Complicated Pregnancy: Pregnancy complications Flashcards

Question

1. Use of magnesium sulphate in eclampsia? 2. what should you monitor after giving woman magnesium sulfate?

Answer 1

1. prevent seizures in patients with severe pre-eclampsia and treat seizures once they develop. 2. monitor reflexes and respiratory rate

Answer 2

Magnesium sulphate should be given as soon as the decision to deliver has been made IV bolus of 4g over 5-10 minutes should be given followed by an infusion of 1g / hour urine output, reflexes, respiratory rate and oxygen saturations should be monitored during treatment respiratory depression can occur: calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression treatment should continue for 24 hours after last seizure or delivery (around 40% of seizures occur post-partum)

Answer 3

Placenta fully or partially attached to the lower uterine segment Cause of antepartum haemorrhage

Answer 4

Vaginal bleeding from week 24 gestation until delivery

Answer 5

Minor placenta praevia- placenta is low but does not cover the internal cervical os Major placenta praevia- placenta lies over the internal cervical os.

Answer 6

Spontaneous Mild trauma e.g. vaginal examination May get damaged as the presenting part of the fetus moves into lower uterine segment

Answer 7

Multiparity Multiple pregnancy Maternal age>40 Previous placenta praevia Lower segment scar History of uterine infection (endometriosis)

Answer 8

Shock in proportion to visible loss no pain uterus NOT tender lie and presentation may be abnormal Fetal HR usually normal Coagulation problems rare Small bleeds before large

Answer 9

Any women presenting with painless vaginal bleeding May be spotting to massive haemorrhage

Answer 10

How much bleeding was there and when did is start? Was it fresh red or old brown blood, or was it mixed with mucus? Could the waters have broken (membranes ruptured?) Was it provoked (post-coital) or not? Is there any abdominal pain? Are the fetal movements normal? Are there any risk factors for abruption? e.g. smoking/drug use/trauma – domestic violence is an important cause. IF bleed is ongoing or there is a significant vaginal bleed- A-E if the woman is clinically stable proceed to examination

Answer 11

Pallor, distress, check capillary refill, are peripheries cool? Is the abdomen tender? Does the uterus feel ‘woody’ or ‘tense’ (which may indicate placental abruption)? Are there palpable contractions? Check the lie and presentation of the fetus/fetuses. Ultrasound can be used to help. Check fetal wellbeing with a cardiotocograph (CTG) at 26 weeks gestation or above: (otherwise auscultate the fetal heart only). Read the hand-held pregnancy notes: are there scan reports? This will be helpful in establishing whether there could be placenta praevia

Answer 12

Digital vaginal exam should NOT be performed before an USS as it may provoke severe haemorrhage Often picked up on the 20 week abdominal USS Use of transvaginal USS improves accuracy and is considered safe

Answer 13

I- placenta reached lower segment but not the internal os II- placenta reaches internal os but doesn't cover it III- placenta covers the internal os before dilation but not when dilated IV (major)- placenta cover the internal os

Answer 14

Placental abruption Vasa praevia Uterine rupture Benign or malignant lesions e.g. polyps, carcinoma, cervical ectropion Infections e.g. candida, BV and chlamydia

Answer 15

FBC- assess any maternal anaemia Clotting profile Kleinbauer test- if women is Rhesus Negative ( to determine the amount of feto-maternal haemorrhage and thus the dose of anti-D required Group and Save Crossmatch- if we need to transfuse U&Es and LFTs to exclude any pre-eclampsia or HELLP syndrome Assess fatal wellbeing using CTG Definitive diagnosis is via USS

Answer 16

Usually identified in an asymptomatic patient at their 20 week USS Placenta praevia minor- repeat scan at 36 weeks is recommended as the placenta is likely to have moved superiorly Placenta praevia major- repeat scan at 32 weeks is recommended and a plan for delivery should be made at this point Placenta praevia usually warrants an elective C-section- usually at 38 weeks

Answer 17

Induction of labour at 37-38 weeks Ursodeoxycholic acid Vit K supplementation

Answer 18

Seperation of a normally sited placenta from the uterine wall resulting in maternal haemorrhage into the intervening space

Answer 19

Proteinuric hypertension Cocaine use Multiparity Maternal trauma Increasing maternal age

