Pregnancy Complications Flashcards
What is the definition of a spontaneous abortion?
Spontaneous loss of pregnancy before 24 weeks
What is the difference between a threatened and inevitable abortion?
A threatened miscarriage refers to bleeding from the gravid uterus before 24 weeks gestation when there is a viable foetus and no evidence of cervical dilatation.
Abortion becomes inevitable if the cervix has already begun to dilate
What is a missed miscarriage?
This is a missed miscarriage, also called a silent miscarriage. It’s called a missed miscarriage because you won’t realise that anything has gone wrong. You may not have had any of the usual signs of miscarriage, such as pain or bleeding. It may be that an embryo didn’t develop at all and the pregnancy sac is empty.
What are some causes of spontaneous abortion?
Hormone Imbalances Trauma to cervix, previous surgery Chromosomal, genetic or structural abnormalities of foetus Congenital uterine issues Fibroids Cervical Incompetence Increasing maternal age Maternal diabetes
What are some risk factors for an ectopic pregnancy?
Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception
What are the symptoms of an ectopic pregnancy?
Period of amenorrhoea (with +ve urine pregnancy test)
+/_ Vaginal bleeding
+/_ Pain abdomen
+/_ GI or urinary symptoms
What investigations should be done for an ectopic pregnancy?
Scan – no intrauterine gestational sac, may see adnexal mass, fluid in Pouch of Douglas
Serum BHCG levels – may need to serially track levels over 48 hour intervals- if a normal early intrauterine pregnancy HCG levels will increase by at least 66%ish
Serum Progesterone levels – with viable IU pregnancy high levels > 25ng/ml
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 APH?
Placenta praevia Placental abruption APH of unknown origin Local lesions of the genital tract Vasa praevia (very rare)- Usually the blood loss is small and is due to rupture of a foetal vessel within the foetal membranes
When is placenta praevia more common?
Multiparous women
Multiple pregnancies
Previous caesarean section
What are the grades 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 presentation of placenta praevia?
Painless PV bleeding
Malpresentation of the foetus
Incidental
Soft, non tender uterus +/- fetal malpresentation
What are the managements of PPH?
Medical management – oxytocin, ergometrine, carbaprost, tranexemic acid
Balloon tamponade
Surgical – B Lynch cutre, ligation of uterine, iliac vessels, hysterectomy
What is a placental abruption?
Haemorrhage resulting from premature separation of the placenta before the birth of the baby (due to a retroplacental clot)
What are factors associated with placental abruption?
Pre-eclampsia/ chronic hypertension Multiple pregnancy Polyhydramnios Smoking, increasing age, parity Previous abruption Cocaine use
What are the three types of placental abruption?
Revealed
Concealed
Mixed (concealed and revealed)
What is the presentation of placental abruption?
Pain
Vaginal bleeding (may be minimal bleeding)
Increased uterine activity
What is the definition of preterm labour?
Onset of labour before 37 completed weeks gestation (259 days)
32-36 wks mildly preterm
28-32 wks very preterm
24-28 wks extremely preterm
What are predisposing factors for preterm labour?
Multiple pregnancy Polyhydramnios APH Pre-eclampsia Infection eg UTI Prelabour premature rupture of membranes Majority no cause (idiopathic
What does tocolysis allow in preterm labour?
Allows time to give steroids to help with foetus’ breathing. Allows time for transfer
What are the parameters for hypertension in pregnancy?
Mild HT– Diastolic BP 90-99, Systolic BP 140-49
Moderate HT- Diastolic BP 100-109, Systolic BP 150-159
Severe HT- Diastolic BP ≥110, Systolic BP ≥ 160
What are the definitions of gestational hypertension and pre-eclampsia in terms of onset?
Gestational hypertension BP in set classed raised parameters but new hypertension (develops after 20 weeks)
Pre-eclampsia- New hypertension > 20 weeks in association with significant proteinuria
What are the parameters for proteinuria in pre eclampsia?
Automated reagent strip urine protein estimation > 1+
Spot Urinary Protein: Creatinine Ratio > 30 mg/mmol
24 hours urine protein collection > 300mg/ day
What hypertensive drugs are safe and widely used in pregnancy?
Labetalol
Nifedipine
Methyldopa
What is the definition of pre eclampsia?
