Complicated Pregnancy 1 Flashcards
(44 cards)
Define miscarriage [2]
Spontaneous termination <24 weeks gestation with no evidence of life
Define a threatened miscarriage? [3]
Vaginal bleeding (small amount) +/- pain
Viable pregnancy <24 weeks
Cervix closed on speculum examination – cervix not dilated
Inevitable miscarriage definition [2]
Outcome [2]
Cervix open, bleeding heavy ~ clots
viable pregnancy <24 weeks
Outcome: most likely will progress to miscarriage
Whats the difference between a complete or incomplete abortion?
Complete all POC have been expelled, the cervix closed and bleeding stopped.
In incomplete POC expelled but some remain, cervix open and bleeding ongoing
How do we confirm if a woman has had a complete abortion?
We need to either see the POC and confirm them to be that.
Or have a previous scan that confirms there was a viable pregnancy before
Define a septic miscarriage [2]
NB More common in incomplete miscarriage
When infection ascends into the uterus and throughout the pelvis following a miscarriage.
Define a missed abortion [2]
Appearance on US [2]
When the foetus has died but the uterus hasn’t attempted to expel the POC.
It can appear on US like a gestational sac lacking a foetus or a foetal pole <7mm without heart beat
List the major causes of a miscarriage [4]
- Abnormal conceptus, mainly chromosomal
- Uterine abnormality
- Cervical Incompetence
- Maternal conditions
What 2 uterine abnormalities could cause a miscarriage?
A congenital abnormality
Fibroids
What causes cervical incompetence?
How can this be managed?
Trauma including past surgical procedures eg LLETZ
Mx: Cervical suture at 14w
What maternal problems could cause a miscarriage? [5]
Increasing age Low progesterone SLE DM, Thyroid disease Acute infections e.g. appendicitis
How would we manage a threatened abortion? [1]
Why?
Advice [2]
Conservative management
Why? best to try to get the foetus past 24wks so we can deliver and it will survive
Avoid strenuous activity and sexual intercourse but bed rest not necessary
Hormones or tocolytic agents are ineffective
How would we manage an inevitable abortion? [3]
NB Attempts to save fetus are futile
Conservative: rescan at 2w to ensure no retained POC
Profuse bleeding: ergometrine IM
Unacceptable bleeding >2w, pain or retained POC: SMM
How would we manage a missed miscarriage? [5]
Expectant
- waiting 7-14d for miscarriage to complete spontaneously
Medical
- Vaginal MISOPROSTOL
- Seek senior help if bleeding hasn’t stopped in 48h
- Indicated if higher haemorrhage risk
SMM:
- Manual vacuum aspiration under LA or GA
How do we define a recurrent miscarriage?
How do we manage a septic miscarriage? [2]
> 3 losses before 24w with same biological father
Mx:
- Abx
- Evacuate the uterus of remaining POC
Define an Antepartum Haemorrhage [1]
Bleeding from genital tract >24wks but before delivery
List the major causes of an APH [5]
Placenta Praevia Placental Abruption Local lesion of genital tract APH - idiopathic Vasa Praevia
In what women is Placenta Praevia a risk? [5]
Multiparous Multiple pregnancy Previous C-section IVF assisted Previous surgical termination
Placenta previa grading and classification [4]
NB First 2 minor, last 2 major
Graded 1-4:
1) Placenta doesn’t touch internal cervical orifice (Os)
2) Placenta reaches Os
3) Placenta eccentrically covers Os
4) Central Placenta Praevia (directly over Os)
How does a case of placenta praevia present? [4]
- Painless PV bleeding
- ~Malpresentation - transverse or oblique
- Soft non-tender uterus
- Shock if lot of blood loss
- Maternal condition correlates with amount of bleeding PV
How do we confirm a case of placenta praevia?
TVUSS
Often picked up on routine 20w scan
Don’t do vaginal exam till you’ve ruled it out with US as it could trigger a bigger bleed.
Management of placenta previa:
Caution during c-section [1]
Mx is dependent on:
Gestation
Severity
Watch out for PPH if c-section
Mx is dependent on gestation
- 30 weeks = conservative
- But if severe bleeding > disregard GA
Define Placental Abruption
Hemorrhage resulting from premature separation of placenta before birth
What are the types of placental abruption? [3]
Revealed - blood can escape through Os
Concealed - Blood trapped between placenta/uterine wall
Mixed
