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Complications of Pregnancy Flashcards

1
Q

What is a spontaneous miscarriage?

A

Termination/loss of pregnancy before 24 weeks gestation

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2
Q

What is a threatened miscarriage?

A

Vaginal bleeding ± pain
Viable pregnancy
Closed cervix on speculum examination

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3
Q

What is an inevitable miscarriage?

A

Viable pregnancy

Open cervix with bleeding that could be heavy ± clots

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4
Q

What is a missed miscarriage?

A

No symptoms or could have bleeding
Gestational sac seen on scan
No clear fetus or a fetal pole with no heart seen in the sac

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5
Q

What is a incomplete miscarriage?

A

Most of pregnancy is expelled but some product remains
Open cervix
Vaginal bleeding

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6
Q

What is a complete miscarriage?

A

When everything is passed and there is nothing on a scan

Cervix is closed and bleeding has stopped

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7
Q

When can a septic miscarriage occur?

A

Especially in cases of an incomplete miscarriage

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8
Q

What can cause a spontaneous miscarriage?

A

Abnormal conceptus - chromosomal, genetic or structural
Uterine abnormal - congenital and fibroids
Cervical incompetence can be primary or secondary
Maternal - increasing age, diabetes
Iatrogenic

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9
Q

How do you manage a miscarriage?

A 
Threatened = conservative
Inevitable = if bleeding is heavy may need evacuation
Missed = conservative, medical, surgical
Septic = antibiotics and evacuate uterus
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10
Q

What are the risk factors for ectopic pregnancy?

A

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

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11
Q

What is the presentation for an ectopic pregnancy?

A

Period of ammenorhoea
± Vaginal bleeding
± Pain in the abdomen
± GI or urinary symptoms

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12
Q

What are the investigations for ectopic pregnancy?

A

Scan = no sac, fluid in pouch of Douglas
Serum BHCG levels - 48h between and should see 66% increase in normal
Serum progesterone levels - >25ug/ml

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13
Q

What is the management or ectopic pregnancy?

A

Medical = methotrexate
Surgical
Conservative

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14
Q

What is an antepartum Haemorrhage?

A

APH is a haemorrhage from the genital tract after the 24th week of pregnancy but before delivery of the baby

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15
Q

What are the causes of an antepartum haemorrhage?

A 
Placenta previa
Placental abruptioin
Unknown origin
Local lesion
Vasa praevia (rare)
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16
Q

What is a placenta previa?

A

Where all or part of the placenta implants in the lower uterine segment

More common in:

  • Multiparous women
  • Multiple pregnancies
  • Previous c-section
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17
Q

What is the classifications of placenta previa?

A

Classificaltion

  • Grade I = enroaching on lower but not the cervical os
  • Grade II = reaches OS
  • Grade III = covers OS
  • Grade IV = central placenta preavia
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18
Q

What is the presentation of placenta previa?

A

Presentation

  • Painless PV bleeding
  • Malpresentations of the fetus
  • Incidental
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19
Q

What is the features, diagnosis and management of placenta previa?

A

Features

  • Maternal condition correlates with ammount of bleeding
  • Soft, non-tender ± malpresentation

Diagnosis

  • USS to locate
  • DO NOT do a vaginal examination

Management

  • Gestation
  • Severity
  • C-section, watch for PPH (post partum haemorrhage)
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20
Q

What is the management of PPH?

A

Medical

  • Oxytocin
  • Ergometrine
  • Carbaprost
  • Tranecemic acid

Balloon tamponade

Surgical

  • B lynch suture
  • Ligation of uterine iliac vessels
  • Hysterectomy
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21
Q

What is placental abruption?

A

Haemorrhage resulting from a premature separation of the placenta before the birth of the baby

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22
Q

What are the risk factors for placental abruption?

A 
Pre-eclampsia
Multiple pregnancies
Polyhydramnios
Smoking, age, parity
Previous abruption
Cocaine use
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23
Q

What are the clinical types and presentation of placental abruption?

A

Placental abruption

  • Revealed
  • Concealed
  • Mixed

Presentation

  • Pain
  • Vaginal bleeding
  • Increasing uterine activity
24
Q

What is the management of placental abruption?

A

Management will vary from treatment to vaginal delivery to c-section depending on

  • Amount of bleeding
  • General condition of mother and baby
  • Gestation
25
Q

What are the complications of placental abruption?

A

-Maternal shock
-Fetal death
Maternal DIC and renal failure
-Postpartum haemorrhage

26
Q

What is preterm labour?

A

Onset of labour before 37 completed weeks of gestation
24-28 = extreme
28-32 = moderate
32-37 = mild

27
Q

What are predisposing factors to preterm labour?

A 
Multiple pregnancies
Polyhydramnios
APH
Pre-eclampsia
Infection 
Prelabour premature rupture of membranes
28
Q

What is the management of preterm delivery?

A

Diagnosis
-Contractions and evidence of cervical change

Consider possible causes like abruption or infection

Consider tocolysis to allow for steroids and transfer
2 doses of steroids
Transfer to unit with NICU
Aim for vaginal delivery

29
Q

What are neonatal morbidity resulting from prematurity

A 
Resp distress
Intraventricular haemorrhage
Cerebral plasy
Nutrition
Temp control
Jaundice
Infection 
Visual impairments
Hearing loss
30
Q

What is chronic hypertension values?

A 
Mild = 90/140
Moderate = 100/150
Severe = 110/160+
31
Q

What is gestational hypertension?

