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Reproductive System Brian > Complications in Pregnancy 1 > Flashcards

Complications in Pregnancy 1 Flashcards

1
Q

What are some examples of complications in pregnancy?

A
  • Miscarriage
  • Ectopic pregnancy
  • Antepartum haemorrhage
  • Preterm labour
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2
Q

What is a miscarriage?

A

Miscarriage = spontaneous loss of pregnancy before 24 weeks gestation

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3
Q

What is an abortion?

A

Abortion = voluntary termination

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4
Q

What are the different classes of miscarriage and there presentation?

A
  • Threatened
    • Bleeding from gravid uterus before 24 weeks gestation where there is viable foetus and no evidence of cervical dilation
    • Vaginal bleeding with or without pain, viable pregnancy, closed cervix on speculum examination
  • Inevitable
    • Becomes inevitable if cervix has already began to dilate
    • Viable pregnancy, open cervix with bleeds that could become heavy
  • Incomplete
    • Only partial expulsion of products of conception
    • Vaginal bleeding, open cervix
  • Complete
    • Expulsion of all products of conception
    • Cervix closed and bleeding has stopped
  • Septic
    • After incomplete miscarriage risk of ascending infection, known as septic abortion
  • Missed
    • Foetus has died but uterus made no attempt to expel the products of conception
    • No symptoms, or could have bleeding
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5
Q

What is a threatened miscarriage?

A
  • Bleeding from gravid uterus before 24 weeks gestation where there is viable foetus and no evidence of cervical dilation
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6
Q

What is an inevitable miscarriage?

A
  • Becomes inevitable if cervix has already began to dilate
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7
Q

What is an incomplete miscarriage?

A
  • Only partial expulsion of products of conception
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8
Q

What is a complete miscarriage?

A
  • Expulsion of all products of conception
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9
Q

What is a septic miscarriage?

A
  • After incomplete miscarriage risk of ascending infection, known as septic abortion
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10
Q

What is a missed miscarriage?

A
  • Foetus has died but uterus made no attempt to expel the products of conception
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11
Q

What is the aetiology of miscarriage?

A
  • Abnormal conceptus
    • Chromosomal, genetic, structural
  • Uterine abnormality
    • Congenital, fibroids
  • Cervical weakness
    • Primary, secondary
  • Maternal
    • Increasing age, diabetes
  • Idiopathic
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12
Q

What is the prevalence of miscarriage?

A

15% in lifetime

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13
Q

What is the management of miscarriage?

A
  • Threatened
    • Conservative, just wait
  • Inevitable
    • If bleeding heavy may need evacuation
  • Missed
    • Conservative
    • Medical – prostaglandins (misoprostol)
    • Surgical – SMM (surgical management of miscarriage)
  • Septic
    • Antibiotics and evacuate uterus
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14
Q

What is an ectopic pregnancy?

A

Pregnancy implanted outside uterine cavity, usually in ampulla of fallopian tubes

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15
Q

Where does an ectopic pregnancy usually occur?

A

Ampulla of fallopian tubes

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16
Q

What is the incidence of ectopic pregnancy?

A

1:90 pregnancies

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17
Q

What are risk factors for ectopic pregnancy?

A
  • Pelvic inflammatory disease
  • Previous tubal surgery
  • Previous ectopic
  • Assisted conception
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18
Q

What is the presentation of ectopic pregnancy?

A
  • Period of ammenorhoea (with positive urine pregnancy test)
  • Maybe vaginal bleeding
  • Maybe abdominal pain
  • Maybe GI or urinary symptoms
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19
Q

What investigations are done for ectopic pregnancy?

A
  • USS
    • No intrauterine gestational sac, may see adnexal mass, fluid in pouch of douglas
  • Serum BHCG levels
    • May need to track over 48 hour intervals
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20
Q

What is the mangement of ectopic pregnancy?

A
  • Medical
    • Methotrexate
  • Surgical
    • Laparoscopy
    • Or maybe salopingectomy (remove the tube) or salpingotomy (leave a damaged tube, remove embryo)
  • Conservative
21
Q

What does APH stand for?

A

Antepartum haemorrhage

22
Q

What is an antepartum haemorrhage?

A

Haemorrhage from the genital tract after 24th week of pregnancy but before delivery of baby

23
Q

What is the aetiology of APH?

A
  • Placenta praevia
    • Placenta partially or totally covers the mothers cervix
  • Placental abruption
  • Local lesions of genital tract
  • Vasa praevia
    • Foetal blood vessels cross or run near the internal opening of uterus
  • Idiopathic
24
Q

What is a placenta praevia?

