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Yr 3 - Reproduction > Complications of Pregnancy 1 > Flashcards

Complications of Pregnancy 1 Flashcards

1
Q

What is an abortion/spontaneous miscarriage?

A

Termination/loss of pregnancy before 24 weeks (with no evidence of life)

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2
Q

What is the incidence of spontaneous miscarriage?

A

15%

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3
Q

What are the types of spontaneous miscarriage?

A 
Threatened
Inevitable 
Incomplete
Complete
Septic
Missed
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4
Q

What is a threatened miscarriage?

A

Bleeding from gravid uterus <24 weeks where fetus is viable with NO EVIDENCE of cervical dilation

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5
Q

When does abortion become “inevitable”?

A

When the cervix begins to dilate

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6
Q

What is a septic abortion?

A

Incomplete abortion leading to an ascending infection into the uterus, leading to PID

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7
Q

What is a missed abortion?

A

Pregnancy where fetus dies but the uterus makes no attempt to expel to the products

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8
Q

How does a threatened miscarriage present?

A

Vaginal bleeding +/- pain
Viable pregnancy
Closed cervix

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9
Q

How does an inevitable miscarriage present?

A

Viable pregnancy

Open cervix with ?heavy bleeding +/- clots

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10
Q

How does a missed miscarriage present?

A

Asymptomatic
or
Brown/bleeding vaginal loss

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11
Q

How is missed miscarriage found?

A

Gestational sac on scan

No clear fetus/fetal pole/no fetal heart

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12
Q

How does an incomplete miscarriage present?

A

Most of pregnancy expelled out, some products remaining
Open cervix
Vaginal bleeding ?heavy

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13
Q

When is septic miscarriage most likely?

A

Cases of incomplete miscarriage

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14
Q

How does a complete miscarriage present?

A

Passed all products of conception
Cervix closed
Bleeding stopped

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15
Q

How should a complete miscarriage be managed?

A

Confirmed by scan

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16
Q

What are the main causes of spontaneous miscarriage?

A 
Abnormal conceptus
Unknown
Maternal
Uterine abnormality
Cervical incompetence
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17
Q

What are the most common abnormal concepti leading to miscarriage?

A

Chromosomal
Genetic
Structural

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18
Q

What are the most common uterine abnormalities leading to miscarriage?

A

Congenital issues

Fibroids

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19
Q

What are the most common maternal factors leading to miscarriage?

A

Increasing age

Diabetes

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20
Q

How is threatened miscarriage managed?

A

Conservative management

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21
Q

How is inevitable miscarriage managed?

A

Evacuation if bleeding is heavy

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22
Q

How is missed miscarriage managed?

A

Conservative
Medical - prostaglandins (Misoprostol)
Surgical - SMM (surgical management of miscarriage)

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23
Q

How is septic miscarriage managed?

A

Evacuate uterus

Antibiotics

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24
Q

What is the most common type of ectopic pregnancy?

A

Ampullary Tubal ectopic

Then isthmus, then cornual

25
Q

How common are ectopic pregnancies?

A

1 in 90 pregnancies

26
Q

What are the risk factors for ectopic pregnancies?

A 
(damage to fallopian tubes)
PID
Previous Tubal surgery
Previous ectopic
Assisted conception
27
Q

What is the presentation of ectopic pregnancy?

A 
Period of ammenorrhoea (+ +ve pregnancy test)
Maybe:
Vaginal bleeding 
Painful abdomen
GI/urinary symptoms
28
Q

How should a suspected ectopic pregnancy be investigated?

A

Scan
Serum beta-hCG levels tracked over 48hrs
Serum Progesterone

29
Q

How will ectopic pregnancies appear on scan?

A

No intrauterine gestational sac
Possible adnexal mass
Fluid in pouch of Douglas

30
Q

How are ectopic pregnancies managed?

A

Methotrexate

Salpingectomy/Salpingotomy

31
Q

What is antepartum haemorrhage?

