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Reproduction and Sexual Health > Early Pregnancy Complications > Flashcards

Early Pregnancy Complications Flashcards

1
Q

define a miscarriage

A

removal of products of conception prior to 24 weeks gestation

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2
Q

what is the most common cause of early bleeding in pregnancy

A

miscarriage

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3
Q

outline some of the causes of miscarriage

A

infection
abnormal conceptus - chromosomal
uterine abnormalities - incompetent uterus
toxins - smoking, alcohol, drugs, infection
immune diseases
trauma - amniocentesis, coitus
IUCD

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4
Q

describe the features of a threatened miscarriage

A 
pregnancy test positive 
cervix is closed 
pain and bleeding
uterus = gestational age 
foetal heart beat present + foetal pole present
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5
Q

how is a threatened miscarriage managed

A

reassurance and rest

avoid coitus

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6
Q

what is an inevitable miscarriage

A 
pregnancy test positive
cervical os open 
foetal heart beat present 
pain and bleeding
choice of management is up to woman between conservative, medical or surgical
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7
Q

what is an incomplete miscarriage

A

some of the products of conception have passed whilst others remain in the uterus
cervical os open - products may be visible
woman usually in cervical shock with heavy bleeding
no foetal heartbeat

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8
Q

how does cervical shock present

A

occurs when there is incomplete emptying of conceptus
severe abdo pain
nausea/vomiting
sweating, faint, tachycardia
manage with fluids, uterotonics and remove products of conception

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9
Q

how is an incomplete miscarriage managed

A

blood transfusion if in shock
oxytocic
remove POCs
bimanual compression

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10
Q

what are the features of a complete miscarriage

A

all POC have passed
uterus is empty and small for gestational age
no foetal heart beat
may have pain, amenorrhoea

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11
Q

how is a septic miscarriage managed

A

antibiotics, resuscitation and evacuation of uterus

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12
Q

how many miscarriage must a woman have had before they are classified as recurrent

A

3 or more

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13
Q

how is a miscarriage managed conservatively

A

allow the pregnancy to run its natural course

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14
Q

how is a miscarriage managed medically

A

administration of misoprostol

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15
Q

how is a miscarriage managed surgically

A

evacuation of uterus

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16
Q

if a woman with recurrent miscarriage is found to have antiphospholipid syndrome or thrombophilia, what drugs can help her pregnancy

A

low dose aspiring and daily fragmin injections

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17
Q

what is a molar pregnancy

A

a non-viable fertilised egg is made with overgrowth of placental tissue - swollen fluid appearing with grape like clusters

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18
Q

describe a partial molar pregnancy

A

one set of DNA from the egg and 2 from the sperm - fertilised egg causes triploidy
foetus may be present

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19
Q

describe a complete molar pregnancy

A

no DNA from the egg and 2 sets from the sperm causing diploidy
no foetus is present, just overgrowth of placental tissue

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20
Q

a complete mole carries a small risk of what cancer

A

choriocarcinoma

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21
Q

how does a molar pregnancy present

A

extreme hyperemesis
fundus is large for dates
heavy bleeding which may appear like frogspawn

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22
Q

describe the HCG and USS findings seen with molar pregnancy

A

HCG - unusually high for dates hence hyperemesis

USS - snow storm appearance

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23
Q

how is a molar pregnancy managed

A

surgical evacuation irrespective of type, tissue is sent to histology to determine type of mole
women are followed up at specialist centres

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24
Q

what is hyperemesis

A

excessive and prolonged vomiting

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25
Q

list some complications of hyperemesis

A 
dehydration 
ketosis 
electrolyte disturbance 
nutritional imbalance 
weight loss 
altered LFTs
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26
Q

how is hyperemesis managed

A

IV fluids and anti-emetic (oral if possible)

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27
Q

state the first and second line antiemetics used for hyperemesis

A

first line - cyclizine and prochlorperazine

second line - ondansetron and metaclopramide

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28
Q

give some examples of sensitising events requiring Anti-D immunisation

A 
placental abruption
abdo trauma 
amniocentesis/CVS
foetal death
vaginal bleeding from 12 weeks 
TOP 
ectopic pregnancy
delivery of Rh+ve baby
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29
Q

outline some of the risk factors for developing hypertension in pregnancy

A 
increasing maternal age
BMI >30 
FH of hypertension 
parity 
previous hypertension 
African origin
medical conditions such as renal disease, diabetes, connective tissue diseases and thrombophilia
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30
Q

what BP measurements warrant hospital admission

A

> 170/110 mmHg

>140/90 with significant proteinuria

31
Q

what are the 3 types of hypertension to be aware of during pregnancy

A

pre-existing hypertension
pregnancy induced hypertension
pre-eclampsia

32
Q

what are the features of pregnancy induced hypertension

A

usually develops in second trimester
resolves within 6 weeks postnatally
no additional features such as proteinuria and headache

33
Q

what is the blood pressure target for someone with hypertension in pregnancy

A

140/90mmHg

34
Q

which antihypertensives are safe to use in pregnancy

A

labetolol
nifedipine
hydralazine
methyldopa

35
Q

which antihypertensive is contraindicated in asthma

A

labetolol

36
Q

which antihypertensive is contraindicated in depression

A

methyldopa

37
Q

are ACEi/ARBs safe in pregnancy

A

no as can causes renal agesis

38
Q

what is pre-eclampsia

A

pregnancy induced hypertension with proteinuria and oedema

39
Q

what causes pre-eclampsia to develop

A

failure of trophoblastic invasion of spinal arteries leaving them vasoactive
hypertension is a compensatory mechanism

