pregnancy complications Flashcards
what is miscarriage
spontaneous loss of pregnancy before 24 weeks gestation (15%)
list the types of miscarriage
threatened
inevitable
incomplete
complete
septic
missed
describe the types of miscarriage
threatened: viable pregnancy, vaginal bleeding +/- pain, closed cervix
inevitable: viable pregnancy, heavy bleeding +/- clots, open cervix
incomplete: most of pregnancy is expelled out, (heavy) bleeding, open cervix
complete: passed out all products of conception, bleeding stopped, closed cervix
septic:
missed: asymptomatic, brown discharge, no clear foetus (empty gestational sac) or foetal pole with no ♡
what is the aetiology of spontaneous miscarriage
maternal: uterine abnormality (fibroids), cervical weakness, increasing age, diabetes
conceptus: chromosomal, genetic or structural abnormality
unknown
what is the management of miscarriages?
expectant management:
medical management: misoprostol
surgical management:
what is an ectopic pregnancy?
pregnancy implanted outside the uterine cavity (~1%)
give examples of sites of miscarriage?
- ampulla of fallopian tube (most common)
- isthmus of fallopian tube
- interstium of fallopian tube
- ovary (rare)
what are the risk factors for ectopic pregnancy?
- pelvic inflammatory disease
- previous tubal surgery
- previous ectopic surgery
- assisted conception
how do ectopic pregnancies present?
- vaginal bleeding
- pain abdomen
- GI or urinary symptoms
how are ectopic pregnancies investigated?
scan
- no intrauterine gestational sac
- may see adnexal mass
- fluid in Pouch of Douglas
serum BHCG
- track levels over 48 hour intervals
- if normal early intrauterine pregnancy, HCG levels will increase by at least 66%
how are ectopic pregnancies managed?
- conservative
- medical: methotrexate
- surgical: laproscopy - salpingectomy or salpingotomy
what is an antepartum haemorrhage?
haemorrhage from the genital tract after the 24th week of pregnancy but before delivery of the baby
what are the causes of antepartum haemorrhage?
- placenta praevia
- placental abruption
- unknown origin
- local lesions of the genital tract
- vasa praevia (very rare)
what is placenta praevia
placenta implants in lower uterine segment
common in: multiparous women, multiple pregnancies, previous C section
what is the presentation of placenta praevia
- painless bleeding
- malpresentation of foetus
- soft, non tender uterus
diagnosis: ultrasound scan (incidental)
management: c section, watch for PPH
what are the classifications of placenta praevia?
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
what is the management of PPH ?
medical
- oxytocin
- ergometrine
- carboprost
- tranexemic acid
surgica
- balloon tamponade
- b lynch cutre
- ligation of the uterine and iliac vessels
- hyserterectomy
what is placental abruption?
haemorrhage resulting from premature separation of the placenta before the birth of the baby
what are the risk factors for placental abruption?
- pre-eclampsia/ chronic hypertension
- polyhydramnios
- smoking, increasing age, parity, cocaine use
- previous abruption
- multiple pregnancy
what is the presentation of placental abruption?
- painful bleeding (may be minimal)
- increased uterine activity
abruption can be:
- revealed (can see blood)
- concealed (bleeding inside so can’t see)
- mixed
what is the management of APH depend on?
either:
- expectant treatment
- vaginal delivery
- immediate Caesarean section
depends on:
- amount of bleeding
- general condition of mother and baby
- gestation
what are possible complications of placental abruption?
- maternal shock, collapse
- foetal distress & death
- maternal DIC, renal failure
- postpartum haemorrhage ‘couvelaire uterus’
what is preterm labour?
onset of labour before 37 completed weeks of gestation (259 days)
- 32-36 wks mildly preterm
- 28-32 wks very preterm
- 24-28 wks extremely preterm
spontaneous or induced
what are some predisposing factors for preterm labour?
- multiple pregnancy
- polyhydramnios
- APH
- pre-eclampsia
- infection eg UTI
- prelabour premature rupture of membranes
- idiopathic
how is preterm labour diagnosed?
- contractions with evidence of cervical change
- test: foetal fibronectin
consider possible cause: abruption, infection