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Pregnancy Complications Flashcards

1
Q

What is an ectopic pregnancy?

A

Pregnancy implanted outside of the uterine cavity, most commonly the fallopian tube.

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2
Q

What is the presentation of an ectopic pregnancy?

A

Vaginal bleeding, abdo pain, GI or urinary symptoms. Period of ammenorhoea (they need to be pregnant in the first place.

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3
Q

What does an ultrasound scan show in ectopic pregnancy?

A

No intrauterine gestational sac, may see adrenal mass, fluid in pounch of douglas. Expanded fallopian tube on one side.

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4
Q

How is an ectopic pregnancy treated?

A

Methotrexate. Surgical: mostly laparascopy, salpingectomy, salpingotomy for few.

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5
Q

What is the common pathology causing a molar pregnancy?

A

2 sperm fertilising one egg with no chromosomes. Result in imbalance in methylated (switched off) genes. 2 lots of Dad’s genes with Dad’s changes casues placental overgrowth. Trophoblast cells proliferate becasue they have too many of Dad’s methylated genes. No fetal growth. Can rarely give rise to malignant choriocarcinoma.

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6
Q

What is seen on ultrasound of a molar pregnancy?

A

Uterine cavity shows some placental tissue but no fetus, fallopian tubes normal.

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7
Q

How does a molar pregnancy present?

A

Minor bleed in early pregancy

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8
Q

What is the treatment of molar pregnancy?

A

If BhCG returns to normal, no further treatment. If BhCG stays high, cure by methotrexate.

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9
Q

Why do mothers with gestational diabetes produce larger babies?

A

Effects of too much glucose in the mother. Glucose crosses the placenta and raises the babies blood glucose. Insulin goes up in the baby. Baby cannot reduce its glucose as mum keeps sending more across the placenta. Susceptibility to intruterine death

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10
Q

What are the risk factors for gestational diabete mellitus?

A

Increased BMI >30
Previous macrosomic baby >4.5kg
Previous GDM
Family history of diabetes
Women from high risk groups for developing diabetes
Polyhydramnios
Recurrent glycosuria in current pregnancy

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11
Q

What is the pathology in acute chorioamnionitis?

A

Acute inflammation: neutrophils present in membranes (chorioamnionitis), cord, and fetal plate of placenta. Ascending infection: bacteria are typically perineal or perianal flora which ascend vagina and get into amniotic sac.
Infection of fluid surrounding the baby

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12
Q

How can acute chorioamnionitis present in the baby?

A

Intrauterine death
Ill in first days of life: neonatal unit
Cerebral palsy later in life

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13
Q

What is an overtwisted cord?

A

Common cause of intruterine death and neonatal illness. Caused by normal, active baby moving and twisitng round its own cord. Results in poor blood flow to and from the baby.

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14
Q

What is a placental abruption ?

A

Haemorrhage resulting from premature separation of the placenta from uterus with a collection of blood (a haematogenous) behind placenta before the birth of the baby. Incidence: 0.6% of all pregnancies. Results in hypoxia in the baby. Any separation of placenta from the uterine wall decreases baby’s supply of oxygem from mother.

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15
Q

What are the causes of placental abruption?

A

Hypertension

Trauma

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16
Q

How does a placental abruption present?

A

Bleeding per vagina. Pain. Increased uterine activity. Haematoma.

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17
Q

What factors are associated with placental abruption?

A 
Pre-eclampsia/ chronic hypertenison 
Multiple pregnancy 
Polyhydramios 
Smoking, increasing age, parity 
Previous abruption 
Cocaine use
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18
Q

What are the clinical subtypes of placental abruption?

A

Revealed: blood seen
Concealed: internal bleeding
Mixed: concelaed and revealed

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19
Q

What are the complications of placental abruption?

A

Maternal shock, collpase
Fetal distress then death
Maternal DIC, renal failure
Postpartum haemorrhage

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20
Q

What is a threatened miscarriage?

A
  • Vaginal bleeding +/- pain
  • Viable pregnancy
  • Closed cervix on speculum examination
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21
Q

What is an Inevitable miscarriage?

A
  • Non- Viable pregnancy
  • Open cervix with bleeding that could be heavy (+/- clots)
  • Pregnancy tissue remains in the uterus
  • Pregnancy will proceed to complete it incomplete
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22
Q

What is a missed miscarriage?

A

No symptoms, or could have bleeding/ brown loss vaginally

Gestational sac seen on scan

No clear fetus or a fetal pole with no fetal heart seen in the gestational sac

Fetus has died but uterus has made no attempt to expel the pregnancy tissue

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23
Q

What is an incomplete miscarriage?

A

Most of the pregnancy is expelled out, some products of pregnacy remianing in the uterus
Open cervix, vaginal bleeding (may be heavy)

24
Q

What is a complete miscarriage?

A

Passed all POC, cervix closed and bleeding has stopped

25
Q

What is a septic miscariage?

A

Associated with infection. Especially in cases of an incomplete miscarriage.

26
Q

What are the causes of antepartum haemorhhage?

A 
Placenta praevia
placental abruption
APH of unknown origin
local lesion of the genital tract
vasa praevia
27
Q

What is antepartum haemorrhage?

A

Haemorrhage from the genital tract after the 24th week of pregnancy but before delivery of the baby.

28
Q

What is placental praevia?

A

All or part of the placenta implants in the lower uterine segment.

29
Q

When is placenta praevia more common?

A

Multiparous women
Multiple pregnancies
Previous caesarean section

30
Q

How does placenta praevia present?

