Complications in pregnancy Flashcards by Sophie C

Common complications in pregnancy (4)

Miscarriage

Ectopic Pregnancy

Antepartum haemorrhage

Preterm labour

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What is the difference between abortion and miscarriage?

Miscarriage : spontaneous loss of pregnancy before 24 weeks gestation

Abortion: voluntary termination

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Spontaneous Miscarriage - what are the 6 different types you can get

Incidence of spontaneous miscarriage is around 15%,
maybe higher

Threatened
Inevitable
Incomplete
Complete
Septic
Missed

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Threatened miscarriage - 3 features

Vaginal bleeding+/- pain
Viable pregnancy
Closed cervix on speculum examination

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Inevitable miscarriage features -2

Viable pregnancy
– Open cervix with bleeding
that could be heavy (+/-clots

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Missed Miscarriage (Early Fetal Demise - features 3

No symptoms, or could have bleeding/ brown loss vaginally
Gestational sac seen on scan
No clear fetus (empty gestational sac) or a fetal pole with no fetal heart seen in the gestational sac

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Incomplete Miscarriage- features

Most of pregnancy expelled out, some products of pregnancy remaining in the uterus
open cervix, vaginal bleeding (may be heavy)

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Complete miscarriage & Septic miscarriage features

Complete miscarriage
– passed all products of conception (POC), cervix closed and bleeding has stopped (should ideally have confirmed the POC or should have had a scan previously that confirmed an intrauterine pregnancy)

Septic Miscarriage
especially in cases of an incomplete miscarriage

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Aetiology of Spontaneous Miscarriage - 5 types

chromosomal, genetic, structural

Uterine abnormality
- congenital, fibroids

Cervical weakness
- Primary, secondary

Maternal
- increasing age, diabetes

Unknown

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Management of Miscarriage

- 4 types

Threatened - conservative, “just wait” – most stop bleeding and are okay

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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What is a Ectopic pregnancy?

Pregnancy implanted outside the uterine cavity

1 in 20

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Risk factors for ectopic pregnancies? (4)

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

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Presentation of ectopic pregnancies ? (4)

Period of ammenorhoea (with +ve urine pregnancy test)
+/_ Vaginal bleeding
+/_ Pain abdomen
+/_ GI or urinary symptoms

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Investigations for ectopic pregnancies

Scan – no intrauterine gestational sac, may see adnexal mass, fluid in Pouch of Douglas

Serum BHCG levels – may need to serially track levels over 48 hour intervals- if a normal early intrauterine pregnancy HCG levels will increase by at least 66%ish

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Management for ectopic pregnancies (3)

Medical – Methotrexate

Surgical – (mostly laparoscopy– Salpingectomy, = remove the tube
Salpingotomy for few indications) - leave damaged tube and take embryo

Conservative

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Antepartum Haemorrhage (APH) is?

APH - haemorrhage from the genital tract after the 24th week of pregnancy but before delivery of the baby.

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Causes of Antepartum Haemorrhage? (5)

Placenta praevia

Placental abruption

APH of unknown origin

Local lesions of the genital tract

Vasa praevia (very rare)

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Placenta praevia- what is it? - incidence? where is it more commonly seen in

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All or part of the placenta implants in the lower uterine segment

Incidence
1/200 pregnancies

More common in
Multiparous women
multiple pregnancies
previous caesaren section

Placenta praevia – old classification 1-5 - describe them

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Grade I Placenta encroaching on the lower segment but not the internal cervical os

Grade II Placenta reaches the internal os

Grade III Placenta eccentrically covers the os

Grade IV Central placenta praevia

RCOG classification

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Low lying- placenta is less than 20 mm from internal os

Placenta previa – covering the os

Placenta praevia presentation (3)

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Painless PV bleeding
Malpresentation of the fetus
Incidental

why are you likely to do a cs for Placenta praevia ?

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cervix dilatation will cause bleeding

Clinical features for Placenta praevia?

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Clinical features
Maternal condition correlates with amount of bleeding PV
Soft, non tender uterus +/- fetal malpresentation

Diagnosis for Placenta praevia?

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Ultrasound scan to locate placental site

- VAGINAL EXAMINATION MUST NOT BE DONE WITH SUSPECED PLACENTA PRAEVIA

Management for Placenta praevia?

Gestation Severity Caesarean

Management of PPH? - medical and surgical

Medical management – oxytocin, ergometrine, carboprost, tranexemic acid Balloon tamponade Surgical – B Lynch cutre, ligation of uterine, iliac vessels , hysterectomy

What is Placental abruption (2)

Haemorrhage resulting from premature separation of the placenta before the birth of the baby Incidence 0.6% of all pregnancies

Factors associated with Placental Abruption include? (6)

``` Pre-eclampsia/ chronic hypertension Multiple pregnancy Polyhydramnios Smoking, increasing age, parity Previous abruption Cocaine use ```

Clinical types and presentation of placental abruption?

Placental abruption Revealed (see the blood) Concealed (bleeding but inside so can’t see!) Mixed (concealed and revealed)

Presentation of placental abruption?

Pain Vaginal bleeding (may be minimal bleeding) Increased uterine activity

General management of APH? depends on what 3 things?

Management will vary from expectant treatment to attempting a vaginal delivery to immediate Caesarean section depending on Amount of bleeding General condition of mother and baby Gestation

Complications of placental abruption (4)

- Maternal shock, collapse (may be disproportionate to the amount of bleeding seen) - Fetal distress then death - Maternal DIC, renal failure - Postpartum haemorrhage ‘couvelaire uterus’

Preterm Labour - when is this?

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

How is the timing of a preterm baby defined?

32-36 wks mildly preterm 28-32 wks very preterm 24-28 wks extremely preterm Spontaneous or induced (iatrogenic

Babies are resuscitated after how many weeks old?

22 weeks

Reasons for preterm babies ?

– pre eclampsia, infection, PPH, placental praevia

preterm labour is more common in?

30 - 40% multiple pregnancy

Predisposing factors of pre term labour?

``` Multiple pregnancy Polyhydramnios APH Pre-eclampsia Infection eg UTI Prelabour premature rupture of membranes Majority no cause (idiopathic ```

Preterm Delivery is a major cause of?

perinatal mortality and mobidity Gestation dependent

Management of Preterm Delivery? -how to diagnose it properly - what should you make sure you consider?

Diagnosis Contractions with evidence of cervical change on VE Test- Fetal fibronectin Consider possible cause abruption, infection

Management Preterm Delivery? 24-26 weeks

Generally regarded as very poor prognosis | decisions made in discussion with parentsand neonatologists

All cases of preterm delivery are regarded as viable - what should you consider?

Consider tocolysis to allow steroids/ transfer Steroids unless contraindicated Transfer to unit with NICU facilities Aim for vaginal delivery

What are tocolysis?

drugs preventing uterine contractions, labour suppressants

Neonatal Morbidity resulting from Prematurity - what conditions

``` respiratory distress syndrome intraventricular haemorrhage cerebral palsy nutrition temperature control jaundice infections visual impairment hearing loss ```

Complications in pregnancy Flashcards

(44 cards)