Pregnancy complications Flashcards
What is eclampsia + how common is pre-eclampsia?
Seizures - usually following pre-eclampsia but can occur without HTN or proteinuria
10% pregnancies get pre-eclampsia
RF for pre-eclampsia
Nulliparity Chronic HTN Extremes of age Multiple pregnancy Assisted conception Obesity Pre-existing disease Molar pregnancy FHx pre-eclampsia Hx of placental abruption
HELLP syndrome - what is it, S+S, complications, management
Haemolysis, elevated liver enzymes + low platelets
Epigastric/ RUQ pain, N+V, HTN, dark urine DIC, liver failure may occur
Deliver + give magnesium sulphate
High dose steroids
Oxytocin to be used in 3rd stage (not Syntometrine as this increases BP)
Uterine rupture - S+S, risk factors, management, risk of rupture in VBAC + induction
Risk with multiparous women on uterine stimulants
S+S: fresh vaginal bleeding, haematuria, fetal distress, constant severe abdo pain
Immediate laparotomy to save baby
Risk of rupture is 0.3% if VBAC, 3% if induced
Uterine inversion - risk factors, S+S, management
Associated with grand multips + incorrect management of 3rd stage
Presents as vasovagal shock: pale, clammy, hypotensive, bradycardic
Mass at introitus
Manage with O’Sullivans method - reduce inversion by hydrostatic technique
VTE - when is it likely to occur?
Antepartum DVT more common than postpartum VTE higher intrapartum
Cerebral vein thrombosis = usually in intrapartum period (seizures, fever, vomiting, photophobia)
VTE - why does it occur in pregnancy?
Pregnancy = hypercoagulable state
Blood clotting factors X, VII + fibrinogen increased
Protein S activity decreased
Suppression of fibrinolysis
Blood flow altered by obstruction + immobility
VTE pre-existing RF
Previous VTE
Thrombophilia
Age >35
Obesity
Parity >4
Gross varicose veins
Paraplegia
Sickle cell
Inflammatory disorders
Medical disorders
New onset VTE RF
Ovarian hyperstimulation syndrome
Hyperemesis
Dehydration
Long haul travel
Severe infection
Immobility
Pre-eclampsia
Prolonged labour
Instrumental delivery
Excessive blood loss
S+S VTE
DVT: leg pain, swelling, tenderness, fever, erythema, elevated WCC
PE: SOB, collapse, chest pain, haemoptysis, raised JVP
Cerebral vein thrombosis: seizures, fever, vomiting, photophobia
VTE investigation + prevention
CXR - if normal = V/Q
If abnormal = CTPA
LMWH for prophylaxis
Score >4 = LMWH from 12 wks + PP
Score 3 = LMWH from 28 weeks + PP
Score 2 = LMWH for 10 days PP
Risk assessment for VTE prophylaxis in CS
Low risk (hydration + mobilisation) Elective CS, uncomplicated pregnancy, no RF
Moderate risk - prophylaxis Age >35, obesity, parity >4, labour >12 hrs, infection, pre-eclampsia, immobility, emergency CS
High risk - heparin >3 moderate RF, pelvic surgery, personal or fam hx of VTE, antiphospholipid antibody syndrome
Hyperemesis gravidarum - risk factors, S+S
Excessive vomiting, severe enough to cause dehydration, weight loss, electrolyte disturbance
High risk with multiples + molar
Complications of hyperemesis
Liver/ renal failure Hyponatraemia - then rapid reversal = central pontine myelinosis Thiamine deficiency = leading to Wernicke’s encephalopathy IUGR
Causes metabolic hypocholoraemic alkalosis
Management of hyperemesis
Admit, give fluids (500ml NaCl) + thiamine
Diagnose with ++ketones in urine
Daily U+Es
Antiemetics if needed - prochlorpramazine
Prolonged pregnancy risks
>42 weeks Placental function declines.
