W11L2 Tues pregnancy complication Flashcards
Pregnancy timeline
First trimester: First 12 weeks
* Embryonic period 3 – 8 weeks, Period of the fetus 9 weeks onward
* 4 – 13 weeks period of greatest risk to birth defects
Second trimester: 13 – 27 weeks
Third trimester: 28 weeks onward
* Pregnancy is considered at term after 37 weeks
* Post term anything above 40 weeks
What is Miscarriage ,it’s rate and possible cause
Spontaneous loss of a pregnancy before 20 gestational weeks
* Incidence: 20-30% of pregnancies
* Risk reduces with gestational age – highest in early pregnancy
* 50% due to chromosomal errors – not viable
* 50% potentially due to implantation errors – uterine environment
risk factor for miscarriage
- Maternal age
- Previous miscarriage
- Chronic disease
- Lifestyle factors; smoking, alcohol, drugs, BMI
- Infections during early pregnancy; chicken pox, toxoplasmosis,listeriosis
Miscarriage – clinical presentation/diagnosis
- clinical admission due to Vaginal bleeding and abdominal pains/cramping
- Clinical investigations:
– Serum hCG does not rise (or falls) when taken 48 hrs apart
– On ultrasound, absence of fetal cardiac activity (diagnostic if no fetal heart and the gestational sac size is >25 mm, or crown- rump length >7mm)
Miscarriage – management
-observation (watch + wait),
-medical management (stimulate uterus to pass pregnancy tissue; induce myometrial contractility or inhibit progesterone to induce shedding of uterine lining; Mifepristone/Misoprostol);
- surgery (dilation + curettage D&C – suction to remove pregnancy tissue, if don’t want expectant management or bleeding/infection)
what is Ectopic pregnancy
Pregnancy implanting outside of the uterus
* 96% implant in the Fallopian tubes
* Possible other sites: cervical, interstitial, cesarean scar, ovary
* Pregnancy of unknown location
incidence of ectopic pregnancy and consequences
- Incidence: 1-2% of pregnancies
- Not viable pregnancies
- Leading cause of maternal death in the first trimester – rupture
risk factor for ectopic pregnancy
- Previous ectopic pregnancy
- Pelvic inflammatory disease – other genital infections
- Tubal surgery
- IVF
- Smoking
- Age
Clinical presentaiton for ectopic
- Positive pregnancy test
- Abdominal pain
- Bleeding
- Can be asymptomatic
diagnosis of ectopic pregnancy
- Confirm pregnancy – hCG
- hCG discriminatory zone (not always reliable)
- Assess pregnancy location
- Ultrasound - if no gestational sac in the uterus then high clinical suspicion of an ectopic pregnancy
- Determine site of the ectopic pregnancy
Ectopic pregnancy –expectant management
- Watch and wait approach as it May resolve without intervention
- Only offered if hCG is low (<500 IU/L) and declining and no signs or rupture
- require Close monitoring
Ectopic pregnancy –medical management
- Methotrexate – chemotherapeutic
- Injected intramuscularly or in some intrasac
- Only effective for smaller ectopic pregnancies (hCG < 3000 IU/L)
- Must be stable and no signs of rupture
Ectopic pregnancy – surgery
- Most common management
- Shorter time to resolution
- Salpingectomy – takes ectopic pregnancy and tube
- Salpingostomy – pull out sac and leave the tube
- Laparoscopic salpingectomy is the most common surgical treatment approach
Fetal anomalies, what is it, and incident
- Structural changes to one or more part of the fetus
- Incidence: 3% major anomalies, 4-5% minor anomalies
Possible cause of fetal abnormality
- Can be structural or chromosol
- Finding of a structural anomaly increases the probability of chromosomal abnormalities
- Etiology is diverse; genetic (down syndrome), infectious (zika), nutritional (neural tube) or environmental (radiation, drugs)
common congenital anomalies
- Heart defects – structural problem of the heart. Affects 1 per 100 babies born.
- Neural tube defects – structural problems with the brain and spinal cord. 1-5 per 1000 babies born.
- Down syndrome – additional chromosome 21 (trisomy 21). 1 per 600-700 babies born.
Diagnosis of fetal anomalies
- Structural fetal anomalies on ultrasound; 13 weeks and 20 week ultrasound
- Offered further genetic testing
- Amniocentesis - cytogenetic analysis (including FISH), prenatal microarray
- Prenatal screening
- Postnatal diagnostic testing - gene sequencing
Fetal anomalies – management
- Highly dependent on the anomaly
- Some anomalies are not combatable with life
- Many have no curative approach
- Structural abnormalities
- Fetal surgery –neural tube defects can be closed in-utero
- Postnatal repair – heart defects
- Termination
- Management of the disorder postnatally
What is genetic screening
- Screening for chromosomal anomalies
- Is NOT a diagnostic test
- Occur prior or during pregnancy
Pre-pregnancy screening
- Genetic carrier screening
- Most include cystic fibrosis, fragile X and spinal muscular atrophy
pregnancy screening
- Combined in first trimester screening (ultrasound, blood test and risk factors)
- Non-invasive prenatal testing (NIPT) – analyses cell free fetal DNA circulating in mums blood. Provide a risk estimate for trisomy 21, 18 and 13, and sex chromosome aneuploidies
Preterm birth: what is it and incident rate
Delivery <37 gestational weeks
* Incidence: 5- 10 %
* 60% Spontaneous preterm birth
* 40% Iatrogenic preterm birth
* Largest cause of neonatal mortality and morbidity
Preterm birth - viability
Viability different in different clinical settings
* Poor lung maturity
* In Australia between 22 – 24 weeks
* In low resource settings – 28 weeks
-The longer it stay in the utero, the higher the rate of survival is
Consequences of preterm birth
Immediate:
- Death
-Intracerebral bleeding
- respiratory
-distress syndrome
- bronchopulmonary dysplasia
-necrotising enterocolitis
Later in life: Cognitive delay, mental disability
