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Year 3- Reproduction > Complications of Pregnancy > Flashcards

Complications of Pregnancy Flashcards

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1
Q

Abortion?

A

Voluntary termination of pregnancy

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2
Q

Miscarriage?

A

Spontaneous loss of pregnancy before 24wks gestation

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3
Q

There are many categories of miscarriage.
What happens in a threatened miscarriage?

A

Bleeding from uterus before 24wks gestation in a viable pregnancy

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4
Q

There are many categories of miscarriage.
What happens in an inevitable miscarriage?

A

Cervix already began to dilate in a viable pregnancy

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5
Q

There are many categories of miscarriage.
What happens in an incomplete miscarriage?

A

Only partial expulsion of the products of conception

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6
Q

There are many categories of miscarriage.
What happens in a complete miscarriage?

A

Complete expulsion of the products

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7
Q

What is he risks following an incomplete miscarriage?

A

Risk of ascending infection into the uterus which can then spread throughout the pelvis

->this is known as septic miscarriage

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8
Q

There are many categories of miscarriage.
What happens in a missed miscarriage?

A

Foetus has died but uterus makes no attempts to expel the products on conception

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9
Q

When is a missed miscarriage diagnosed?

A

No symptoms/could have bleeding or brown loss vaginally
Gestational sac seen on scan
No clear foetus, no foetal heart

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10
Q

What are some of the causes of spontaneous miscarriage?

A

Abnormal conceptus- chromosomal, genetic, structural
Uterine abnormality- congenital, fibroids
Cervical weakness
Maternal- increasing age, diabetes

->usually difficult to identify the underlying factor

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11
Q

What are some maternal health conditions which are known to increases risks of spontaneous miscarriage?

A

SLE- lupus
Thyroid conditions
Diabetes
Infections e.g. pyelitis, appendicitis

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12
Q

Management of threatened miscarriage?

A

Conservative management
Just wait, most cases, bleeding stops

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13
Q

Management of inevitable miscarriage?

A

If bleeding is heavy, may need evacuation

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14
Q

Management of missed miscarriage?

A

Conservative
Medical- prostaglandins
Surgical- suction evacuation

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15
Q

Management of septic miscarriage?

A

Antibiotics and evacuate uterus

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16
Q

Ectopic pregnancy?

A

Pregnancy implanted outwith the uterine cavity

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17
Q

Where is the most common location of ectopic pregnancy?

A

Fallopian tube, especially in the ampullary region

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18
Q

Risk factors of ectopic pregnancy?

A

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic pregnancy
Assisted conception

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19
Q

Presentation of ectopic pregnancy?

A

Period of amenorrhoea (with +ve urine pregnancy test)
+/- vaginal bleeding
+/- abdominal pain
+/- GI or urinary symptoms

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20
Q

Investigations done to investigate a potential ectopic pregnancy?

A

Scan- no intrauterine gestational sac.
Serum BHCG levels

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21
Q

Medical management of ectopic pregnancy?

A

Methotrexate injection

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22
Q

Surgical management of ectopic pregnancy?

A

Most laparoscopy- salpingectomy, salpingotomy for few indications)

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23
Q

Where is the pouch of Douglas?

A

Behind the uterus

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24
Q

Antepartum haemorrhage?

