14
Q

when do the majority of spontaneous miscarriages occur

A

Majority < 12 weeks

- more common in older women

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15
Q

why do spontaneous miscarriages tend to occur

A

20-30% of all pregnancies

60% due to chromosomal abnormalities

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16
Q

what does not cause miscarriage

A

Exercise, intercourse, emotional trauma

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17
Q

what are the 6 types of miscarriage

A 
Threatened 
Inevitable
Incomplete
Complete
Septic
Missed
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18
Q

What is a threatened miscarriage

A

light/painless bleeding from vagina (PV).
 Fetus is alive, cervical os is closed.
o 25% will go on to miscarry.

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19
Q

what is an inevitable miscarriage

A

bleeding heavier vs threatened.
 Fetus may be alive at this point, cervical os is open.
o (!) Miscarriage about to occur.

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20
Q

what is an incomplete misccarige

A

only some of the fetal parts have passed.
 Cervical os is open.
 PV bleeding continues.

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21
Q

what is a complete miscarriage

A

All fetal tissues have been passed.
 Bleeding has diminished stopped.
 Uterus no longer enlarged, cervical os is closed.

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22
Q

What is a septic miscarriage

A

contents of uterus infected = endometritis or chorioamnionitis.
 Tender uterus, fever may be absent.
 May progress to pelvic infection.

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23
Q

What is an missed misccarige

A

Fetus has not developed and died in utero.

o Cervical os is closed.

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24
Q

what are the symptoms of a septic miscarriage

A
  • Contents of uterus infected causing endometritis
  • Vaginal loss offensive
  • Tender uterus
  • May be present with sings of pelvic infection
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25
Q

what are the investigations that you do in a miscarriage

A

Ultrasound scan
- Detects the location and viability – may show retained tissue, if any doubt repeat scan after 1 week (NICE)

Serum B HCG
- Increases in greater than 66% in 48 jrs in viable pregnancy

Other bloods

  • FBC
  • G+ S
  • Rhesus status - give Anti D to rhesus negative women
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26
Q

How do you manage a miscarriage

A

Expectant
 Wait for spontaneous resolution
o Resuscitation if blood loss is substantial

Medical Management
 Removal of fetal tissue (using prostaglandins such as misoprostol).

Surgical Management
 Curettage (scraping instrument)/surgical aspiration.= this can cause scarring of the womb which will cause fertility problems
= done under ultrasound guidance

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27
Q

what is recurrent miscarriage

A

3 or more consecutive miscarriages

Affects 1% of couples

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28
Q

What are the causes of a recurrent miscarriage

A
  • problems in the uterine cavity e.g. large fibroids
     Autoimmune disease (e.g. anti-phospholipid syndrome): 25%.
     Chromosomal defects (4%).
     Hormonal factors
     Infection.
     Others (obesity, smoking, maternal age, drug abuse.
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29
Q

How do you investigate a recurrent miscarriage

A

Autoimmune + thrombophilia screen

Karyotyping(of maternal and paternal causes)

Pelvic US scan

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30
Q

How do you manage a recurrent miscarriage

A

 Depends on cause (anticoagulation theraphy, genetic counselling, metformin, cervical cerclage etc..).

31
Q

what is cervical incompetence a cause of

A
  • it is a cause of mid-trimester miscarriage
32
Q

what is cervical incompetence

A
  • this is when the cervix opens up too early and the foetus has passed
  • scan now looks at people who are high risk or have had a pre-term and trimester
  • can put a stitch in the cervix
33
Q

what two stitches can you put in the cervix in cervical incompetence

A
  • abdominal cerclage
  • Vaginal cerclage
  • Vaginal one can be snipped out and then there can be a vaginal birth whereas the abdominal one the baby has to be born by C section
34
Q

What is an ectopic pregnancy

A

 Implantation of the fertilised ovum outside the endometrial cavity.

35
Q

What are the risk factors for an ectopic pregnancy

A
  • Smoking
  • Scarring in womb and previous structures
  • Previous ectopic – 10-15% chance that you will have another
  • STIs
  • Emergency contraction
  • IVF
  • Pelvic surgery
  • IUCD in situ
36
Q

what are ectopics commonly found

A

Fallopian tube

- can be in the ampulla or isthmus or interstitial(junction between the tube and endometrial cavity

37
Q

How do women present with ectopic pregnancies

A
  • Women of reproductive age
  • Positive pregnancy test/ Amenorrhoea 4-10 weeks
  • PV bleeding
  • Low abdo pain
  • Collapse +/- shoulder tip pain
38
Q

What would you find on examination of a ectopic pregnancy

A

 Tachycardia, abdominal tenderness.
 Uterus is smaller than expected gestation
 Cervical os is closed.

39
Q

How do you investigate an ectopic pregnancy

A

 Uterine bHCG: confirms pregnancy
 Trans-vaginal USS: allows visualisation.
 Quantitative spectrum: bHCG if the uterus is empty.
 Diagnostic Laparoscopy

40
Q

How do you manage an ectopic pregnancy

A

Acute Presentation: if patient is haemodynamically unstable; urgent laparotomy and salpingectomy (removal
of the fallopian tube).

Subacute Presentation: various ways of treatment:
 Surgical: laparoscopy and salpingectomy/salpingectomy.
 Medical
 Conservative

41
Q

What is gestational trophoblastic disease

A

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

42
Q

who is gestational trophoblastic disease common in

A

More common at extremes of reproductive age

Twice as common in Asian women than Caucasian women

43
Q

what are the types of gestational trophoblastic disease

A

complete molar pregnancy

partial molar pregnancy

44
Q

What happens in a complete molar pregnancy

A

Hydatidiform mole: no fetus, only the placenta forms.
 Cell are diploid but all chromosomes are derived from the father. ( no maternal chromosomes)
- sperm from the father fertilises an empty egg
 5-10% will turn malignant
- excessive amounts of bHCG can be produced .

