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PAR3031 - MATERNITY > WEEK 3 > Flashcards

WEEK 3 Flashcards

1
Q

what is Antepartum haemorrhage?

A

defined as
bleeding from the genital tract in the second half of
pregnancy, remains a major cause of perinatal mortality and maternal morbidity in the developed world.

In approximately half of all women presenting
with APH, a diagnosis of placental abruption or placenta praevia will be made; no firm diagnosis will be made
in the other half even after investigations.

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2
Q

What is Hyperemesis Gracidarum (HEG)

A

Sever vomiting in pregnancy

persistant vomiting leading to fluid and electrolyte depletion, marked ketourinea and nutritional deficience and rapid weight loss

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3
Q

What causes Hyperemesis Gracidarum (HEG)?

A

Unknown, thought to be endocrine in origin

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4
Q

WHen does Hyperemesis Gracidarum (HEG) usually start?

A

Usually around 6/40

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5
Q

What history based questions should you ask with Hyperemesis Gracidarum (HEG)?

A
  • characteristic of the vomit
  • this pregnancy - gestation problems
  • Last time to toilet
  • Previous pregnancy - problems G’s P’s
  • previous medical history
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6
Q

What are potential causes of Early PV bleeding?

A
  • impantation bleed
  • cervical lesions
  • miscarraige
  • ectopic pregnancy
  • incompetent cervix
  • hydatidiform mole
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7
Q

what is a hydatidiform mole?

AKA molar pregnancy

A

characterised by rapid growth of trophoblastic tissue

where chorion villi become fluid filled, with no viable embryo

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8
Q

WHat are the two types of hydatidiform moles?

A
  • complete (no fetal tissue, develops from empty egg)

- incomplete

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9
Q

what are some causes of hydatidiform moles?

A
  • poor nutrition
  • advanced age >40
  • young age <18
  • mexican and asian decent increased risk
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10
Q

What are signs & symptoms of hydatidiform moles?

A
    • preggo test
  • ## nausea etcPartial signs: signs consistent with incomplete miscarriage

Complete signs: dark brown vaginal bleeding

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11
Q

Define a miscarriage?

A

Expulsion of the products of conception from the uterus via the birth canal before the 20th week

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12
Q

what are the 2 classifications of misscarriage?

A
  • spontaneous

- induced

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13
Q

What re the causes of misscarriage?

A
  • Foetal
  • Genital tract
  • Maternal
  • Trauma
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14
Q

What are the foetal causes of miscarriage?

A

– Foetal abnormality
(chromosomal)
– poor implantation
– Abruption of the ovum

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15
Q

What are the maternal causes of miscarriage?

A

– Diseases-rubella, influenza,
acute fever, renal disease,
hypertension, – Age – ABO incompatibility, – Drugs- anaesthetics,
chemotherapy, toxic – Psychological- stress, anxiety

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16
Q

What are the Genital tract causes of miscarriage?

A

– Retroverted uterus
– Bicornuate uterus
– Myomas
– cervical incompetence

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17
Q

What are the trauma tract causes of miscarriage?

A

– MCA – Direct blow – criminal interference – abdominal surgery

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18
Q

what are the classifications of spontaneous miscarriage?

A
  • missed
  • threatened
  • inevitable
  • complete
  • incomplete
  • septic
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19
Q

What is the definition of a threatened spontaneous miscarriage?

A

cervix closed, membrane in tact

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20
Q

what is the presentation of threatened spontaneous miscarraige?

A

Pain
– Slight →severe; cramps;
– lower abdominal/back

Vaginal bleeding
– Nil → Slight → Heavy

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21
Q

What is the Inevitable of a threatened spontaneous miscarriage?

A

cervix is open

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22
Q

what is the presentation of inevitable spontaneous miscarraige?

A

– Free vaginal bleeding,
– ? ruptured membranes -amniotic fluid seen
– Foetal sac & contents protruding through dilating
cervical os
– More acute abdominal pain-rhythmic

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23
Q

What is the Missed of a threatened spontaneous miscarriage?

A

Products of conception not viable, retained in

the uterus & no signs of abortion

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24
Q

what is the presentation of missed spontaneous miscarraige?

A

 Physiological signs of pregnancy regress
 Any signs of pain & bleeding cease
→ brown discharge- +/- offensive → decay
 Blood coagulation disorders may develop
– if missed abortion of > 6 to 8 weeks

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25
Q

What is the complete of a threatened spontaneous miscarriage?

