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Complications in pregnancy Flashcards

1
Q

What is miscarriage?

A

Spontaneous loss of pregnancy within 24 weeks gestation

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2
Q

What is abortion?

A

Voluntary termination of pregnancy

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3
Q

What are the different categories of spontaneous miscarriage?

A 
Threatened 
Inevitable
Incomplete
Complete
Septic
Missed
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4
Q

How does threatened miscarriage present?

A

Vaginal bleeding
Possibly pain
Viable pregnancy
Closed cervix on speculum examination

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5
Q

How does inevitable miscarriage present?

A

Viable pregnancy
Open cervix
Bleeding
Possibly clots

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6
Q

How does a missed miscarriage present?

A

No symptoms
Possible bleeding
Gestational sac seen on scan
No clear fetus

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7
Q

How does incomplete miscarriage present?

A

Most of pregnancy expelled
Some stuff remains in uterus
Open cervix
Vaginal bleeding

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8
Q

How does complete miscarriage present?

A

Passed all products of conception
Cervix closed
Bleeding stopped

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9
Q

What are some maternal factors in spontaneous miscarriage?

A

Increasing age

Diabetes

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10
Q

What are some uterine abnormalities which may cause spontaneous miscarriage?

A

Congenital

Fibroid

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11
Q

How is threatened miscarriage managed?

A

Conservative

Wait and see

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12
Q

How is inevitable miscarriage managed?

A

May need evacuation if bleeding heavy

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13
Q

How is missed miscarriage managed?

A

Conservatively
Misoprostol
Surgical

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14
Q

How is septic miscarriage managed?

A

Antibiotics

Evacuate uterus

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15
Q

What is an ectopic pregnancy?

A

Pregnancy implanted outside uterus

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16
Q

What are some risk factors for ectopic pregnancy?

A

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

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17
Q

How does ectopic pregnancy present?

A

Vaginal bleeding
Amenorrhoea with positive preg test
Abdominal/back/shoulder bleeding

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18
Q

How would you tell an ectopic pregnancy on a scan?

A

No intrauterine gestational sac
Adnexal mass
Fluid in pouch of douglas

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19
Q

How are ectopic pregnancies managed?

A

Methotrexate

Laparoscopy

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20
Q

What is salpingectomy?

A

Removal of the tube

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21
Q

What is salpingotomy?

A

Leave damaged tube

Remove embryo

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22
Q

What is APH?

A

Antepartum haemorrhage

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

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23
Q

What are some causes of APH?

A 
Placenta praevia
Placental abruption
APH of unknown origin
Local lesions of the genital tract
Vasa praevia (very rare)
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24
Q

What is placenta praevia?

A

All or part of placenta implants in lower uterine segment

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25
Q

How does placenta praevia present?

A

Painless PV bleeding
Malpresentation of fetus
Incidental

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26
Q

How is placenta praevia diagnosed?

A

Ultrasound

NO VAGINAL EXAM

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27
Q

How is placenta praevia managed?

A

C section
Watch for PPH
Oxytocin, ergometrine, carboprost
Balloon tamponade

28
Q

Can smoking affect chances of placental abruption?

A

Yes, increases them

29
Q

How does placental abruption usually present?

A

Pain
Vaginal bleeding
Increased uterine activity

30
Q

Placental abruption can lead to what kind of complications?

A 
Maternal shock/collapse
Fetal distress/death
Maternal DIC
Maternal renal failure
PPH
31
Q

What is preterm labour?

A

Onset of labour before 37 completed weeks gestation

32
Q

What are some factors which may predispose a mother to preterm labour?

A 
Multiple pregnancy
Polyhydramnios
APH
Pre-eclampsia
Infection eg UTI
Prelabour premature rupture of membranes
33
Q

What is polyhydramnios?

A

Too much amniotic fluid

34
Q

How is preterm delivery managed?

A

Tocolysis considered
Steroids unless contraindicated
Transfer to NICU equipped unit
Aim for vaginal delivery

35
Q

What is tocolysis?

A

Medications used to prevent uterine contractions and suppress labour

36
Q

What are some neonatal morbidities associated with prematurity?