A

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

->one of the greatest obstetric emergencies

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25
Causes of Antepartum haemrrohage?
Placenta praevia Placental abruption Local lesions of genital tract Vasa praevia (v rare)
26
Placenta praevia?
Placenta is attached to the lower segment of the uterus
27
Placental abruption?
Placenta has started to sperate from the uterine wall
28
When is placenta praevia more common?
Multiparous women (women who have given birth one or more times in the past) Multiple pregnancies Previous C-section
29
Presentation of placenta praevia?
Painless PV bleeding Malpresentation of the foetus on US ->may be incidental upon US of foetus for another reason
30
How is diagnosis of placenta praevia usually made?
Via ultrasound
31
Management of placenta praevia?
Depends on gestation and severity of blood loss Patient admitted to hospital, diagnosis made by ultrasound and blood transfusion may be required. Deliver baby via C-section, watch for postpartum haemorrhage ->note that vaginal examination is contraindicated
32
Postpartum haemorrhage>
Any bleeding after delivery >500mls
33
How can postpartum haemorrhage be managed medically?
Oxytocin Ergometrine Carboprost Tranexamic acid
34
What are some of the other forms of management of postpartum haemorrhage?
Balloon tamponade Surgical
35
List some of the factors associated with placental abruption.
Pre-eclampsia/ chronic hypertension Multiple pregnancy Polyhydramnios Smoking Increasing age Previous abruption Cocaine use
36
Three types of placental abruption?
Revealed Concealed Mixed ->in revealed, see blood. In concealed, don't see blood as inside
37
Presentation of placenta abruptuon?
Severe abdominal pain Vaginal bleeding Increased uterine activity ->note bleeding may be minimal
38
Management of antepartum haemorrhage?
Depends on amount of bleeding and the general condition of mother and baby, as well as the gestation. However, may attempt vaginal delivery or go to an immediate C-section.
39
Complications of placental abruption?
Maternal shock/collapse Foetal distress, then potentially death Maternal DIC Renal failure Postpartum haemorrhage
40
Preterm labour?
Onset of labour before 37wks gestation
41
Predisposing factors to preterm labour?
Multiple pregnancy Polyhydramnios APH- antepartum haemorrhage Pre-eclampsia Infection e.g. UTI Prelabour premature rupture of membranes ->majority are idiopathic
42
How is a diagnosis of preterm labour made?
Contractions with evidence of cervical change on vaginal examination Test- foetal fibronectin
43
Management of preterm delivery?
Consider tocolysis to allow steroids/transfer Steroids unless contraindicated Transfer to unit with NICU facilities Aim for vaginal delivery
44
List some of the potential neonatal morbidities resulting from prematurity.
Respiratory distress syndrome Intraventricular haemorrhage Cerebral palsy Nutrition Temperature control Jaundice Infections Visual impairment Gearing loss
45
Hypertension can be common in pregnancy. What are the systolic and diastolic cutoffs for mild HT in pregnancy?
140/90 Diastolic- 90-99 Systolic- 140-49
46
Hypertension can be common in pregnancy. What are the systolic and diastolic cutoffs for moderate HT in pregnancy?
150/100 Diastolic- 100-109 Systolic- 150-159
47
Hypertension can be common in pregnancy. What are the systolic and diastolic cutoffs for severe HT in pregnancy?
>160/110
48
What is meant by chronic hypertension in pregnancy?
Hypertension either pre-pregnancy or at booking (<20wks gestation)
49
What is meant by gestational hypertension in pregnancy?
New hypertension which has developed in pregnancy, usually develops after 20wks
50
What is the difference between gestational hypertension and pre-eclampsia?
Pre-eclampsia is new hypertension >20wks gestation AND significant proteinuria
51
When in chronic hypertension in pregnancy more common?
In increased maternal age ->this makes sense as hypertension often occurs in older age anyways
52
Describe the changes to anti-hypertensive drugs in pregnancy.
Women with pre-existing hypertension need to switch meds. Stop ACEi, ARB's, anti-diuretics Aim to keep BP <150/100 using labetalol, nifedipine, methyldopa
53
What needs to be monitored in women with chronic hypertension in pregnancy?
Monitor for superimposed pre-eclampsia Monitor foetal growth ->bear in mind there is a higher risk of placental abruption
54
As mentioned, pre-eclampsia is when there is hypertension and proteinuria. Quantify this though.
HT on two occasions more than 4hrs apart Proteinuria more than 300mgs/24hrs
55
Risk factors for pre-eclampsia?
First pregnancy Extremes of maternal age Pre-eclampsia in previous pregnancy Pregnancy interval >10yrs FH of pre-eclampsia Underlying medical disorders: chronic hypertension, renal disease, diabetes, autoimmune conditions
56
Pre-eclampsia has mutisystem involvement. Which systems does it affect?
