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Obstetrics > Problems in Pregnancy > Flashcards

Problems in Pregnancy Flashcards

1
Q

What is a High BMI in Pregnancy

A

Obese is classed as a BMI of 30 or over. It is not recommended to lose weight during pregnancy. 40 and over is significant. BMI is done at booking then two more times.

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2
Q

Risks of High BMI in Pregnancy

A
  • If BMI over 30 then chance of gestational diabetes is 3 times more likely
  • Increased risk of pre/eclampsia
  • Increase chance of stillborn from 1 in 200 to 1 in 100
  • Increase risk of shoulder dystocia
  • Heavier bleeding after birth
  • Blood clots
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3
Q

Actions that can be Taken for High BMI Pregnancies

A
  • Can be offered heparin injections to reduce risk of blood clots
  • Folic acid can reduce the risk of baby having a neural tube defect
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4
Q

How Common is HTN in Pregnancy

A
  • Pregnancy-induced HTM (PIH) or gestational HTN are generic terms that define significant rise in BP after 20 weeks.
  • Approx 15% of women who present with pregnancy induced HTN will develop eclampsia
  • PIH is usually mild at 140/90
  • PIH seen in 10% of all pregnancies
  • Can be seen post partum up to 6 weeks post birth
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5
Q

What is Pre-Eclampsia? Diagnosis, When it Occurs and What it Effects

A
  • Commonly occurs between 24-28 weeks
  • Diagnosis of pre-eclampsia includes BP above 140/90, oedema and detection of protein in urine sample. Can have two of these.
  • The degree can be mild, moderate or severe
  • Can effect liver, kidneys and blood clotting without proteinuria (HELLP syndrome)
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6
Q

Pathophysiology of Pre- Eclampsia

A

The pathophysiology is not fully understood but it is primarily a placental disorder associated with poor placental perfusion resulting in stunting of growth due to poor blood flow

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7
Q

Risk Factrors for Developing Eclamptic Disorders

A
  • First child/first child with new partner
  • Previous severe pre-eclampsia
  • Essential HTN (pre-existing chronic HTN)
  • Diabetes 1 or 2
  • Obesity
  • Twins or more
  • Renal disease
  • Advanced maternal age (35+)
  • Young maternal age (16>)
  • Pre-existing cardiovascular disease
  • Family hx
  • Multiple pregnancies
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8
Q

Assessment and Management of Pre-Eclampsia

A
  • Raised BP of 140/90 and OR a diastolic over 90 on two occasions in labour or immediately after birth
  • BP of 150/100 in pregnancy, labour or immediately after birth
  • Both require urgent transfer to obstetrics unit
  • Assess whether time-critical or not and pre-alert if needed
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9
Q

What is Severe Pre-Eclampsia?

A

A multi organ disease although HTN is a cardinal feature, other complications include:
- Intra-cranial haemorrhage
- Stroke
- Renal failure
- Liver failure
- Abnormal blood clotting

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10
Q

Signs and Symptoms of Severe Pre-Eclampsia

A
  • BP 160/110
  • Headache - severe and frontal (frq unrelieved by analgesia)
  • Visual disturbances - blurred, flashing lights, double vision or floating spots
  • Epigastric pain (often mistaken for heartburn)
  • Right sided upper abdominal pain - stretching from the liver
  • Muscle twitching or tremor
  • Nausea/vomiting
  • Confusion
  • Rapidly progressing oedema to the face, hands or feet
    NOTE: absence of these symptoms doesn’t exclude the diagnosis. Agitation and restlessness can be a sign of an underlying problem or impending deterioration
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11
Q

Assessment and Management of Severe Pre-Eclampsia

A
  • Raised BP of 150/100 before or immediately after birth, particularly seen with the signs and symptoms needs a rapid transfer
  • Transfer to consultant lead unit
  • Manage oxygen sats
  • Obtain large bore IV access (DO NOT administer fluids as to not provoke pulmonary oedema)
  • CCP can administer Magnesium sulphate if available
  • Caution using lights and sirens as strobes and noise may cause seizures
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12
Q

What is Eclampsia?

A

Eclampsia is generalised tonic/clonic convulsions and is identical to an epileptic convulsion

  • The BP may only be mildly elevated at presentation eg 140/80-90mmHg
  • Hypoxia during a convulsion may lead to significant foetal compromise and death
  • Eclampsia can present up to 6 weeks post delivery
  • Eclampsia can occur with no warning or pre-existing HTN.
  • Seizures are usually quite self limiting can be severe and repeating
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13
Q

Assessment and Management of Eclampsia

A
  • Assess if time critical or not eg recurrent convulsions
  • Correct any A or B problems and pre-alert to nearest obstetrics unit
  • Obtain large bore IV
  • O2 therapy if needed
  • If less than 20 weeks follow pre-eclampsia protocols
  • If no hx of HTN and bp is normal follow normal convulsions protocol
  • Position left lateral position for transfer
  • If the pt convulses for longer than 2-3 minutes or has subsequent convulsions administer diazepam or give magnesium if CCP available
  • NO fluids
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14
Q

What are the Causes of Bleeding in Pregnancy up to 20 Weeks (3)

A
  • Miscarriage
  • Ectopic pregnancy (usually less than 13 weeks, bleeding may be concealed)
  • Benign causes (cervical changes, implantation)
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15
Q

What are the Causes of Bleeding in Pregnancy After 20 Weeks? (5)

A
  • Placenta praevia
  • Placental abruption
  • Uterine rupture
  • Trauma
  • Vasa praevia - blood vessels cover cervix and can rupture
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16
Q

Management of Bleeding in Pregnancy After 20 Weeks

A
  • All bleeding seen by clinicians or reported by the women after 20 weeks should be treated as time critical.
  • Pre-alert with bleeding post 20 weeks
17
Q

What is an Ectopic Pregnancy? When/Where do they occur?