Answer 20

* Shock out of keeping with visible loss * pain constant * tender, tense uterus * normal lie and presentation * fetal heart: absent/distressed * coagulation problems * BEWARE pre-eclampsia, DIC, anuria

Answer 21

Fetus alive < 36 weeks * fetal distress: immediate caesarean * no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation Fetus alive > 36 weeks * Fetal distress: immediate caesarean * no fetal distress: deliver vaginally Fetus dead * Induce vaginal delivery *

Answer 22

Maternal: * shock * DIC * renal failure * PPH Fetal * IUGR * hypoxia * death

Answer 23

* associated with high perinatal mortality rate * responsible for 15% of perinatal deaths

Answer 24

Painful vaginal bleeding Woody uterus and painful on palpation

Answer 25

* Revealed: bleeding tacks down from the site of placental separation and drains through the cervix. This results in vaginal bleeding * Concealed: bleeding remains within the uterus and typically forms a clot retroplacentally. This bleeding is not visible but usually enough to cause systemic shock

Answer 26

* Placenta praevia * Marginal placental bleed * Vasa praevia * Uterine rupture * Local genital causes e.g. polyps or infections

Answer 27

Where fetal blood vessels run near the internal cervical os. Triad of: * vaginal bleeding * Rupture of membranes * Fetal compromise

Answer 28

Any degree of glucose intolerance with onset or first recognition during pregnancy

Answer 29

Progressive insulin resistance in pregnancy Woman with borderline pancreatic reserve is unable to respond to the increased insulin requirements, resulting in transient hyperglycaemia.

Answer 30

* BMI>30kg/m2 * previous macrosomic baby weighing 4.5kg or above * previous gestational DM * first degree relative with DM * South asian/black caribbean/Middle eastern

Answer 31

may be asymptomatic polyuria polydipsia fatigue

Answer 32

Fetus has hyperinsulinaemia due to increased glucose. Insulin is similar structure to growth hormones so: * Macrosomia-> lead to labour complications e.g. shoulder dsytocia * Organomegaly * Erythropoiesis * Polyhydramnios * Increased rates of pre-term delivery After delivery, baby has been used to high glucose, risk of becoming hypoglycaemic- needs regular feeding High insulin can cause reduction in pulmonary phospholipids--> high risk of transient tachypnoea of the newborn

Answer 33

Oral glucose tolerance test: fasting plasma glucose is measured, then 75g glucose drink is given- with a repeat plasma glucose measurement after 2 hours Fasting glucose > 5.6mmol/L 2hrs postprandial glucose > 7.8 mmol/L

Answer 34

Booking- if previous gestational diabetes 24-28 weeks gestation- if RF are present, or if previous gestational DM Any point during pregnancy- if 2+ glycosuria on one occasion, or 1+ on 2 occasions

Answer 35

* newly diagnosed women should be seen in a joint diabetes and antenatal clinic within a week * women should be taught about self-monitoring of blood glucose * advice about diet and exercise should be given if the fasting plasma glucose level is < 7 mmol/l a trial of diet and exercise should be offered * if glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started * if glucose targets are still not met insulin should be added to diet/exercise/metformin * gestational diabetes is treated with short-acting, not long-acting, insulin * if at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started * if the plasma glucose level is between 6-6.9 mmol/l, and there is evidence of complications such as macrosomia or hydramnios, insulin should be offered * glibenclamide should only be offered for women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment

Answer 36

Fasting: 5.3mmol/L 1 hour after meals: 7.8 mmol/L 2 hour after meal: 6.4 mmol/L

Answer 37

All diabetic medication stopped immediately after delivery. Blood glucose checked and ensured it has returned to normal before discharge 6-13 week post partum, fasting glucose test is recommended, if normal, tests should be offered yearly

Answer 38

As you are hypercoaguable

Answer 39

If had previous VTE

Answer 40

Hospitalisation Surgery Co-morbities Thrombophilia

Answer 41

Age > 35 Body mass index > 30 Parity > 3 Smoker Gross varicose veins Current pre-eclampsia Immobility Family history of unprovoked VTE Low risk thrombophilia Multiple pregnancy IVF pregnancy

