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Midwifery Care for Complex Needs (Pregnancy) > Complications in Early Pregnancy > Flashcards

Complications in Early Pregnancy Flashcards

1
Q

What is threatened miscarriage?

A
  • Any vaginal bleeding in pregnancy <22/40
  • with or without abdominal pain
  • pregnancy may continue
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2
Q

What is inevitable miscarriage?

A
  • Specific clinical features indicate that pregnancy is in the process of physiological expulsion from the uterine cavity
  • pregnancy will not continue
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3
Q

What is incomplete miscarriage?

A
  • Early pregnancy tissue is partially expelled

- Could result from missed miscarriage

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4
Q

What is complete miscarriage?

A
  • Early pregnancy tissue is fully expelled
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5
Q

What is a missed miscarriage?

A
  • US features consistent with non viable continuation of pregnancy
  • Early pregnancy tissue may be partially expelled
  • Usually no signs/symptoms and picked up on a scan
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6
Q

What tests may be carried out in EPU (depending on location and available services)?

A
  • History and examination

- Transvaginal US and blood tests (hCG & progesterone)

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7
Q

What are the most common symptoms?

A
  • Lower abdominal pain

- Bleeding

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8
Q

What is the expectant management time following confirmation of miscarriage?

A

7-14 days unless indication for treatment

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9
Q

Why might further treatment be needed?

A
  • increased risk of bleeding/contradictions to blood transfusion
  • Previous traumatic pregnancy/birth e.g. Stillbirth/APH
  • Signs of infection
  • Unacceptable to the woman
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10
Q

If bleeding/pain is resolved what is advised?

A

Pregnancy test 3 weeks later

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11
Q

What is medical management?

A
  • Vaginal administration of Misoprostol recommended for treatment of missed or incomplete miscarriage (oral is also an option)
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12
Q

What is expected following Misoprostol?

A
  • Bleeding within 24 hours
  • V&D common
  • Repeat pregnancy test at 3 weeks - R/V if positive
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13
Q

When is surgical management offered?

A

When clinically appropriate or maternal request

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14
Q

What is the leading cause of maternal death in early pregnancy?

A

Ectopic pregnancy - can rupture and deterioration is rapid

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15
Q

What is an ectopic pregnancy?

A

Implantation of a fertilised ovum outside the uterine cavity (95% fallopian tubes)

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16
Q

When do women present in ectopic pregnancy?

A

5-9 weeks
Positive pregnancy test/vaginal bleeding
Pelvic pain

17
Q

What are other reported symptoms of Ectopic pregnancy?

A
  • Breast tenderness
  • Shoulder tip pain
  • Urinary problems
  • Rectal pressure/pain
  • Nausea, V&D
  • Fainting
18
Q

How is ectopic pregnancy diagnosed?

A
  • TV US (90% are visible after 6+6/40)

- hCG assessment - lower increased in concentration than normal

19
Q

How is ectopic pregnancy managed?

A
  • Monitoring - rescan and hCG
    • Medical treatment - IM methotrexate (requires follow up as increased risk of further treatment/haemorrhage
  • Surgery - salpingectomy if risk of infertility
  • Anti D if required
20
Q

What is a molar pregnancy?

A
  • Rare complication
  • abnormally fertilised egg implants
  • too much genetic material
21
Q

How does molar pregnancy originate?

A

Placental trophoblast

22
Q

What is the most common form of molar pregnancy?

A

Hydatidiform mole

23
Q

What are indications of molar pregnancy?

A
  • similar symptoms to miscarriage
  • exaggerated pregnancy symptoms
  • Large for gestational age
24
Q

How is molar pregnancy managed?

A
  • Abnormally high hCG levels
  • Diagnosis, US and serum hCG
  • Chemotherapy if choriocarcinoma
  • Monitor hCG for 6 months
  • Avoid pregnancy for 12 months if chemo
25
Q

What is the recurrence rate of molar pregnancy?

A

15-20%

26
Q

How many people are affected by infertility?

A

3-5%, 1 in 7 couples

27
Q

What is primary infertility?

A

Delay in conception, never previously conceived

28
Q

What is secondary infertility?

A

Delay in conception, previously conceived other pregnancies

29
Q

What is anovulation?

A
  • No ovulation - can be primary or secondary amenorrhea
  • various causes
  • careful investigations to exclude pathology - e.g. hyperprolactinaemia - suppresses periods
  • PCOS
30
Q

what is premature ovarian failure?

A
  • Can occur at any age, risk increases 35-40

- Commonly chromosomal

31
Q

What is endometriosis?

A
  • Endometrial tissue located outside the uterus

- Pelvic pain, dysmenorrhea, menorrhagia, dysparenia, adhesions, infertility

32
Q

What is the treatment for endometriosis?

A
  • Analgesia
  • hormonal contraceptives
  • GnRH agonists/gonadotrophin inhibitors
33
Q

What are some male factors for infertility?

A
  • congenital abnormalities: undescended testes, cryptorchidism
  • CF
  • anti-sperm antibodies from disruption of normal blood/sperm barrier e.g. testicular torison
34
Q

What is IUI?

A

Intrauterine insemination
- specific situations e.g. physical or psychological issue prevents vaginal intercourse/barrier contraception needed e.g. HIV, same sex relationships

35
Q

What is donor insemination?

A
  • Injection of sperm into uterus
36
Q

What is IVF?

A
  • superovulation, transvaginal ultrasound guided oocyte retrieval
  • insemination in laboratory
37
Q

What adverse outcomes are associated with IVF?

A
  • FGR
  • Premature birth
  • Hypertensive disorders
  • GDM
  • Intrahepatic choleostasis of pregnancy
  • placenta praevia/abruption

Midwifery Care for Complex Needs (Pregnancy) (3 decks)

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