A hypertensive syndrome that occurs in pregnant women after 20 weeks’ gestation, consisting of new-onset, persistent hypertension (defined as a BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic, based on at least 2 measurements taken at least 4 hours apart) with one or more of the following: 1) proteinuria (defined as urinary excretion of ≥0.3 g/24 hours of protein); 2) evidence of systemic involvement, such as renal insufficiency (elevated creatinine), liver involvement (elevated transaminases and/or right upper quadrant pain), neurological complications, haematological complications; 3) fetal growth restriction
What are the risk factors of pre eclampsia?
Primiparity Pre-eclampsia in previous pregnancy Family history of pre-eclampsia BMI >30 Maternal age >35 years Multiple (twin) pregnancy Sub-fertility Gestational hypertension Pre-gestational diabetes Polycystic ovary syndrome (PCOS) Autoimmune disease Renal disease Chronic hypertension BP ≥80 mmHg diastolic at booking Interval of 10 years or more since previous pregnancy High-altitude residence
What are the symptoms and signs of pre eclampsia?
20 weeks' gestation BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic and previously normotensive Headache Upper abdominal pain Reduced fetal movement Foetal growth restriction Oedema Visual disturbances Seizures Breathlessness- pulmonary oedema Oliguria Hyper-reflexia and/or clonus Cerebral haemorrhage, stroke HELLP (hemolysis, elevated liver enzymes, low platelets) DIC (disseminated intravascular coagulation) Renal failure Cardiac Failure IUGR Prematurity Increased foetal mortality
What investigations should be done in pre eclampsia?
LFTs FBC Renal function tests Frequent BP checks Urine Dipstick Coagulation tests CTG US for baby growth
What is the management of pre eclampsia?
Delivery of baby is the best treatment but depends on gestation
Anti-hypertensives
Steroids for fetal lung maturity if gestation <36 weeks
Magnesium sulphate bolus + IV infusion for seizures
Avoid fluid overload – aim for 80mls/hour fluid intake
Low dose Aspirin from 12 weeks till delivery for prophylaxis
How is the diagnosis of gestational hypertension made?
To establish the diagnosis, 2 blood pressure (BP) measurements should be taken at least 6 hours, and no more than 7 days, apart
What are the risk factors for gestational hypertension?
Nulligravidity Black or Hispanic ethnicity Multiple pregnancies Obesity Mother being small for gestational age Type 1 diabetes mellitus Migraine
Why does gestational diabetes occur?
Human placental lactogen, progesterone, human chorionic gonadotrophin and cortisol from the placenta have anti-insulin action so the insulin requirements of the mother increase
Maternal glucose crosses the placenta and induces increased insulin production in the fetus. The fetal hyperinsulinemia causes macrosomia
What are the effects of gestational diabetes on the foetus?
Hypoglycemia at birth
Resp distress at birth
Fetal congenital abnormalities e.g – cardiac abnormalities, sacral agenesis especially if blood sugars high peri-conception
Miscarriage
Fetal macrosomia, polyhydramnios
Operative delivery, shoulder dystocia
Stillbirth, increased perinatal mortality
What are the risk factors for gestational diabetes?
Advanced maternal age (>40 years) Elevated BMI Polycystic ovarian syndrome (PCOS) Non-white ancestry FHx of diabetes mellitus Low-fibre and high-glycaemic index diet Weight gain as young adult Previous gestational diabetes Physical inactivity
How is Virchow’s triad affected during pregnancy?
Pregnancy is a hypercoagulable state (to protect mother
against bleeding post delivery)
-increase in fibrinogen, factor VIII, VW factor, platelets
-decrease in natural anticoagulants – antithrombin III
-increase in fibrinolysis (Hypercoagulability)
Increased stasis – progesterone, effects of enlarging uterus (stasis)
May be vascular damage at delivery/ caesearean section (vessel damage)
What are the risk factors for VTE in pregnancy?
Older mothers, increasing parity Increased BMI Smokers IV drug users PET Dehydration – hyperemesis Decreased mobility Infections Operative delivery, prolonged labour Haemorrhage, blood loss > 2 l Previous VTE (not explained by other predisposing eg. fractures, injury), those with thrombophilia (protein C, protein S, Anti thrombin III deficiencies, etc), strong family history of VTE Sickle cell disease
What is the prevention for VTE during pregnancy?
TED stockings
Advice increased mobility, hydration
Prophylactic anti-coagulation with 3 or more risk factors (may be indicated even with one risk factor if significant risk), may need to continue 6 weeks postpartum
