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Y3 - Repro > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

What are causes of maternal collapse?

A

Massive haemorrhage
Cardiac problems
Pulmonary and amniotic fluid embolism
Drug reaction
Trauma

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2
Q

What is maternal collapse?

A

An acute event involving cardiorespiratory systems and/or brain resulting in reduced or absent conscious level at any stage in pregnancy and up to 6 weeks after delivery

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3
Q

What is the most common cause of maternal collapse?

A

Massive haemorrhage

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4
Q

What is an amniotic fluid embolism?

A

Amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse

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5
Q

What is the prognosis of amniotic fluid embolism?

A

Dangerous - often fatal

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6
Q

What is the presentation amniotic fluid embolism?

A

Acute hypotension
Respiratory distress
Acute hypoxia
Seizure
Cardiac arrest

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7
Q

When can amniotic fluid embolism present?

A

During labour, delivery, or within 30 mins of delivery

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8
Q

What is the pathophysiology of amniotic fluid embolism?

A

Amniotic fluid enters maternal circulation
This triggers a syndrome similar to that seen in anaphylaxis and septic shock
Pulmonary distress develops due to vascular occlusion - by debris or vasoconstriction
This can resolve, LV dysfunction or failure results
After the initial event, disseminated intravascular coagulation develops, resulting in massive postpartum haemorrhage

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9
Q

What is the management of amniotic fluid embolism?

A

Immediate specialist assistance
Supportive in ITU

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10
Q

What are cardiac causes of maternal collapse?

A

MI
Aortic root dissection
Cardiomyopathy

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11
Q

What is the presentation of aortic root dissection

A

Central chest or inter scapular pain
Wide pulse pressure

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12
Q

What is the cause of aortic root dissection in pregnancy?

A

Mainly secondary to systolic hypertension

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13
Q

How concerning are new cardiac murmurs in pregnancy?

A

Physiological systolic murmurs are common in pregnancy
But any new cardiac murmur needs referral to cardiologist with imaging
Most often these are ejection systolic murmurs caused by increased blood flow, tend to be grade 1 or 2 and don’t radiate

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14
Q

What are the most common causative organs of sepsis in pregnancy?

A

Group A, B, D streptococcus
Pneumococcus
E coli

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15
Q

Should you be concerned about sepsis in the absence of pyrexia and raised WCC?

A

Yes - bacteraemia can still be present and can progress rapidly to septic shock and collapse - high index of suspicion

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16
Q

What are the most common causes of drug toxicity causing collapse in obstetrics?

A

Magnesium sulphate (in the presence of renal impairment)
Local anaesthetic agents injected IV by accident

17
Q

What is the presentation of drug toxicity causing collapse in pregnancy?

A

Drowsiness, light-headedness
Sedation
Circumoral paraesthesia (around the mouth)
Twitching and convulsion

18
Q

What is the pathophysiology of anaphylaxis causing collapse in pregnancy?

A

Significant intravascular volume redistribution leads to decreased cardiac output
Acute ventricular failure and myocardial ischaemia
Upper airway occlusion secondary to angio-oedema, bronchospasm and mucous plugging of smaller airways contribute to hypoxia and ventilation difficulties

19
Q

What its the positional management of maternal collapse, and why is it done?

A

Left tilt, or manual displacement of the uterus
To avoid aortocaval compression
Iff the uterus compresses the IVC the volume of blood returning to the heart will be lower as will cardiac output - CPR will be less effective

20
Q

What is the protocol for maternal collapse if cardiac output is not restored after 3 mins of CPR in a women who is still pregnant?

A

The foetus should be delivered by C-section - will improve the effectiveness of maternal resuscitation efforts and may save the baby

21
Q

What is the definition of gestational hypertension

A

Systolic BP >140mmHg or diastolic >90mmHg
Increase above booking readings of >30mmHg systolic, or >15mmHg diastolic
No proteinuria or oedema

22
Q

What is pre-eclampsia?

A

Pregnancy induced hypertension + proteinuria
Seen after 20 weeks gestation

23
Q

What does ore-eclampsia increase the risk of?

A

Fetal prematurity and intrauterine growth retardation
Eclampsia
Haemorrhage due to placental abruption
Cardiac failure
Stroke
VTE
DIC, HELLP
Pulmonary oedema
Multi-organ failure

24
Q

What are risks factors for pre-eclampsia?

A

Hypertensive disorder in prev pregnancy, chronic hypertension
CKD
Autoimmune disease
T1 or T2 diabetes
Multiple pregnancy
Age 40+
Pregnancy interval of 10 years +
BMI 35+ at first visit
Family history of pre-eclampsia

25
Q

What are clinical features of severe pre-eclampsia?

A

HTN - >170/100mmHg
Proteinuria
Headache (cerebral oedema)
Papilloedema
RUQ or epigastric pain
Sudden onset oedema
Hyper-reflexia, clonus
Platelets <100, abnormal liver enzymes, HELLP

26
Q

What is the character of the seizures in eclampsia?

A

Tonic clonic

27
Q

How is pre-existing hypertension managed in pregnancy?

A

Switch from any pre-existing anti-hypertensives to:
Labetalol
Nifedipine
Methyldopa

28
Q

What is the management of pregnancy-induced hypertension?

A

Labetalol
Nifedipine
Methyldopa
Hydralazine

29
Q

What is the management of pre-eclampsia?

A

Antihypertensives as before
IV magnesium sulphate if severe - to reduce chance of eclampsia
Definitive treatment is delivery of baby
IM steroids (metamethasone or dexamethasone) to encourage fetal lung maturation if gestation <34 week (<38 weeks if plan to deliver by C/S)

30
Q

Which risks does giving IM steroids before delivery reduce?

A

Neonatal death
Intraventricular haemorrhage
Necrotising enterocolitis
Intensive care admission and need for respiratory effort
Systemic infections

31
Q

What is the management of eclampsia?

A

IV magnesium sulphate
Urgent delivery by fastest method - usually C/S

32
Q

What is the management for prevention of pre-eclampsia, and who is it given to?

A

For women with history of pre-eclampsia or risk factors
Low dose aspirin started at 12 weeks gestation
Increased surveillance for signs and symptoms and regular growth scans

Y3 - Repro (13 decks)

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