A

APH - haemorrhage from genital tract after 24th week of pregnancy, before delivery of baby

32
Q

Antepartum haemorrhage is associated with what?

A

Significant maternal & neonatal morbidity and mortality

33
Q

What are the causes of Antepartum haemorrhage?

A 
Placenta praevia
Placental abruption
Unknown 
Local lesions of genital tract
Vasa praevia
34
Q

What is placenta praevia?

A

All/part of placenta implants in the lower uterine segment

35
Q

What is the incidence of placenta praevia?

A

1 in 200 pregnancies

36
Q

When is placenta praevia more common?

A

Multiparous women
Multiple pregnancies
Previous C-sections

37
Q

How is placenta praevia classified?

A

Grade I - IV
Grade I - encroaching lower segment (not in os)
Grade II - Placenta reaches the internal os
Grade III - Placenta eccentrically covers the os
Grade IV - Central placenta praevia

38
Q

How does placenta praevia present?

A

Painless PV bleeding
Malpresentation of fetus
Incidental finding
Soft, non-tender uterus

39
Q

How is placenta praevia diagnosed?

A

USS to locate placental site

DO NOT DO VAGINAL EXAM

40
Q

How is placenta praevia managed?

A

Depends on gestation and degree of bleeding
C-section
OBSERVE FOR PPH

41
Q

How is PPH managed?

A

Medical - Oxytocin, Ergometrine, Carbaprost, Tranexamic acid

Surgical - Balloon tamponade, Ligation of uterine vessels

42
Q

What is placental abruption?

A

Haemorrhage resulting from premature separation of placenta before birth

43
Q

What is the incidence of placental abruption?

A

0.6%

44
Q

Placental abruption is associated with what?

A

Retroplacental clot

45
Q

Incidence of placental abruption is associated with what?

A 
Cocaine use
Previous abruption
Pre-eclampsia/HTN
Polyhydramnios
Maternal age
Parity
Social status
Smoking
46
Q

What are the types of placental abruption?

A

Revealed
Concealed
Mixed

47
Q

What is a revealed placental abruption?

A

Major haemorrhage revealed as blood escapes and passes through os

48
Q

What is a concealed placental abruption?

A

Blood is concealed behind the placenta, increasing fundal height consistent with gestation
Uterus appears bruised (Couvelaire uterus)

49
Q

How does placental abruption present?

A

PAIN
Vaginal bleed (may be minimal)
Increased uterine activity

50
Q

How is placental abruption managed?

A

Varies depending on volume of bleed, condition of mother, gestation
Vaginal delivery
Immediate C-section

51
Q

What complications are associated with placental abruption?

A

Maternal shock - collapse
Fetal death
Maternal DIC, renal failure
Post-artum haemorrhage

52
Q

What is the range of preterm labour?

A

32-36 wks mildly preterm
28-32 wks very preterm
24-28 wks extremely preterm

53
Q

What are the types of preterm labour?

A

Spontaneous

Iatrogenic (induced)

54
Q

What is the incidence of preterm labour?

A

5-7% in singletons

30-40% in multiples

55
Q

What factors predispose preterm labour?

A 
Multiple pregnancy
Polyhydramnios
Antepartum Haemorrhage
Pre-eclampsia
Infection
Premature rupture of membranes
56
Q

What is the largest cause of preterm labour?

A

Idiopathic

57
Q

How is preterm labour managed?

A

Confirm: Contractions with evidence of cervical change

Consider cause

58
Q

How is <24-26wk preterm labour managed?

A 
Poor prognosis
All considered viable:
Consider tocolysis
Steroids unless contraindicated
Transfer to NICU
Aim for vaginal delivery
59
Q

What neonatal morbidities occur due to prematurity?

A 
IRDS
Intraventricular haemorrhage
Cerebral palsy
Nutrition issues
Temperature control
Jaundice
Infections
Visual impairment
Hearing loss

Yr 3 - Reproduction (37 decks)

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