A

Expulsion of all products of conception

– embryo, placenta and intact membranes

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26
Q

what is the presentation of complete spontaneous miscarraige?

A

 Usually occurs < the 8th week of gestation
 Pain (A/A)
 Vaginal loss
– slight. → mod; bright red → brown

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27
Q

What is the incomplete of a threatened spontaneous miscarriage?

A

Not all products of conception are expelled.
– Foetus usually expelled but part of placenta is
retained

28
Q

what is the presentation of incomplete spontaneous miscarraige?

A

 Usually occurs >8 weeks but < 20 weeks
 Bleeding mod → profuse
 Abdominal pain &/or backache ++++
 Risk of cervical shock if foetus caught in cervix

29
Q

What is the septic of a threatened spontaneous miscarriage?

A

Infection due to lack of removal of the products of

conception

30
Q

what is the presentation of septic spontaneous miscarraige?

A

 History of abortion
 Unwell, headache, nausea, sweating & shivering,
flushed/hot skin, ↑ temp, abdo pain
 Tender uterus- bulky, offensive vaginal
discharge, may be pinkish in color

31
Q

What are the general signs of miscarriage?

A

Pain-
– central, in low abdomen,
– intermittent backache

Vaginal bleeding- blood stained discharge
– brown spotting/bright red loss
• Minimal → heavy

May experience
– Uneasiness prior to onset of symptoms

32
Q

What is cervical shock?

A

where products of coneption partially caught in cervix

  • signs of shock not due to hypovolaemia
33
Q

What are some risk factors of cevical shock?

A
  • past Hx of miscarriage
  • potential miscarriage on ultrasound
  • smoking
  • obesity
34
Q

What are some symptoms of cevical shock?

A

− Pain – cramps; signs of pregnancy ? Subsiding; PV loss;
light or heavy bleeding – with jelly like clots; may have
nausea or tender breasts

− Level of shock out of proportion to blood loss

35
Q

define ectopic pregnancy?

A

Fertilized ovum
embeds outside the
uterine cavity, usually
in the fallopian tubes

36
Q

WHat are the various possible implantation sites for ecotopic pregnancy?

ON EXAMS

A
  • cervical
  • peritoneal
  • interstitial
  • tubal (isthmus)
  • Tubal (ampullar)
  • Infundibular (osital)
  • Ovarian
  • Abdominal
37
Q

What are the risk factors for ectopic pregnancy?

A

 Narrowing of the tube
– ?oedema ?inflammation ?infection

 Kinking of tube
– ?adhesions ? Scarring

 Damage to lining of tube
– endometriosis or PID; smoking

 Delay in transit of ovum; mini pill
– Previous surgery;

 IVF-tubal surgery

38
Q

what are signs and symptoms of ectopic pregnancy?

A
  • History of amenorrhea

 Mild lower abdominal pain-
– occasionally sharp, stabbing; ↑ intensity over a few days
especially with bowels; tenderness on one side; rebound
tenderness; adnexal tenderness

 Shoulder tip pain (KEY MARKER)

 Tachycardia

 Postural hypotension

 Dizziness and fainting

 Nausea & diarrhoea

 +/- bleeding or slight brown discharge

 U/S: Uterus empty

39
Q

what are signs and symptoms of Ruptured ectopic pregnancy?

A

 Sudden severe abdominal pain
 Profound shock- collapse
 Vaginal Bleeding - minimal
 Referred shoulder tip pain

40
Q

Define incompetent cervix?

A

Painless dilatation of cervix; the foetus, placenta &

membranes completely expelled

41
Q

what causes incompetent cervix

A

Unknown - ? weakness of retaining sphincter

mechanism at the junction of the uterus & cervix;

42
Q

what is the presentation of incompetent cervix?

A

Painless delivery of foetus b/n 16-23/40

43
Q

where is the normal site for implantation?

A

endometrium of upper uterus

44
Q

how much does the placenta weigh?

A

1/6 of baby weight

45
Q

What does the placenta do?

A

transfer nutrients and excretory products via diffusion

no mixingof maternal and foetal blood

46
Q

what are 5 functions of the placenta?

A

 Nutritive – Amino acids; simple sugars

 Respiratory – O & CO2 exchange

 Excretory – Waste products

 Endocrine – βHCG; HPL; Oestrogens, Progesterone,

 Barrier – For most but not all

47
Q

define antepartum haemorrhage?