Renal Liver Vascular Cerebral Pulmonary
57
Maternal complications of pre-eclampsia?
Eclampsia- seizures Severe hypertension increasing risks of strokes or cerebral haemorrhage Renal failure Pulmonary oedema Cardiac failure
58
Foetal complications of pre-eclampsia?
Impaired placental perfusion which can lead to prematurity, foetal distress
59
Symptoms/signs of severe pre-eclampsia?
Headache, blurring of vision Severe hypertension and proteinuria Reduced urine output Convulsions (eclampsia) Clonus/brisk reflexes
60
Biochemical/haematological abnormalities in severe pre-eclampsia?
Raised LFTs Raised urea, creatinine, urate Low platelets Low haemoglobin
61
Management of pre-eclampsia?
Frequent BP checks and urinalysis Check symptoms Check for hyper-reflexia and tenderness over liver Bloods Foetal investigations- scan for growth, cardiotocography
62
What is the only cure for pre-eclampsia?
Delivery of baby ->conservative management can be given if aiming for increased foetal maturity before delivery
63
Although delivery of the baby is the only cure for pre-eclampsia, what needs to still be monitored after?
Monitoring of pre-eclampsia must continue after delivery as risks still continue and could still develop into eclampsia
64
Treatment of seizures/impending seizures of eclampsia?
Magnesium sulphate bolus + IV infusion Control of BP Avoid fluid overload
65
What is used for prophylaxis for pre-eclampsia in subsequent pregnancies?
Low does aspirin Given from 12wks to delivery
66
What are women with pre-eclampsia at increased risk of developing in later life?
Hypertension
67
Gestational diabetes?
Diabetes in pregnancy- carbohydrate intolerance or abnormal glucose tolerance that reverts to normal after delivery
68
What are mother's with gestational diabetes at increased risks of developing in later life?
Type II diabetes
69
What is the management of pre-existing diabetes in a pregnant mother?
Insulin requirements increases Foetal hyper-insulinemia occurs
70
What are some of the risks to the foetus after delivery to a mother with pre-existing diabetes?
Increased risk of neonatal hypoglycaemia Increased risk of respiratory distress
71
What effect does diabetes have on the foetus?
Increased risks of foetal congenital abnormalities e.g. cardiac abnormality, sacral agenesis Impaired lung maturity Neonatal hypoglycaemia Jaundice ->especially if blood sugards high peri-conception
72
What are some of the increased risks on the mother if she has diabetes in pregnancy?
Miscarriage Foetal macrosomia Shoulder dystocia Stillbirth Pre-eclampsia Infections
73
What are some pre-existing maternal issues which can worsen if there is diabetes in pregnancy?
Nephropathy Retinopathy Hypoglycaemia
74
What makes up the preconception management of diabetes if the mother is wanting to become pregnant?
Better glycaemic control Folic acid 5mg Dietary advice Retinal and renal assessment
75
What is the management of diabetes during pregnancy?
Optimise glucose control- insulin requirements will increase Can continue oral anti-diabetic meds e.g. metformin but may need to add insulin for tighter glucose control Watch foetal growth Watch for ketonuria/infections
76
Why may Csection be considered in mothers with diabetes?
Baby may be bigger- macrosomia
77
What are other aspects of management which need to be carried out in delivery of a baby when the mother has diabates?
Induction of pregnancy Maintain blood sugar in labour with insulin-dextrose infusion Continuous CTG foetal monitoring Early feeding of baby to reduce neonatal hypoglycaemia ->mother can go back to pre-pregnancy regimen of insulin post delivery
78
Risk factors for gestational diabetes?
Increased BMI > 30 Previous macrosomic baby (>4.5kg) Previous GDM FH of diabetes
79
Management of gestational diabetes?
Control blood sugars- by diet, but metformin/insulin if sugars remain high Annual check of HbA1C as higher risk of developing overt diabetes
80
Venous thromboembolism is a lot more common in pregnancy because of Virchow's triad. What makes up this?
Stasis of blood Hypercoagulability Vessel wall injury ->all of which occur in pregnancy
81
What are some of the factors which increased risk of a thromboembolism in pregnancy?
Older mothers Increased BMI Smokers IVDU Pre-eclampsia Dehydration Decreased mobility Infections Prolonged delivery Haemorrhage Previous VTE Sickle cell disease
82
What can be used as prophylaxis for VTE in pregnancy?
TED stockings Advise increased mobility, hydration Prophylactic anti-coagulation with three or more risk factors
83
Signs/symptoms of VTE?
Pain in calf Swelling Heat Calf muscle tenderness Breathlessness Pain on breathing Cough Tachycardia Hypoxic Pleural rub
84
Investigations if suspect VTE?
ECG Blood gases Doppler V/Q lung scam CTPA- CT pulmonary angiogram
85
Treatment of VTE?
Appropriate anticoagulation
86

Year 3- Reproduction (33 decks)

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