A

Painless PV bleeding. Malpresentation of fetus. Incidental finding. Maternal condition correlates with amount of PV bleeding. Soft tender uterus +/- fetal malpresentation

31
Q

What must not be done in suspected placenta praevia?

A

Vaginal examination

32
Q

What is the classification of placenta praevia?

A

Grade I Placenta encroaching on the lower segment
but not the internal cervical os
• Grade II Placenta reaches the internal os
• Grade III Placenta eccentrically covers the os
• Grade IV Central placenta praevia

33
Q

What may happen after birth in placenta praevia?

A

Post partum haemorrhage

34
Q

What is considered a preterm labour?

A

Onset of labour before 37 completed weeks gestation

35
Q

What are the predisposing factors for a preterm labour?

A 
Multiple pregnancy 
Polyhydramnios
APH
Pre-eclampsia 
Infection 
UTI
Prelabour premature rupture of membranes
36
Q

What conditions cause morbidity in premature neonates?

A

• respiratory distress syndrome • intraventricular haemorrhage • cerebral palsy • nutrition • temperature control • jaundice • infections • visual impairment • hearing loss

37
Q

What is pre-eclampsia?

A

Hypertensive disorder of pregnancy with multi organ involvement. Characterised by new onset hypertension, raised BP, proteinuria usually after 20 weeks gestation. Occurs as a result of cerebral oedema or cerebral haemorrhage.

38
Q

When can pre-eclampsia occur?

A

Can occur in antepartum, Intrapartum and postpartum periods.

39
Q

What is the maternal presentation of pre-eclampsia?

A

Headache, BP> 160 systolic, hyper reflexes, visual changes. Tonic colonic seizures. Proteinuria of more than 300mgms/ 24hrs. Protein: creatinine ratio > 30 mgms/mmol.

40
Q

What is the management of pre-eclampsia?

A

ABC approach. LFT, U&E, coagulation, FBC. Magnesium surface. Antihypertensives: labetolol, hydralazine. Steriods for fetal lung maturity if gestation <36wks. Aim for prompt delivery.

41
Q

What prophylaxis is given to decrease risk of pre-eclampsia in the next pregnancy?

A

low dose aspirin should be given from 12 wks

42
Q

What organs are involved in pre-eclampsia?

A 
Kidney
Liver
Vascular 
Brain 
Lungs
43
Q

What is eclampsia?

A

Severe complication of eclampsia

High BP results in seizures during pregnancy

44
Q

What are the risk factors for developing pre-eclampsia?

A 
First pregnancy 
Extremes of maternal age
Pre-eclampsia in previous pregnancy 
Pregnancy interval > 10 yrs
BMI >35
FH of Pre-eclampsia
Multiple pregnancy 
Underlying medical conditions:
- Chronic hypertension
- Pre-existing renal disease
- Pre-existing diabetes
- Autoimmune disorders: antiphospholipid antibodies, SLE
45
Q

What are the maternal complications of pre-eclmapsia?

A 
Eclampsia (seizures)
Severe hypertension 
Haemolysis,elevated liver enzymes, low platelets 
Disseminated intra vascular coagulation 
Renal failure 
Pulmonary oedema
46
Q

What are the fetal complications of pre-eclampsia?

A

Impaired placental perfusion> intrauterine growth restriction, prematurity, increased PN mortality

47
Q

What is the treamtent for seizures or impending seizures in eclmapsia?

A

Magnesium sulphate bolus + IV infusion
Control BP: IV labetolol, hydrallazine
Avoid fluid overload

48
Q

How common is pre-eclampsia?

A

5-8% of pregnant women

49
Q

What should a diabetic mother obtain before conception?

A

Before conception: better glycemic control, ideally blood sugars should be around 4-7 mmol/l andHbA1c< 6.5%. Folic acid 5mg before conception along with dietary advice and retinal and renal assessment.

50
Q

Why is there an increased risk of venous thrombo-embolism in pregnancy?

A

Pregnancy is a hypercoaguable state
Increase in fibrinogen, factor VII, VW factor, platelets
Decrease in natural anti-coagulants: antithrombin II
Decrease in fibrinolysis
Increase stasis: progesterone, effects of enlarging uterus
May be vasuclar damage at delivery/ section

51
Q

What is the presentation of thrombo-embolism in pregnancy?

A

Pain in calf, increased girht of affected leg, calf muscles tenderness, breathlessness, pain on breathing, cough, tachycardia, hypoxia, pleural rub etc.

52
Q

What can be the only sign of PE?

A

Unexplained Tachycardia

53
Q

What is a venous thromboembolism treated with in pregnancy?

A

Low molecular weight heparin

Prophylactic anticoagulation with 3 or more risk factors

54
Q

Why is warfarin not used in pregnancy ?

A

Teratogenic (can be used when breast feeding)

55
Q

What increases the risk of VTE in pregnancy?

A 
Older mothers, increasing parity
Incresaed BMI, smokers
IV drug users
PET
Dehydration
Decreased mobility 
Infections 
Operative delivery, prolonged labour
Heamorrhage, blood loss> 2l
Previous VTE
Sickle cell disease
56
Q

What investigations are used in venous-thromboembolism?

A

ECG
Blood gases
Doppler V/Q
Computed tomography pulmonery angiogram

57
Q

What should be checked in a pregnant woman with chicken pox?

A

Check immunity status by taking serum IgG
If IgG positive: immune
If IgG negative: non-immune

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