A

 Bleeding from the birth canal in excess of 15mls
from the 20th (approx) week of gestation to the birth
of the neonate

48
Q

what are the 3 main types of antepartum haemorrhage?

A

 Placenta Praevia
 Placental abruption
 Vaso praevia

49
Q

what are the risk factors of antepartum haemorrhage?

A
  • Maternal age >40
  • Complex medical history prior to pregnancy
  • Multigravida
  • Known placenta praevia
  • History of abruption
  • Coagulopathies
  • Use of Crack Cocaine
50
Q

What is placenta pravia?

A

Placenta partially or wholly

implanted in the lower part of the uterus.

51
Q

with placenta pravia, when do bleeding signs start to show?

A

• Can start spotting from 28
weeks
• more severe around 32-36
weeks

52
Q

What are the 4 grades of placenta pravia?

A

 1 - placenta lies in lower segment but does not
reach the internal os
 2 - edge of placenta is attached to lower
segment of uterus & reaches internal os
 3 - edge just covers internal os -bleeds once
cervix starts to dilate past 3-4cm
 4 - placenta centrally covers the internal os -
torrential haemorrhage is likely

53
Q

What is the presentation of placenta pravia?

A 
 Painless recurrent bleed of various amounts – tends to be BRIGHT RED
 Dx by transvaginal ultrasound
 Premature labour
 Shock
 Foetal malpresentation
54
Q

What is Vasa preavia?

A

 (type 1) Foetal vessels
crossing or running in
close proximity to the
inner cervical os.

 (Type 2) Vessels course within
the membranes
(unsupported by the
umbilical cord or
placental tissue)
55
Q

what is the presentation of Vasa Preavia?

A

 Can be detected on transvaginal U/Sound
– 2nd trimester

 Painless Vaginal bleeding – fresh blood
– Usually limited; non continuous
– Usually when the membranes rupture

 Lack of foetal movements
– After membranes rupture

 Usually late 3rd trimester of pregnancy
– Associated with labour

56
Q

What is placental abruption?

A 
Premature separation of the placenta from the
uterine lining (after 20 weeks)
57
Q

how often does placental abruption occur?

A

 Occurs in 3-5% of all pregnancies

58
Q

what is the process of placental abruption?

A

– bleeding from maternal venous sinuses into
placental bed → further separates placenta →
blood retained behind placenta → infiltrates
myometrium → extravasation causing marked
damage such as bruising & oedema

59
Q

what are the risk factors for placental abruption?

A 
 Presence of complex medical disorders before pregnancy
 Substance abuse especially methamphetamine use
 Multi gravida
 Maternal age over 40
 Previous history of abruption
 Hypertension
 Pre-eclampsia
 Trauma
 Unknown
60
Q

What are the 3 types of placental abruption?

A

• Central/concealed
- Separation is in the middle

• Revealed/marginal
- Separation is near the edge of the placenta

• Partially revealed
- Combination of both of the above

61
Q

what is the presentation of placental abruption?

A

 Vaginal bleeding may or may not occur
(depending on type)

 ↑ Pulse ↓ BP, hypovolaemic shock,

 Abdo pain ++

 Tender uterus

 Anxious; “impending doom”
→ Concealed bleeding into uterine muscle
→ Causes uterine enlargement
→ Extreme pain & hard & rigid abdomen

62
Q

What are some complications of placental abruption?

A

 Disseminated Intravascular coagulation (DIC)-
– inappropriate coagulation within blood vessels

 Post partum Haemorrhage (PPH)

 Renal failure

 Pituitary necrosis

 Distressed baby

 Foetal death in-utero (FDIU)

63
Q

What is a uterine rupture?

A

 Tear in the uterus
– often associated with
prior caesarean section

64
Q

What are the risk factors for uterine rupture?

A

 Previous caesarean section

 Other uterine surgery or termination of pregnancy

 Grand multiparity (>6)

 Undiagnosed cephlopelvic disproportion

 Macrosomic (large) baby

 Placenta percreta

 External cephalic version

 Uterine abnormalities

65
Q

What are the clinical signs of placental rupture?

A

 If in labour
– Sudden cessation of contractions
– Elevation of the presenting part

 Severe constant pain

 Foetal death (FDIU)

 Maternal shock disproportionate with clinical signs
– Concealed haemorrhage

PAR3031 - MATERNITY (11 decks)

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