Problems in pregnancy Flashcards
What is the definition of a preterm baby?
A baby delivered between 24 to 36+6 weeks
What are the survival rates for a baby born at 24 weeks?
20-30%
What are the survival rates for a baby delivered at 32 weeks?
> 95%
What are the survival rates for a baby born at 27 weeks?
80%
What are some of the causes of preterm birth?
-Infection
-‘Over distension’:
Multiple
Polyhydramnios
-Vascular:
Placental abruption
-Intercurrent illness:
Pyelonephritis / UTI
Appendicitis
Pneumonia
-Cervical incompetence
-Idiopathic
What is polyhydramnios?
Excess amniotic fluid surrounding the baby
What are the risk factors for having a preterm labour?
Previous preterm labour Uterine anomalies Age (teenagers) Parity (=0 or >5) Ethnicity Poor socio-economic status Smoking Drugs (especially cocaine) Low BMI (
What are the indications for cesarean delivery of preterm labour?
Severe pre-eclampsia, kidney disease or poor fetal development
What is the definition of ‘small for gestational age’?
Infant with a birthweight that is less than 10th centile for gestation corrected for maternal height, weight, fetal sex and birth order
What are the maternal risk factors for poor growth of fetus?
- Lifestyle: Smoking Alcohol Drugs - Height and weight - Age - Maternal disease e.g. hypertension
What are fetal risk factors for poor growth?
Infection e.g. rubella, CMV, toxoplasma
Congenital anomalies e.g. absent kidneys
Chromosomal abnormalities e.g. Down’s syndrome
What placental factors can cause poor fetal growth?
Infarction
Abruption
What is infarction or abruption of placenta often secondary to?
Hypertension
What is a ‘symmetrical’ picture of intrauterine growth restriction?
Baby has small head and small abdomen
What is an ‘asymmetrical’ picture of intrauterine growth restriction?
Baby has normal head and small abdomen
What is the most common cause of iatrogenic prematurity?
Pre-eclampsia
What percentage of primagravid women are affected by pre-eclampsia?
10%
What happens to blood pressure in early pregnancy?
BP falls until 22-24 weeks
What happens to blood pressure in later pregnancy?
After 22-24 weeks, continues to rise
When does pregnancy induced hypertension usually begin?
Second half of pregnancy
When does pregnancy induced hypertension usually resolve itself?
6 weeks after delivery
How can pregnancy induced hypertension be distinguished from pre-eclampsia?
No proteinuria in PIH
Better outcomes than pre-eclampsia
What proportion of cases of pregnancy induced hypertension go on to develop pre-eclampsia?
15%
What are the three features of pre-eclampsia?
Hypertension
Proteinuria (≥0.3g/l or ≥0.3g/24h)
Oedema
What is the consequence of the first stage of pre-eclampsia?
Abnormal placental perfusion
What is the consequence of the second stage of pre-eclampsia?
Maternal syndrome, multi-system involvement
What systems are involved in pre-eclampsia?
CNS Renal Hepatic Haematological Pulmonary Cardiovascular Placental
What are the risks to the CNS in pre-eclampsia?
Eclampsia Hypertensive encephalopathy Intracranial haemorrhage Cerebral Oedema Cortical Blindness Cranial Nerve Palsy
What renal disease is associated with pre-eclampsia?
Reduced GFR Proteinuria Increased serum uric acid (also placental ischaemia) Increased creatinine / potassium / urea Oliguria /anuria Acute renal failure: - acute tubular necrosis - renal cortical necrosis
What is HELLP syndrome?
Haemolysis, Elevated Liver enzymes, Low Platelets
What haematological disease is associated with pre-eclampsia?
Reduced Plasma Volume Haemo-concentration Thrombocytopenia Haemolysis Disseminated Intravascular Coagulation
What pulmonary disease is associated with pre-eclampsia?
PE
Pulmonary oedema
What placental disease is associated with pre-eclampsia?
Intrauterine growth restriction (IUGR)
Placental Abruption
Intrauterine Death
What are the symptoms of pre-eclampsia?