45
Q

what do you manage the complete molar pregnancy

A
  • surgery to remove the molar tissue
  • 15% of molar tissue remains in the deeper tissue of the body and this can result in a gestational tumour
  • need to have chemotherapy to get rid of it
46
Q

what is a partial molar pregnancy

A
  • some foetal tissue might be seen within the molar tissue
  • ## two sperm fertilise the egg at the same time therefore there is one set of chromosomes from the mother and two from the father
47
Q

How do you manage a partial molar pregnancy

A
  • surgery to remove the molar tissue
  • only 1% will have abnormal cells remaining in the deep tissue and have a persistent gestational tumour - this will need to have chemotherapy to get rid of it
48
Q

What are the clinical features of a molar pregnancy

A

 PV Bleeding
 HG (excess HCG production)
o HCG secreted by syncytiotrophoblast.
 Passage of vesicles per vaginum.

49
Q

How would you investigate a molar pregnancy

A

Investigations

 Ultrasound: snowstorm appearance.

50
Q

What would you see on examination of a molar pregnancy

A

Examination
 Large uterus
 Early pre-eclampsia and hyperthyroidism may occur.

51
Q

How else do you manage a molar pregnancy

A

ERCP + tissue for histology

Serial HCG: To detect persistent disease

Avoid pregnancy until HCG levels 0: otherwise increase need for chemotherapy

52
Q

what is an antepartum haemorrhage

A

This is bleeding from the genital tract at >24 weeks gestation

53
Q

what are the causes of an antepartum haemorrhage

A 
Placenta abruption
Placental praevia
Incidental genital tract pathology
Uterine rupture
Vasa praevia
54
Q

What is placental abruption

A
  • painful vaginal bleed from a normally sited placenta due to placenta partially/completely from the uterus before the baby is born
  • can be concealed, revealed or mixed
55
Q

what are the risk factors for placenta abruption

A
  • Prev abruption,
  • ↑ BP, Trauma
  • Smoking
  • idiopathic
  • Multiparity
  • ECV
  • Polyhydramnios
56
Q

Why are the clinical features of placental abruption

A
  • Intense constant abdo pain
  • +/- PV bleeding
  • Shock, Oliguria, DIC
  • Tense ‘woody’ uterus
  • Fetal heart rate weak or absent
57
Q

what is the management of a placental abruption

A
  • deliver the baby
  • Stabilise mother first
  • Admit and resuscitate
  • Steroids in <39 weeks if time permits
  • Anti D + Kleihauer
  • Fetal distress: Urgent LSCS
  • Dead baby: Coagulopathy likely, IOL when safe
  • Conservative: If not fetal or maternal distress. Steroids and observe
58
Q

what is a placenta praaevia

A

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

59
Q

what are the two different types of a placenta praaevia and what is the difference between them

A

Major PP: covers the os

Minor PP: does not cover the os. (less than 2cm from the internal os)

60
Q

what are the risk factors of a placenta praevai

A

Prior praevia

Multiparity

Multiple pregnancy

Advanced maternal age

Prev LSCS

Smoking

61
Q

what are the clinical signs of a placenta praevia

A
  • Painless vaginal bleeding: usually between 32-37 weeks
  • Uterus soft and non tender
  • Malpresentation is common
  • Requires c section delivery
  • May result in pre-term delivery
62
Q

what do you not do in a placenta praaevia

A

no vagial examination

63
Q

What is a placenta acreta

A

this is when the placenta Does not attach to the endometrium and goes further in for example to the myometrium

64
Q

what is the management of the placenta acreta

A

Admit if bleeding

  • IV Line, x match 4-6 units blood
  • Anti D if rhesus negative
  • If mother and baby stable, manage expectantly
  • Consider antenatal steroids
  • If maternal/fetal compromise/ >37 weeks: EMCS
  • Consider Caesarean hysterectomy
65
Q

What is pre-eclampsia

A

Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys

66
Q

what is pre-eclampsia due to

A

• Due to abnormal maternal adaptation to trophoblasts and formation of placental blood vessels.

67
Q

what is pre-eclamspia characterised by

A
  • Maternal hypertension.
  • Renal impairment; causing proteinuria.
  • Fluid retention; oedema.
  • Weight gain.
68
Q

What are the risk factors for pre-eclampsia

A
  • age
  • previous
  • diabetes
  • obesity
  • hypertension
  • autoimmune diseases
  • sickle cell disease
  • high age gap between pregnancies e.g. not having a pregnancy for 10 years

placental abnormalities

  • hypoxia
  • ischemia repercussion injury
  • damage to the placental vili
69
Q

what are the signs and symptoms of pre eclampsia

A
  • Headaches
  • Seeing spots
  • Stomach pain
  • Feeling nausea and throwing up
70
Q

How do you manage pre-eclampsia

A

Aim Bp<135/85

Monitor fetal growth

Anti-hypertensives + anti-convulsants

Timely delivery

71
Q

what causes monozygotic twins versus what causes dizygotic twins

A

Monozygotic: chance event

Dizygotic: Racial predisposition, IVF, Parity >5, Older ages

72
Q

when does twin to twin transfusion happen

A

Only in mono-chorionic pregnancies

16-24 weeks most common

Discrepant growth and liquor volume

73
Q

how do you treat twin to twin transfusion

A

have laser treatment that is used to ablate anastomosing vessels
- has a 70% survival

Human Development 2 (34 decks)

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