Increased risk of intrapartum deaths
Risk: meconium aspiration, oligohydraminos, macrosomia, shoulder dystocia, cephalhaematoma, hypothermia, hypoglycaemia, polycythaemia
Cephalhaematoma
Common injury during forceps delivery or prolonged labour
Swelling of scalp due to bleeding
Fetal postmaturity syndrome - S+S
Post term infants who have malnutrition
Scaphoid abdomen, little SC fat, peeling skin, anxious look
Skin stained with meconium
Risks of PPROM
Chorioamnionitis
Cord prolapse
Absence of liquor = pulmonary hypoplasia, postural deformities
Prematurity
Infection
Chorioamnionitis S+S, management + prophylaxis
Fever, abdo pain, vaginal discharge, tachycardia, uterine tenderness
Give steroids, cefuroxime + metronidazole
Prophylaxis = erythromycin
Spontaneous, threatened + inevitable miscarriage
Spontaneous = fetus dies before 24 weeks
Threatened = fetus still alive but there is bleeding, os closed
Inevitable = bleeding, os open
Incomplete, complete, septic + missed miscarriage
Incomplete = some fetal parts have passed, os open
Complete = fetus has passed, os closed
Septic = endometritis caused by contents, offensive vaginal discharge
Missed = USS finds dead fetus, os closed
Management of miscarriage
Conservative if no signs of infection
Medical: misoprostol
Medical termination of pregnancy
Mifepristone
Drugs to avoid in pregnancy
Lithium - Epsteins anomaly
Co-amoxiclav = necrotising enterocolitis
Tetracyclines = tooth discolouration
What is the treatment for obstetric cholestasis?
ursodeoxycholic acid (UDCA)
What foods should pregnant women avoid?
Raw meat, pate, ripened cheese
When is Rh disease most likely to occur, and when should Ab be checked?
Most likely in 1st trimester
Checked at booking, 28 + 34 weeks
What is checked in the neonatal period if Rh disease is confirmed?
Peak systolic velocity of fetal middle cerebral artery - measured weekly to look for signs of anaemia. If velocity is increase, FBS is indicated
What is the Kleihauer test?
Assesses number of fetal cells in maternal circulation, to see if large dose of Anti-D needed after large haemorrhage
Which laxatives + anti-emetics are used in pregnancy?
Avoid stimulant
Cyclizine + prochlorperazine
What could polyhydraminos in the absence of diabetes signify?
TORCH infection
What is the IUGR criteria on USS?
Elevated ratio FL:AC + HC:AC
Unexplained oligohydraminos
What signs on doppler indicate the head sparing effect?
Increased flow to middle cerebral artery
How do you work out dosage for LMWH?
Weight
What to give if a mother has pre-eclampsia from 26-36 weeks?
Steroids
What are the parameters for class I of shock in APH/ PPH (vol blood loss, HR, RR, BP, mental state) + how to treat
Blood loss = <750ml
HR, RR, BP = normal
Anxious
Tx = fluids
What are the parameters for class II of shock in APH/ PPH (vol blood loss, HR, RR, BP, mental state) + how to treat
Blood loss = 750-1500ml
HR <120
RR <30
BP reduced
Anxious
Tx = fluids
What are the parameters for class III of shock in APH/ PPH (vol blood loss, HR, RR, BP, mental state) + how to treat
Blood loss = 1500-2000ml
HR <140
RR <35
BP reduced
Confused
Tx = fluids +/- blood
What are the parameters for class IV of shock in APH/ PPH (vol blood loss, HR, RR, BP, mental state) + how to treat
Blood loss >2000ml
HR >140
RR >35
BP reduced
Lethargic
Tx = fluids + blood
What is the criteria for major haemorrhage protocol?
HR >110, BP <90 OR
5L in 24hr or 2.4L in 2hr or >150ml/min
What is provided in major haemorrhage protocol?
4 units RBC + 4 units FFP
TXA (activates factor 2 + is anti-thrombolytic)
How much blood can be lost from the placental if uterus is not contracting efficiently?
700ml/ min
