Pregnancy Complications Flashcards
What is an Ectopic Pregnancy?
Any pregnancy where the implanted site is outside the uterine cavity
Ectopic Pregnancy S&S
Most non-specific
- Lower abdominal/pelvic pain
- History of Amenorrhea
- Shoulder tip pain
- Brown vaginal discharge
- Localised tenderness
- Haemodynamically unstable
Ectopic Pregnancy DD?
Miscarriage Ovarian Cyst accident UTI Appendicitis Acute Pelvic inflammatory disease
Ectopic A&M?
- ABCDE Approach and treat as necessary
- Monitor Haemodynamic stability carefully in case of fallopian tube rupture
- Reassure woman
- Transfer
What is Placental Abruption?
Placental Abruption is where a part or all of the placenta separates from the wall of the uterus prematurely. It is a key cause of antepartum haemorrhage.
Placental Abruption Pathophysiology?
Placental Abruption is usually caused by a rupture of blood vessels in the endometrium in late pregnancy (>24 weeks). Blood gathers and splits the attachment of the placenta to uterine wall. This detached part of the placenta is now unable to function leading rapid fetal compromise.
What are the two types of placental abruption?
Revealed and Concealed
What is a revealed placental abruption?
Where bleeding tracks down from the site of abruption and exits through the cervix. Results in vaginal bleeding.
What is a concealed placental abruption?
The bleeding remains within the uterus and forms a clot retroplacentally. Bleeding not visible but can cause systemic shock.
Placental Abruption S&S?
- Typically presents with painful vaginal bleeding
- Woody uterus
- Painful uterus
- Pregnancy induced hypertension (PIH)
- Hypovolaemic shock
- Abdominal/back pain
- Tender abdomen
What are the two main causes of early pregnancy haemorrhage (<24 weeks)?
Ectopic and and miscarriage
What is miscarriage?
A loss of pregnancy at less than 24 weeks gestation.
What are some risk factors for miscarriage?
Maternal age >30-35 Previous miscarriage Obesity Smoker Chromosomal abnormalities Uterine anomalies
What are some miscarriage S&S?
- Vaginal Bleeding with or without products of conception
- Suprapubic, cramping pain
- Haemodynamic instability
- Sign of subsiding pregnancy (nausea/breast tenderness)
- Abdominal localised tenderness
Miscarriage A&M?
- Very distressing for mother.
- If tissue passed it may be handled by the mother under advice
- Offer transfer mother and baby
- Discuss mothers preferences
- If unidentifiable tissue use soft item from maternity pack to transport
- If discernible, towel wrap and allow mother to hold if she wishes during transport
- Document
- Always recover tissue if possible
What are the two main causes of Antepartum haemorrhage in late pregnancy (>24 weeks)?
Placental Abruption and Placental Praevia
What is placental praevia?
Placental Praevia is where the placenta is partially or fully attached to the lower uterine segment. This can lead to severe bleeding during pregnancy or when labour begins
What are the two main types of Placental Praevia?
Minor Placental Praevia
Major Placental Praevia
What is minor placental praevia?
Placenta is low but does not cover internal cervical os
What is major placental praevia?
Placenta lies and covers over the internal cervical os
What are some placental praevia risk factors?
Maternal age >40 Previous placental praevia High parity History of UTI Multiple pregnancy
Placental Praevia S&S?
- Painless vaginal bleeding that can be simple spotting up to large haemorrhage
- Haemodynamic instability
- PPH questions
Placental Praevia and Placental Abruption A&M?
- Quickly assess scene on approach
- ABC approach
- Rule out local trauma
- Alert call
- O2 target sats 94-98%
- Obtain Large bore IV access
- Blood loss estimation
- Admin Synometrine IM (if hypertensive admin misoprostol)
- DO NOT admin Synometrine if foetus in situ
- Manage haemodynamic instability
- Ensure VC return using Left Supine Position
- Admin Sodium Chloride if hypotensive/tachycardiac
- Take blood soaked pads
- Record last baby movement
- If no TC perform thorough assessment
- Pain relief