Headache Visual disturbance Epigastric / RUQ pain Nausea / vomiting Rapidly progressive oedema
What are the signs of pre-eclampsia??
Hypertension Proteinuria Oedema Abdominal tenderness Disorientation Small for gestational age Hyper-reflexia / involuntary movements / clonus
What are the risk factors for pre-eclampsia?
Higher maternal age Obesity/high BMI Previous hypertension Family history Multiple pregnancy i.e. twins Nulliparity Previous PET Molar pregnancy
Who develops more severe pre-eclampsia: nulliparous or multiparous women?
Multiparous
What are the medical risk factors for developing preeclampsia?
Pre-existing renal disease Pre-existing hypertension Diabetes Mellitus Connective Tissue Disease Thrombophilias (congenital / acquired)
What measurement indicates high risk of cerebral haemorrhage?
Mean arterial pressure >150mmHg
Does control of blood pressure reduce the risk of developing pre-eclampsia?
No
What blood pressure measurement in pregnancy requires immediate treatment?
170/110mmHg
What antihypertensive agents should be avoided in pregnancy?
ACEi
Diuretics
What four drugs can be used to treat hypertension in pregnancy?
Labetolol
Methyldopa
Nifedipine
Hydralazine
What is methyl dopa?
Centrally acting alpha agonist
What condition contraindicates the use of methyldopa?
Depression
What is labetalol?
Alpha and beta blocker
What condition contraindicates the use of labetalol?
Asthma
What is nifedipine?
Ca channel antagonist
What is hydralazine?
Vasodilator
What is the only cure for pre-eclampsia?
Delivery
What are the indications for delivery in pre-eclampsia?
Term gestation Inability to control BP Rapidly deteriorating biochemistry / haematology Eclampsia or other crisis Fetal Compromise - REDF, abnormal CTG
What are crises associated with pre-eclamspia that would indicate delivery?
Eclampsia HELLP syndrome Pulmonary Oedema Placental Abruption Cerebral Haemorrhage Cortical Blindness DIC Acute Renal Failure Hepatic Rupture
Why would steroids be given just before delivery?
Reduce the risk of neonatal respiratory distress syndrome by promoting production of lung surfactant
What is eclampsia?
Tonic-clonic (grand mal) seizure occuring with features of pre-eclampsia
What is the management of severe PE/eclampsia?
Control BP
Stop / Prevent Seizures
Fluid Balance
Delivery
What antihypertensives can be administered in eclampsia?
IV labetolol
IV hydralazine
What medication can be given in eclampsia for seizure prophylaxis and treatment?
Magnesium sulphate IV
What is the main cause of death in eclampsia?
Pulmonary oedema
What are the symptoms of polyhydramnios?
Discomfort
Distended abdomen
Stretched skin
What are the complications associated with polyhydramnios?
Labour
Membrane rupture
Cord prolapse
What are the signs of polyhydramnios?
Tense abdomen
Hard to feel fetal poles
Much larger abdomen for dates
What is the most common cause of polyhydramnios?
Diabetes/gestational diabetes
How is polyhydramnios diagnosed?
Clinical
Ultrasound
What are some of the other causes of polyhydramnios?
Fetal abnormality Multiple gestation AV fistula in placenta Oesophageal atresia Hydrops fetalis
What is hydrops fetalis?
Abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin oedema
What is chorionicity?
Refers to the membrane pattern of twins
What are the complications of multiple pregnancy?
Congenital anomalies Pre term labour Growth restriction Pre eclampsia Antepartum haemorrhage Twin to twin transfusion
What pregnancy complications are specific to pre-existing diabetes?
Congenital anomalies
Miscarriage
Intra uterine death
What pregnancy complications are associated with both pre-existing and gestational diabetes?
Pre eclampsia Polyhydramnios Macrosomia Shoulder dystocia Neonatal hypoglycaemia
What is the initial approach to reducing hyperglycaemia in gestational diabetes?
Diet
Weight control
Exercise
When should hypoglycaemic therapy be considered in gestational diabetes?
Diet and exercise fail to maintain targets
Macrosomia on ultrasound