A

BP like chronic values but new (develops after 20weeks)

32
Q

What is pre-eclampsia?

A

New hypertension >20 in association with proteinuria

Multi-system multi-organ disorder
-Liver, renal, vascular, cerebral and pulmonary

33
Q

What is significant proteinuria?

A

Strip = >1
Spot protein = creatinine ration >30mg/mmol
24h protein = >300mg/day

34
Q

How to manage essential/chronic hypertension?

A

Change drugs if indicated (ramipril = impaired growth)

Aim to keep B <150/100
Monitor fetal growth
May have a higher incidence of placental abruption

35
Q

What is the pathophysiology of pre-eclampsia?

A

Immunological
Genetic predisposition
Secondary invasion of maternal arterioles by trophoblasts –> reduced perfusion
Imbalance between vasodilators/constrictors

36
Q

What are the RF’s for pre-eclampsia?

A 
1st pregnancy
Extremes of maternal age
In previous pregnancy
Large pregnancy interval
BMI >35
FH
Multiple pregnancy
Underlaying disorders
-Hypertension
-Renal disease
-Diabetes
-Autoimmune disorders
37
Q

What are the complications of pre-eclampsia?

A 
Seizures
Haemorrhage and stroke
Renal failure
Pulmonary oedema
Cardiac failure
HELLP and DIC

Fetal = impaired placental perfusion = distress, prematurity and increased mortality

38
Q

What are the Signs and symtoms in severe pre-eclampsia?

A 
Headache, blurred vision, epigastric pain, vomiting, swelling
Severe hypertension
Clonus
Reduced urine output
Convulsions
39
Q

What are the Biochemical changes in severe pre-eclampsia?

A

Raised liver enzymes
Bilirubin if HELLP present
Raised urea and creatinine
Raised urate

40
Q

What are the Haematological changes in severe pre-eclampsia?

A

Low platelets

Low HB and haemolysis

41
Q

What is the Management of severe pre-eclampsia?

A

BP checks and urine protein
Check symptoms + hyper-reflexia
Blood investigations = FBC, LFT’s, RFT’s and coagulation if indicated
Fetal investigations = growth and CTG

Only cure = delivery of baby and placenta

Management is conservative = anti-hypertensives, steroids for lung maturity if gestation
Consider induction of labour

Must monitor post delivery

42
Q

What is the Incidence of PET and eclampsia?

A

5-8% = PET

  1. 5% = severe PET
  2. 05% = seizures
43
Q

What is the treatment of seizures in pregnancy?

A

Magnesium sulphate
Control BP - labetolol
Avoid fluid overload = 80mls/hr

Prophylaxis = low dose aspirin

44
Q

What is Gestational diabetes?

A

Carb intolerence with onset in pregnancy
Abnormal glucose tolerance that reverts to normal after delivery
More at risk of developing T2DM in later life

45
Q

What happens with pre-existing diabetes in pregnancy?

A

Insulin requirements increase
Fetal hyper-insulinemia occurs (macrosomia)
After birth = more risk of neonatal hypoglycaemia and increased risk of resp distress

46
Q

What are the effects of diabetes on mother and baby?

A

Fetal abnormalities
Miscarriage
Fetal macrosomia and polyhydramnios
Operative delivery and shoulder dystocia
Still birth and increased perinatal mortality
Pre-eclampsia
Maternal nephropathy, retinopathy and hypoglycaemia
Infections
Neonate = impaired lung maturity, hypoglycemia and jaundice

47
Q

What is the management of diabetes in pregnancy?

A

Pre = beter glycemic control (4-7mmol/l)
Folic acid 5mg
Dietary advice
Retinal and renal assessment

During = optimise glucose control
Continue metformin but may need insulin
Advice on hypo and glucagon injections
Watch for ketonuria 
Repeat retinal assessments 28/34W
Watch fetal growth 
Observe for PET
Labour induced early (38-40w)
Elective c-section
CTG in labour
48
Q

What are the RF’s for gestational diabetes?

A 
Increased BMI >30
Previous macrosomic baby
Previous GDM
FH of diabetes
Recurrent glucosuria in pregnancy
49
Q

What is the Screening for GDM?

A

HbA1C

OGTT to be done and then repeat at 24-28w

50
Q

What is the management of GDM?

A

Diet control of sugars
Metformin and insulin if needed
Check OGTT post delivery

51
Q

What is Virchow’s triad 3 principles?

A

Stasis
Vessel wall injury
Hypercoagulability

52
Q

Why is venous thrombo-embolism more likely to occur in pregnancy?

A
  • Pregnancy is a hypercoagulable state
  • Increased stasis = progesterone, effects of a growing uterus
  • May be vascular damage at delivery/c-section
53
Q

What causes increased risk of Venous thrombo-embolism in pregnancy

A 
Parity
Increased BMI
Smokers
Drugs
PET
Dehydration
Decreased mobility
Infections
Prolonged labour
Haemorrhage
Previous VTE
Sickle cell
54
Q

What is VTE prophylaxis in pregnancy?

A

TED stockings
Increased mobility and hydration
Prophylactic anti-coagulation and continued 6w post-partum

55
Q

What are the signs and symptoms of VTE?

A 
Pain in calf
Increased girth
Muscle tenderness
Breathlessness
Pain on breathing
Cough
Tachycardia
Hypoxic
Pleural rub
56
Q

What are the investigations for VTW?

A

ECG
Blood gases
Doppler V/Q
CTPA

Appropriate treatment with anti-coagulation if VTE confirmed

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