Complicated Pregnancy 2 Flashcards

1
Q

This deck will cover:

A

Ectopic Pregnancies
Early Labour

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2
Q

How common is an ectopic?

A

1 in 90 pregnancies so pretty common

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3
Q

What are the most common locations for an ectopic?

A

97% tubal:
- Mainly Ampullary
- Some Isthmus
- Rarely Intramural

1% Ovarian

0.1% Cervical

Rarely Fimbrial

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4
Q

In what women would we be particularly wary of ectopics?

A

Risk factors include:
- PID
- Tubal surgery
- H/o
- Assisted conception e.g. IVF

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5
Q

How would you tell an ectopic pregnancy?

A

They’ll initially appear pregnant in that they have a period of amenorrhoea with a +ve pregnancy test.
Ectopic signs include:
- Vaginal bleeding
- Abdo Pain
- GI/Urinary pressure symptoms

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6
Q

How do we test to confirm an ectopic?

A

First do an US, you should see:
- No intrauterine sac
- Possibly an adnexal mass and/or blood in the pouch of douglas

Also do serum BHCG & Progesterone

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7
Q

What does Serum BHCG tell us about an ectopic

A

Serially tracked over 48 hours it increase by atleast 66%
However an ectopic will rise sub-optimally

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8
Q

How can you treat an ectopic pregnancy?

A

1) Conservative (if she’s stable it may shrink on its own)
2) Medical - MTX
3) Surgical - Laparoscopic salpingectomy if there’s a risk of rupture and/or very unstable

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9
Q

Define preterm labour and its grades?

A

Preterm means onset <37wks/259days

Mildly preterm = 32-36wks
Very Preterm = 28-32 wks
Extremely Preterm = 24-28wks

Preterm labour can be both spontaneous or Induced

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10
Q

Is preterm labour more common in single or multiple pregnancies?

A

Multiple duh, seriouslly could you stay being that close to your roomate for 9 months?

(6% in singles and 35% in multiples)

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11
Q

Most Preterm Labours are Idiopathic!!!
But what are the common causes?

A
  • Multiple pregnancy
  • Polyhydramnios
  • APH
  • Pre-eclampsia
  • Infection e.g. UTI
  • Premature membrane rupture
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12
Q

How do we spot if someone’s in pre-term labour?

A

Just like normal labour:
1) Are they contracting?
2) Is there cervical change on VE?

Important to then consider why, look for signs of infection, hypertension or enlarged uterine volume

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13
Q

How do we go about managing a pre-term labour?

A

Firstly involve the family and neonatologist in decisions as there’s a high risk of failure and disability

  • Tocolysis
  • Steroids
  • NICU
  • Vaginal Delivery
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14
Q

What is Tocolysis and when do we use it?

A

Tocolysis encompasses labour suppressant meds.
You can use it for up to 24hrs in order to transfer the patient to a facility with a NICU & to give steroids

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15
Q

Why give steroids in pre-term labour?

A

Speeds up surfactant development allowing the baby to survive outside the womb (i.e. to fuckin breathe)

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16
Q

What are the common complications of prematurity?

A
  • Resp Distress Syndrome
  • Intraventricular HAemorrhage
  • Cerebral Palsy
  • Jaundice
  • Infections
  • Visual or hearing impairment
  • Hypothermia
  • Hypoglycaemia