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Complications in Pregnancy Flashcards

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1
Q

what is the aetiology of miscarriages?

A

> unknown
abnormal conceptus (structural, genetic, chromosomal)
uterine abnormalities (fibroids, congenital)
maternal (increasing age, diabetes)
cervical incompetence

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2
Q

what is an incomplete miscarriage?

A

most of the pregnancy has been expelled but some of the material is still in the uterus

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3
Q

how does an incomplete miscarriage present?

A

> heavy bleeding

> open cervix

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4
Q

what is a threatened miscarriage?

A

a viable pregnancy but with vaginal bleeding (+/- pain) and a closed cervix

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5
Q

how may an inevitable miscarriage present?

A

> open cervix

> heavy bleeding with clots

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6
Q

what management may an inevitable miscarriage need?

A

evacuation if bleeding heavily

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7
Q

how does a missed miscarriage present?

A

no symptoms or bleeding

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8
Q

how is a missed miscarriage investigated?

A

Ultrasound
> empty gestational sac
> no foetal heart

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9
Q

how is a missed miscarriage managed?

A

> conservative
surgical
medical prostaglandins

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10
Q

what is a miscarriage?

A

termination/loss of pregnancy before 24 weeks gestation

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11
Q

what is a septic miscarriage?

A

infection secondary to miscarriage

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12
Q

how is a septic miscarriage managed?

A

> evacuation

> antibiotics

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13
Q

what is a complete miscarriage?

A

all products of conception passed

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14
Q

how does a complete miscarriage present?

A

> bleeding stopped

> cervix closed

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15
Q

what are some risk factors of ectopic pregnancy?

A

> pelvic inflammatory disease
previous ectopic
previous tubal surgery
assisted conception

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16
Q

what is an ectopic pregnancy?

A

pregnancy implanted outside the uterine cavity

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17
Q

how does an ectopic pregnancy present?

A

> amenorrhea (+ve test)
vaginal bleeding
abdominal pain
GI/urinary symptoms

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18
Q

how is an ectopic pregnancy investigated?

A

> scan (no in-uterine gestational sac, adnexal masses, fluid in pouch of douglas)
serum BHCG levels over 24 hours
serum progesterone levels (25mg/ml is viable pregnancy)

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19
Q

what is the management if ectopic pregnancy?

A

> methotrexate

> surgical salpingectomy or salpingotomy

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20
Q

what is antepartum haemorrhage?

A

haemorrhage from the genital tract after week 24 but before delivery

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21
Q

what local lesions can cause antepartum haemorrhage?

A

> erosions
polyps
cancer

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22
Q

what is vasa praevia?

A

rupture of the foetal vessels causing antepartum haemorrhage

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23
Q

what is placenta praevia?

A

all or some of the placenta implants in the lower part of the uterus

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24
Q

what are some causes of antepartum haemorrhage?