A

A pregnancy that is implanted outside the uterus

  • The majority of ectopic pregnancies implant in the fallopian tube
  • Most commonly presents in early pregnancy (<10 weeks)
18
Q

Signs and Symptoms of an Ectopic Pregnancy

A
  • Often presents at 6-8 weeks
  • Crampy lower abdominal or pelvic pain (often lateralised)
  • Vaginal bleeding is variable - often light bleeding or brown discharge only
  • Unexplained dizziness, fainting or syncope
  • Shoulder tip pain
  • Unusual bowel/urinary symptoms
19
Q

Signs and Symptoms of a Ruptured and Deterorating Ectopic Pregnancy

A
  • Pallor and/or clammy
  • Tachy and other signs of hypovolaemic shock
  • Postural hypotension
  • Rigid, tender abdomen with guarding
  • Rebound tenderness (often lateral)
  • Acute, severe lower abdominal or pelvic pain
  • Shoulder tip pain
20
Q

What is a Misscarriage?

A
  • Spontaneous loss of pregnancy before the baby reaches 24 weeks
  • Approximately 1 in 4 pregnancies will result in miscarriage
  • Most common in first trimester in less than 13 weeks

NOTE:
- Ambulance clinicians cannot confirm miscarriage unless observing a deceased baby
- Not confirmed if suspected another baby in utero

21
Q

Classifications of Misscarriage; Suspected, Confirmed, Threatened, Missed, Incomplete

A

Suspected - positive pregnancy test with symptoms (vaginal bleeding, pain)
Confirmed - diagnostic tests confirm pregnancy not continuing
Threatened - vaginal bleeding, positive pregnancy test but pregnancy may continue
Missed - non-viable pregnancy identified by scan without assc w/ pain and bleeding
Incomplete - when products of conception are partially expelled from the uterus

22
Q

Signs and Symptoms of a Misscarriage

A
  • Bleeding - light or heavy, often with clots or jelly like tissue
  • Bleeding - varying from brownish discharge to bright red bleeding, may occur for several days
  • Pain - central, crampy, suprapubic or backache
  • Signs of pregnancy may be subsiding eg nausea or breast tenderness
23
Q

Red Flags with Misscarriage

A
  • Bleeding - light or heavy, often with clots or jelly like tissue
  • Bleeding - varying from brownish discharge to bright red bleeding, may occur for several days
  • Pain - central, crampy, suprapubic or backache
  • Signs of pregnancy may be subsiding eg nausea or breast tenderness
24
Q

What to do If thinking of Not Transferring a Misscarriage

A
  • If no red flags for assessment in ED, by a GP or in an early pregnancy unit according to local arrangements within 4 hours of seeing them
  • EPAU (early pregnancy assessment unit) - can assess up to 16 weeks of pregnancy
25
Q

Management of Misscarriage

A
  • With CONFIRMED and only confirmed miscarriage you then can use your uterotonics and TXA
  • Keep nil by mouth
  • Assess and treat hypovolaemic shock
  • Provide pain relief
  • IV access only if doesn’t delay transfer
  • Transfer left lateral if needed
  • O2 therapy if needed
26
Q

What is FGM?

A

FGM (female genital mutilation, or cutting) refers to all procedures involving partial or total removing of external female genital for non-medical reasons
- It is predominantly practiced in Africa, Yemen, Iraqi Kurdistan and parts of Malaysia and Indonesia
- There are 4 types
- FGM increases the likelihood for pregnancy and birth complications as well as UTI and other infections

27
Q

What are the 3 Types of FGM?

A

Type 1 - removal of the clitoris
Type 2 - removal of clitoris plus part/all of the labia
Type 3 - removal of part/all of the labia, sewn together (covering the urethra), leaving a small opening for urine and menstrual fluid

28
Q

FGM in Pregnancy

A
  • Type 3 and 4 cannot give birth unassisted and must be de-fibulated (reversal surgery) to allow the baby to be born
  • FGM is a prolonged labour with increased risk for newborn resus
  • Can cause significant vaginal and perineal tearing resulting in PPH
  • Women may not realise that FGM has taken place
  • There is higher cases of postnatal wound infection
  • Increased stillbirth and early neonatal death rates
  • Increased neonatal morbidity from hypoxia and brain dmg
29
Q

Risks Assc W/ Multiple Births

A
  • With multiple births there is an increased risk of immediate PPH due to poor uterine tone
  • Multiple births are at higher risk of being born pre-term (before 37 weeks)
30
Q

What is Water Birth and What is its Purpose?

A
  • Birthing method where the mother does the entire labour process in a warm pool or bath, usually supervised by medical professionals.
  • It is supposed to give the baby a gentler transition and smoother delivery process
31
Q

Protocols of Water Births for Paramedics

A
  • We are not trained to deal with water births, it is not within our scope of practice so a midwife ect must be present. We are only responsible for the mother if no trained clinician is present.
  • Ask the mother to leave the water and explain we are untrained and risks to the baby
  • If birth is imminent the follow normal procedures
32
Q

If Birth is Imminent During a Water Birth

A
  1. Use sleeve protectors if available, apron and gloves. Prepare a resus area and keep the room and water warm (important)
  2. If the baby is born under the water ask mother to bring the baby’s head above the water or do it yourself so they can breathe spontaneously
  3. Once born clamp and cut the umbilical cord
  4. Undertake neonate assessment and assessment of mother
  5. Dry baby and warm with warm towels

Obstetrics (5 decks)

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