A

Placenta partially or completely covers mothers cervix

25
Q

What are the different classes of placenta praevia (old classification system)?

A
  • Grade 1
    • Placenta encroaching on the lower segment but not he internal cervix os
  • Grade 2
    • Placenta reaches internal os (orifice of cervix)
  • Grade 3
    • Placenta eccentrically covers the os
  • Grade 4
    • Central placental praevia
26
Q

What are the different classes of placenta praevia, new system?

A
  • Low lying placenta
    • Less than 20mm from internal OS
  • Placental previa
    • Covering os
27
Q

What is the incidence of placenta praevia?

A

1/200 pregnancies

28
Q

What are the risk factors for placental praevia?

A
  • Multiparous woman
  • Multiple pregnancies
  • Previous caesarean section
29
Q

What is the presentation of placenta praevia?

A
  • Painless PV bleeding
  • Malpresentation of foetus
  • Incidental
30
Q

What investigations are done for placental praevia?

A
  • USS
  • Vaginal examination must not be done with suspected placental praevia
31
Q

What should NEVER be done in suspected case of placental praevia?

A

Vaginal examination

32
Q

Describe the management of placental praevia?

A
  • Depends on
    • Gestation
    • Severity
  • Caesarean section
  • Medical management
    • Oxytocin, ergometrine, carboprost, tranexamic acid
  • Surgical management
    • Balloon tamponade
    • B lynch cutre, ligation of uterine, iliac vessels, hysterectomy
33
Q

What is a possible complication of placental praevia?

A
  • Post-partum haemorrhage
34
Q

What is a placental abruption?

A

Haemorrhage resulting from premature separation of placenta before the birth of the baby

35
Q

What is the prevalence of placental abruption?

A

0.6% of pregnancies

36
Q

What are risk factors for placental abruption?

A
  • Pre-eclampsia/chronic hypertension
  • Multiple pregnancy
  • Polyhydramnios
  • Smoking, increasing age, parity
  • Previous abruption
  • Cocaine use
37
Q

What are the different clinical categories of placental abruption?

A
  • Revealed (see the blood)
  • Concealed (bleeding but inside so cannot see)
  • Mixed (concealed and revealed)
38
Q

What is the presentation of placental abruption?

A
  • Pain
  • Vaginal bleeding
  • Increased uterine activity
39
Q

What is the mangement of placental abruption?

A
  • Varies from expectant treatment, attempting delivery or caesarean section depending on
    • Amount of bleeding
    • General condition of mother and baby
    • Gestation
40
Q

What are possible complications of placental abruption?

A
  • Maternal shock, collapse
  • Foetal distress then death
  • Maternal DIC (disseminated intravascular coagulation), renal failure
  • Postpartum haemorrhage
41
Q

What is preterm labour?

A

Onset of labour before 37 weeks completed gestation (259 days)

42
Q

What are the different categories of preterm labour?

A
  • Mildly preterm
    • 32-36 weeks
  • Very preterm
    • 28-32 weeks
  • Extremely preterm
    • 24-28 weeks
43
Q

When is labour considered to be preterm?

A

Before 37 weeks completed gestation (259 days)

44
Q

Describe the epidemiology of preterm labour (incidence)?

A
  • 5-7% in single pregnancy
  • 30-40% in multiple pregnancy
45
Q

What are risk factors for preterm labour?

A
  • Idiopathic (most common)
  • Multiple pregnancy
  • Polyhydramnios
  • APH
  • Pre-eclampsia
  • Infection such as UTI
  • Prelabour premature rupture of membranes
46
Q

How is preterm labour diagnosed?

A
  • Contractions with evidence of cervical change on VE
  • Foetal fibronectin test
47
Q

Describe the management of preterm labour?

A
  • <24-26 weeks
    • Poor prognosis
  • All cases considered viable
    • Consider tocolysis to allow steroids/transfer
      • These are drugs that prevent uterine contractions
    • Steroids unless contraindicated
    • Transfer to unit with NICU facilities
    • Aim for vaginal delivery
48
Q

Describe the prognosis of preterm labour?

A
  • Possible neonatal morbidity from prematurity
    • Respiratory distress syndrome
    • Intraventricular haemorrhage
    • Cerebral palsy
    • Nutrition
    • Temperature control
    • Jaundice
    • Infections
    • Visual impairment
    • Hearing loss

Reproductive System Brian (34 decks)

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