A

> local lesions
vasa praevia
placenta praevia
placental abruption

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25
what are the risk factors for placenta praevia?
> multiparous women > multiple pregnancies > previous c-section
26
what are the classifications of placenta praevia?
1. placenta encroaching on the lower segment. not in int. cervical os 2. placental reaches internal cervical os 3. placenta eccentrically covers the os 4. central placenta praevia
27
how does placenta praevia present?
> PAINLESS PV BLEEDING > malpresentation of the foetus > soft non-tender uterus
28
how do you diagnose placenta praevia?
> ultrasound scan
29
how is placenta praevia managed?
``` > C-section > PPH management - carbaprost - ergometrinas - tranexamic acid - surgical ligation of arteries or hysterectomy ```
30
what are the risk factors for placental abruption?
``` > pre-eclampsia > multiple pregnancy > parity > smoking > polyhydramnios > previous abruptions ```
31
what is placental abruption?
haemorrhage from premature placenta separation
32
how does placental abruption present?
> bleeding > pain > increased uterine activity
33
what are the complications of placental abruption?
> PPH > foetal death > maternal shock (DIC/renal failure)
34
what different types of placental abruption?
> mixed > concealed: uterus increases in height, blood escaping between placenta and uterine wall > revealed: blood externally escaping
35
what is preterm labour?
onset of labour before 37 weeks of completed gestation
36
what are the risk factors for preterm labour?
``` > multiple pregnancies > polyhydramnios > pre-eclampsia > APH > infection > prelabour premature rupture of the membranes > idiopathic ```
37
what is extremely preterm labour?
24-28 weeks
38
what is very preterm labour?
28-32 weeks
39
what is mildly preterm labour?
32-36 weeks
40
how do you diagnose preterm labour?
> contractions | > evidence of cervical change on VE
41
what is the management of preterm labour?
> transfer to unit with NICU > aim for vaginal delivery > consider tocolysis, allow steroid unless contraindicated
42
what is chronic hypertension?
hypertension at pre-pregnancy
43
what is mild chronic hypertension?
90/140
44
what is chronic moderate hypertension?
100/150
45
what is severe chronic hypertension?
110/160
46
what is the management for chronic hypertension in pregnancy?
> aim for <150/100 | > monitor for pre-eclampsia and foetal growth
47
what is pre-eclampsia?
mild hypertension on 2 occasions more than 4 hours apart plus proteinuria of >300mgms/ 24 hours
48
what are the risk factors for pre-eclampsia?
``` > first pregnancy > multiple pregnancy > family history > more than 10 years between pregnancy > extremes of age > underlying medical disorders - chronic hypertension - renal disease - diabetes - autoimmune disorders ```
49
what is the pathophysiology in pre-eclampsia?
> imbalance in vasodilation and vasoconstriction | > secondary invasion of maternal spinal arteries by trophoblasts impaired so there is decreased placental perfusion
50
what are the investigations for pre-eclampsia?
``` > BP and urine > CTG > U+E's > LFT's > Bloods ```
51
how does pre-eclampsia present?
``` > seizures > reduced urine output > severe hypertension and urine proteinuria > vomiting > swelling of hands, face and legs > headache > blurred vision > epigastric pain ```
52
what changes in biochem investigations are seen in pre-eclampsia?
> increased liver enzymes > bilirubin > increase urate > increased urea
53
what changes in haematological investigations are seen in pre-eclampsia?
> decreased platelets > decreased haemoglobin > DIC features
54
what complications of pre-eclampsia are there?
``` > impaired placental perfusion > cardiac failure > pulmonary oedema > renal failure > disseminated intravascular coagulopathy > HELLP > severe hypertension > eclampsia ```
55
what is the conservative management of pre-eclampsia?
> steroids > aim for foetal maturity > anti-hypertensives
56
what is the management for pre-eclampsia?
induction of labour or c-section
57
what is the management for eclampsia and PET?
> seizure control - avoid fluid overload - control of BP (IV labetolol) - magnesium sulphate bolus and IV infusion > prophylaxis in subsequent pregnancies - low dose aspirin from 12 weeks until delivery
58
how does a venous thrombo-embolism present?
> tachycardia > hypoxic > calf pain and swelling > breathlessness, cough, dyspnoea
59
what investigations should be carried out in a venous thrombo-embolism?
``` > ECG > blood gases > doppler > V/Q scan > CT pulmonary angiogram ```
60
what are the risk factors in a venous thrombo-embolism?
``` > previous VTE > sickle cell disease > haemorrhage > prolonged delivery > decreased mobility > dehydration > infections > PET > smoking > older mothers > PWID > increased BMI ```
61
what prophylaxis is there for a venous thrombo-embolism event?
> increasing mobility > TED stockings > hydration > anticoagulation 6 weeks post partum if 3 or more risk factors
62
what causes increased stasis in pregnancy?
> progesterone | > enlarging uterus
63
what causes a hypercoagulable state on pregnancy?
> increased fibrinolysis > increased fibrinogen > decreased natural anticoagulant (antithrombin 2)
64
what are the risk factors for gestational diabetes?
``` > BMI >30 > previous macrocosmic baby > previous GDM > high diabetic risk > family history of diabetes > polyhydramnios current pregnancy > recurrent glycosuria in pregnancy ```
65
how screening is there for gestational diabetes?
> oral glucose tolerance test at 16 weeks and repeat at 28 weeks if there are significant risk factors > offer HbA1C estimation (if more than 6% off OGTT)
66
what is the management for gestational diabetes?
> control of the blood sugar (diet, metformin or insulin) > post delivery: check OGTT at 6-8 weeks > yearly check of HbA1C if at higher risk
67
what hormones significant in pregnancy have anti-insulin actions?
> HCG > cortisol > human placental lactogen > progesterone
68
what does foetal hyperinsulinemia lead to?
macrosomia
69
what are some complications of pre-existing diabetes in pregnancy?
``` > foetal congenital abnormalities > miscarriage > foetal macrosomia > shoulder dystocia > reduced awareness of hypoglycaemia > pre-eclampsia > infection > still birth > neonatal - jaundice - impaired lung maturity - hypoglycaemia ```
70
what preconception management is available for diabetes in pregnancy?
> glycaemic control (HbA1C <6.5%) > folic acid 5mg > dietary advice > retinal and renal assessment
71
what management is available for diabetes during pregnancy?
``` > aware of the hypo. risk > watch for infection > may need to change to insulin > labour - usually induced at 38-40weeks - insulin - early feeding of the baby - continuous ECG - C-section due to macrosomia ```

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