Answer 42

4 or more risk factors: immediate treatment with LMWH until 6 weeks postnatally 3 risk factors LMWH should be initaited from 28 weeks and continued until 6 weeks postnatally

Answer 43

Continue anticoagulation treatment for at least 3 months

Answer 44

Unilateral leg swelling and leg pain Pyrexia Pitting oedma Tenderness Prominent superficial veins

Answer 45

Sudden onset dyspnoea Pleuritic chest pain Cough Haemoptysis Signs: tachycardia, tachypnoea, pyrexia, raised JVP or pleural rub or pleural effusion

Answer 46

Cellulitis ruptured Baker's cyst Superficial vein thrombophlebitis

Answer 47

ACS Aortic dissection Pneumonia Pneumothorax

Answer 48

NO! D-dimer will normally be raised in pregnancy

Answer 49

TRUE- omit the dose 24 hours before any planned induction of labour or C-section. They should not take their dose if they think they are going into labour

Answer 50

Externally- look at pads Cusco speculum exam- avoid until placenta praevia has been excluded by USS. Look for whether blood is fresh or dark, how much blood, are they are clots, are there any cervical lesions, is there any cervical dilatation, or any chance have membranes ruptured Take triple genital swabs to exclude infection if the bleeding is minimal DVE: contraindicated in PLACENTA PRAEVIA, if excluded- can help to see whether cervix if dilated, avoid if membranes have ruptured

Answer 51

Spontaneous abortion Ectopic pregnancy Hydatidiform mole

Answer 52

Spontaneous abortion Hydatidiform mole Placental abruption

Answer 53

Bloody show Placental abruption Placenta praevia Vasa praevia

Answer 54

Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high

Answer 55

BP usually falls during the 1st trimester and continues to fall until 20-24 weeks After this time the BP usually increases to pre-pregnancy levels by term

Answer 56

75mg aspirin od from 12 weeks until babys birth

Answer 57

systolic > 140 mmHg or diastolic > 90 mmHg or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic

Answer 58

Oral labetalol Oral nifedipine and hydralazine (2nd line)

Answer 59

HTN: hypertension after 20 weeks in pregnancy Pre-eclampsia: hypertension associated with proteinuria (>0.3g/24 hrs)

Answer 60

acute event involving the cardiorespiratory systems and/or central nervous system resulting in a reduced or absent conscious level (and potentially cardiac arrest and death), at any stage in pregnancy and up to 6 weeks after birth

Answer 61

5H's Hypovolaemia Hypoxia Hypo/hyperkalaemia Hypo/hypernatraemia Hypothermia 4T's Thromboembolism Toxicity Tension pneumothorax Tamponade Eclampia and pre-eclampsia Intracranial haemorrhage

Answer 62

ABCDE approach If pt RESPONDS: 2222- obstetric emergency call Place in left lateral position if TILTED in theatres or if outside this environment, manually and generally displace the uterus to relieve aortocaval compression Give high flow oxygen- SATS of at least 94% Commence MEOWS chart if not already in use and escalate appropriately Assess fetal wellbeing Check blood glucose level Insert 16G IV cannula Take bloods for: FBC, G&S or crossmatch 4 units U&Es Clotting studies ABG/VBG and lactate Blood cultures should be obtained by separate venous stab as per trust guidelines NO RESPONSE 2222 Maternal cardiac arrest Ensure manual uterine displacement in women above 20 weeks gestation or where the uterus is palpable at or above the level of the umbilicus.

Answer 63

Interests of maternal survival In women over 20 weeks gestation, if not response to CPR within 4 mins of maternal collapse or resuscitation is continued beyond this, the PMCS should be undertaken. Should be achieved within 5 mins of collapse

Answer 64

Baseline bloods- LFTS, U&Es for how LMWH will be metabolised Treat with LMWH Arrange imaging- V/Q scan or CTPA CTPA- increase risk of childhood leukaemia V/Q- small risk of breast cancer Counsel pts on risk

Answer 65

In eclamptic patients, management of the third stage of labour should be with oxytocin and not syntometrine/ergometrine because of the risk of increased BP. | quesmed

Complicated Pregnancy: Pregnancy complications Flashcards

Life- threatening complications pre-eclampsia gestational diabetes Obstetric haemorrhage VTE Sepsis Maternal collapse (89 cards)