Complicated Pregnancy - Early labour and ectopic pregnancy Flashcards
How common is an ectopic?
1 in 90 pregnancies so pretty common
What are the most common locations for an ectopic?
97% tubal:
- Mainly Ampullary
- Some Isthmus
- Rarely Intramural 1%
- Ovarian 0.1%
- Cervical
- Rarely Fimbrial
In what women would we be particularly wary of ectopics?
Risk factors include:
- Pelvic Inflammatory Disease
- Tubal surgery
- Previous ectopic
- Assisted conception e.g. IVF
How would you tell an ectopic pregnancy?
- Period of ammenorhoea
- +/_ Vaginal bleeding
- +/_ Pain abdomen
- +/_ GI or urinary symptoms
How do we test to confirm an ectopic?
First do an US, you should see:
- No intrauterine sac
- Possibly an adnexal mass
- Blood in the pouch of Douglas
Serum BHCG Progesterone
What does Serum BHCG tell us about an ectopic?
Serially tracked over 48 hours it increase by at least 66%
However, an ectopic will rise sub-optimally
How can you treat an ectopic pregnancy?
- Conservative (if she’s stable it may shrink on its own)
- Medical - Methotrexate
- Surgical - Laparoscopic salpingectomy if there’s a risk of rupture and/or very unstable
Define preterm labour and its grades
Preterm means onset <37wks/259days
- 32-36 wks mildly preterm
- 28-32 wks very preterm
- 24-28 wks extremely preterm
Is preterm labour more common in single or multiple pregnancies?
Multiple (6% in singles and 35% in multiples)
Most Preterm Labours are Idiopathic!!! But what are the common causes?
- Multiple pregnancy
- Polyhydramnios: XS amniotic fluid in amniotic sac
- APH
- Pre-eclampsia
- Infection e.g. UTI
- Premature membrane rupture
How do we spot if someone’s in pre-term labour?
Just like normal labour:
- Are they contracting?
- Is there cervical change on VE?
Important to then consider why; look for signs of infection, hypertension or enlarged uterine volume
How do we go about managing a pre-term labour?
<24-26wks very poor prognosis soinvolve the family and neonatologist in decisions as there’s a high risk of failure and disability
- Tocolysis
- Steroids
- Newborn Intensive Care Unit (NICU)
- Vaginal delivery
What is Tocolysis and when do we use it?
Tocolysis encompasses labour suppressant meds.
They are drugs that prevent preterm labour and immature birth by suppressing uterine contractions.
You can use it for up to 24hrs in order to transfer the patient to a facility with a NICU and to give steroids
Why give steroids in pre-term labour?
Speeds up surfactant development allowing the baby to survive outside the womb (i.e. to breathe)
What are the common complications of prematurity?
- Resp Distress Syndrome
- Intraventricular Haemorrhage
- Cerebral Palsy
- Jaundice
- Infections
- Visual or hearing impairment
- Hypothermia
- Hypoglycaemia