40
Q

what are the risk factors for developing pre-eclampsia

A 
increasing maternal age
BMI >35
CKD 
autoimmune disease 
diabetes 
existing hypertension or previous pre-eclampsia 
pregnancy interval >10 years 
first pregnancy
41
Q

how is pre-eclampsia screened for

A

uterine artery doppler

42
Q

outline some of the clinical features of pre-eclampsia

A 
hypertension
headache - cerebral oedema 
Hyperreflexia and clonus 
proteinuria 
visual disturbance
43
Q

what is one of the complications of pre-eclampsia

A

HELLP syndrome

44
Q

what is eclampsia

A

pre-eclampsia + tonic clonic seizures

45
Q

when is the highest change that eclampsia will develop

A

post-partum

46
Q

what are the effects on the foetus with eclampsia

A

bradycardia

reduced variability on CTG

47
Q

what drug is given to prevent seizures with eclampsia

A

IV magnesium sulphate

48
Q

what is HELLP syndrome

A

haemolysis
elevated liver enzymes
low platelets

49
Q

what are the clinical features of HELLP syndrome

A

nausea/vomiting
fatigue
RUQ pain

50
Q

what is the HbA1C target for pregnancy and what level should pregnancy be avoided

A

target - 48 mmol/l

avoid - >86 mmol/l

51
Q

outline several parts of the antenatal care plan that differ for women with existing diabetes

A 
high dose folic acid 
low dose aspirin 
regular eye checks for retinopathy 
growth scans every 4 weeks from 28 weeks 
safety advice about hypos
52
Q

what is the main change in diabetes medication for women with existing diabetes

A

switch any oral hypoglycaemic agents to metformin and insulin

53
Q

when should delivery be planned for in a woman with existing diabetes

A

aim for 38 weeks, opt for c-section if foetal weight >4.5kg

54
Q

what are some of the complications of a child with maternal diabetes

A 
macrosomia 
shoulder dystocia 
polyhydramnios 
still birth 
vaginal trauma in labour
55
Q

what is the screening tests for gestational diabetes

A

high risk women screened at booking

oral glucose tolerance test - fasting and then 2 hour after 75g of glucose

56
Q

what are the diagnostic values for GDM

A

fasting - >5.1mmol/l

2 hour - >8.5mmol/l

57
Q

what is pre-term pre-labour rupture of membranes

A

breakage of the amniotic sac before the onset of labour

58
Q

what causes PPROM

A

infection - weakens the tensile strength of membranes
cervical incompetence
over-distention eg multiple pregnancy and polyhydramnios
placental abruption

59
Q

list some of the adverse effects of baby’s born before 26 weeks

A 
risk of cerebral palsy
walking problems 
blindness
profound deafness 
reduced IQ
60
Q

how is PPROM managed

A

monitor for chorioamnionitis
give antibiotics to prevent ascending infection - erythromycin first line
tocolytics to prevent contraction such as nifedipine

61
Q

what is the most severe complication of anti-D crossing to the baby

A

hydros fetalis

62
Q

what are the features of a foetus with hydros fetalis

A 
extensive oedema causing ascites, pleural or pericardial effusion 
hepatosplenomegaly 
progressive anaemia 
CNS signs 
jaundice
63
Q

list some pre-existing causes for VTE in pregnancy

A 
previous VTE
BMI >30 
smoking 
age >35
varicose veins 
thrombophilia
64
Q

list some obstetric causes for VTE in pregnancy

A 
multiple pregnancy 
c-section 
pre-eclampsia 
prolonged labour 
PPH
65
Q

list some transient causes for VTE in pregnancy

A 
hyperemesis 
ART/IVF
systemic infection 
admission and immobility 
wound infection
66
Q

what investigation is carried out if suspicion of DVT is high

A

duplex ultrasound

67
Q

state the findings for PE on ECG

A 
sinus tachycardia 
T wave inversion 
right axis deviation 
right bundle branch block 
atrial arrhythmias
68
Q

what are the advantages and disadvantages of CTPA and V/Q in pregnancy

A

CTPA is preferred but increases breast cancer risk
V/Q slight risk of childhood cancer in foetus
mother must be informed of the risks

69
Q

how is VTE in pregnancy managed

A

LMWH until 3 days postnatally, then can be swapped for warfarin due to teratogenicity risks and PPH risk until 3 days post party
must be continued until 6 weeks postnatally

70
Q

what are the 3 types of breech presentation

A

complete - legs folded to level of bum
footling - one of both legs hanging down so feet emerge first
frank - legs above bum so bum is delivered first

71
Q

what are the risk factors for a breech baby

A 
idiopathic 
uterine abnormalities 
prematurity 
oligohydramnios 
foetal abnormalities 
placenta praevia
72
Q

how is breech position swapped to cephalic

A

external cephalic version - manually turn the baby into cephalic presentation if vaginal delivery is planned

73
Q

what must a breech baby be screened for after birth

A

hip dislocation at 6 weeks

Klumpkes palsy

Reproduction and Sexual Health (22 decks)

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