Complications during pregnancy - Other Flashcards
Other (than haemorrhage) complications of pregnancy
Pregnancy induced HTN
Pre-eclampsia
Eclampsia
HELLP Syndrome
Amniotic Fluid Embolism / Pulmonary Embolism
Maternal Sepsis
Pregnancy Induced HTM (PIH)
A generic term for a significant rise in blood pressure after 20 weeks gestation, in the absence of proteinuria or other features of pre-eclampsia.
Mostly uncomplicated - outcomes are good
Can be classified as:
Chronic HTN
Gestational HTN
15% of women with PIH develop pre-eclampsia
Pre-eclampsia
PIH associated with proteinuria with or without oedema.
Is relatively common condition but can be fatal for mother and baby.
Primarily a placental disorder - poor placental perfusion.
Incidence of severe pre-eclampsia is 5:1000
Half of women with severe pre-eclampsia will deliver before 36 weeks.
Classified as:
Mild 140-149 / 90-99
Moderate 150-159 / 100-109
Severe >160 / 110
Pre-eclampsia risk factors
10 years or more since last pregnancy
Primiparity or first pregnancy with new partner
Previous sever pre-eclampsia
Essential HTN
Diabetes (1 or 2)
Obesity
Twins or higher multiples
Renan disease
Advanced or Young maternal age (over 40 or less than 16)
Pre existing cardiovascular disease
Pre-eclampsia S and S
Mild/moderate
BP >140/90 with proteinuria and sometimes oedema
Severe BP >160/110 with proteinuria and any one of the following: Headache. Visual disturbances. Epigastric pain. Side sided upper quadrant abdominal pain. Muscle twitching or tremor. Nausea. Confusion. Rapidly progressive oedema.
Eclampsia
Presents as generalised tonic chronic convulsion, identical to epilepsy.
One in three cases present for first time post delivery, within 48 hours.
BP may only be mildly elevated at presentation.
One of the most dangerous complications of pregnancy, 2% mortality in UK.
Convulsions usually self-limiting, 2 to 3 minutes, can occur up to 6 weeks postpartum.
Risk of foetal compromise/death due to hypoxia from convulsion.
HELLP syndrome
A complication/serious form of pre-eclampsia/eclampsia.
Haemolysis (destruction of red blood cells)
Elevated Liver enzymes
Low Platelet count
Typically manifests between 32 to 34 weeks gestation, can present postpartum.
Symptoms are often non-specific.
Results in liver damage which can progress rapidly to liver failure. pt will have tenderness over their liver.
Treatment is delivery of the baby plus blood transfusion.
Mortality is significant without treatment.
Amniotic Fluid Embolism
Entry of amniotic fluid into the maternal circulation via the placental bed.
Can only occur if the maternal circulation is exposed to amniotic fluid, so the placenta has come away from the uterine wall, there is an opening on the inside of the uterine wall allowing amniotic fluid to enter the circulation.
Rare but fifth leading cause of death in the UK.
Mortality rate of 0.33 per 100,000 pregnancies.
More likely to occur in older, multiparous women in advance labour.
Often occurs after waters have broken.
Amniotic fluid Embolism Risk Factors
Termination of pregnancy.
Amniocentesis.
Placental abruption.
Trauma. C-section.
Prior to and up to 30 minutes post delivery.
Amniotic fluid Embolism S and S
Often rapid collapse in advanced labour.
Dyspnoea.
Cyanosis.
Acute hypotension.
Cardiac arrest.
May have feeling of impending doom, agitation, restlessness.
Suspect AFE in any patient in advanced labour with sudden collapse with hypoxia/cardiovascular compromise in the absence of other symptoms.
Pulmonary Embolism
Pulmonary embolism is an obstruction of the pulmonary vessels reducing profusion.
Can be small, major or massive - massive often immediate or rapidly, within an hour, fatal, CPR futile.
PE in pregnancy remains a leading cause of maternal mortality in the developed world.
PE is approximately 10 times more common in pregnant women than non-pregnant women. 1 in 1000.
Highest risk in the postnatal period.
Pumonary Embolism Risk Factors
Over 35. Obesity.
Previous history of PE.
Gross varicose veins.
Major concurrent illness e.g. cancer.
Prolonged Immobility.
Long haul travel.
Lower segment C-section.
Prolonged labour over 12 hours.
Surgical procedures during pregnancy.
Pulmonary Embolism S and S
Dyspnoea.
Tachycardia.
Pleuritic/substernal chest pain.
Apprehension.
Cough.
Haemoptysis.
Syncope/sudden collapse.
Signs of DVT - check legs.
Maternal sepsis
Antepartum and puerperal (6 weeks post delivery) sepsis are on of the leading causes of maternal mortality in the UK.
Can BE:
Directly related, i.e. pregnancy or genital tract related.
Indirectly related, i.e. influenza, pneumonia, E. coli, group a and B strep.
Reduced immunity during pregnancy, more susceptible.
Can have a rapid onset.
Pregnant or Puerperium may present with D and V, nausea and Abdo pain which may seem generalised but in the pregnant/postpartum women should be taken seriously.
Consider any woman who is pregnant, has given birth or had a termination of pregnancy or miscarriage within the past six weeks.
Maternal Sepsis Risk Factors
Impaired immune system due to illness or drugs.
Gestational diabetes, diabetes or other comorbidities.
Undergone invasive procedures e.g. C-section, forceps delivery, removal of retained products of conception.
Prolonged rupture of membranes.
Been in close contact with people with group a strep.
Has continued vaginal bleeding or offensive vaginal discharge.