A 
Respiratory distress syndrome
Intraventricular haemorrhage
Cerebral palsy
Nutrition
Temperature control
Jaundice
Infections
Visual impairment
Hearing loss
37
Q

What is mild HT in pregnancy?

A

Diastolic 90-99

Systolic 140-149

38
Q

What is moderate HT in pregnancy?

A

Diastolic 100-109

Systolic 150-159

39
Q

What is severe HT in pregnancy?

A

Diastolic 110 or greater

Systolic 160 or greater

40
Q

How is pre-eclampsia different from gestational hypertension (PIH)?

A

Both new hypertension after 20 weeks but pre-eclampsia is associated with significant proteinuria

41
Q

How is proteinuria tested for in pre-eclampsia?

A

Automated reagent strip urine protein estimation >1+

Spot urinary protein creatine >30mg/mmol

42
Q

How is hypertension managed in pregnant mothers?

A

Change drugs if needed
Labetolol, nifedipine and methyldopa are popular
Monitor for superimposed pre-eclampsia
Monitor fetal growth

43
Q

Do hypertensive patients have a higher or lower incidence of placental abruption?

A

Higher

44
Q

What are the main causes of pre-eclampsia?

A

Immunological

Genetic

45
Q

How is reduced placental infusion caused in pre-eclampsia?

A

Secondary invasion of maternal spiral arterioles by trophoblasts impaired

46
Q

Are mothers more or less likely to develop pre-eclampsia in their first pregnancy?

A

More

47
Q

How does age affect chances of developing pre-eclampsia?

A

Extremes of maternal age increase chances

48
Q

Does a multiple pregnancy increase or decrease chances of developing pre-eclampsia?

A

Increase

49
Q

What are some underlying health conditions which may pre-dispose a pregnant person to develop pre-eclampsia?

A

Chronic HT
Renal disease
Diabetes
Autoimmune disorders like SLE

50
Q

What are some possible maternal complications in pre-eclampsia?

A 
Seizures
Haemorrhage
Stroke
HELLP
DIC
Renal failure
Pulmonary oedema
Cardiac failure
51
Q

What are some possible fetal complications in pre-eclampia?

A 
Impaired placental perfusion
IUGR
Fetal distress
Prematurity
Increased perinatal mortality
52
Q

What is IUGR?

A

Intrauterine Growth Restriction

53
Q

What is the only “cure” for pre-eclampsia?

A

Delivery of baby and placenta

54
Q

Describe the ideal conservative management of pre-eclampsia?

A

Close observation into postnatal period
Anti-hypertensives
Steroids for fetal lung maturity if gestation <36 weeks

55
Q

What is the treatment for seizure?

A 
Magnesium sulphate bolus + IV infusion
BP control (IV Labetolol)
Avoid fluid overload
56
Q

Describe the prophylactic management for mothers with previous pre-eclampsia?

A

Low dose aspirin from 12 weeks until delivery

57
Q

How is the effect of diabetes on pregnancy managed and mitigated?

A

Better glycaemic control before
Folic acid 5mg
Dietary advice
Retinal and renal assessment

58
Q

When is labour usually induced?

A

38-40 weeks

Earlier if fetal or maternal concerns

59
Q

How is GDM checked up on after delivery?

A

OGTT at 6-8 weeks

60
Q

What is Virchow’s triad?

A

Stasis
Vessel wall injury
Hypercoagulability

61
Q

How is stasis increased in pregnancy?

A

Progesterone

Effects of enlarging uterus

62
Q

How may pregnancy cause vascular damage?

A

Delivery

C section

63
Q

Describe VTE prophylaxis in pregnancy.

A

TED stockings
Increased mobility
Hydrate
Maybe anti-coagulation if indicated with 3 or more risk factors

64
Q

How does VTE present?

A 
Pain in calf
Increased girth of affected leg
Calf muscle tenderness
Breathlessness
Pain on breathing
Cough
Tachycardia
Hypoxia
Pleural rub
65
Q

What are some useful tests for VTE?

A 
ECG
Blood gases
Doppler 
V/Q lung scan
CTPA

Reproduction (25 decks)

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