Complications of Pregnancy

Question 1

Ectopic Pregnancy

• definition
• presents with?
• how do we diagnosis?

Answer 1

Ectopic pregnancy is an implantation in the wrong place (especially in the Ampulla)
it presents with misses menses, vaginal bleeding, and lower abdominal pain.
HCG LEVELS ARE NORMAL- unlike a h. mole which will be really high. follow the HCG levels until they are below 20.

Question 2

Risk factors for ectopic pregnancy

outcomes

Answer 2

history of tubal infection, tubal ligation, reconstructive surgery, PID
-prior ectopic pregnancy
assisted reproductive technology

Outcomes:

• tubal rupture
• INTERPERITONEAL HEMORRHAGE- severe abdominal pain, ipsilateral shoulder pain (phrenic nerve irritation), tachycardia, hypotension, acute abdomen
• tender, guarding, rebound tenderness

Question 3

what is the leading cause of infant mortality?

risk factors?

Answer 3

prematurity is the leading cause of infant mortality. Birth at 20-37 weeks gestation

risk factors for pregnancy include:
multiple pregnancies, pregnancy associated HTN, cervical incompetence or uterine anomalies, antepartum hemorrhage, SMOKING, preterm premature rupture of membranes (PPROM)

Question 4

PPROM

• causes
• management

Answer 4

the amniotic sac ruptures before 37 weeks leading to a higher risk for infection
causes:
-vaginal/cervical infections
-abnormal membrane physiology
-incompetent cervix
-nutritional deficiencies

Management: determined by gestational age, test the amount of amniotic fluid remaining with ultrasound
nitrazine paper-blue=baby (amniotic fluid is alkaline), ferning of the fluid

if >36 weeks and cervix is soft, labor should be induced after 6-12 hours… treat with antibiotics to treat for possible exposure to infection

Question 5

Mal-Presentation

-Breech

Answer 5

Complete Breech: legs are folded at the knees with the feet near the but

Frank: the legs point straight up in front of the baby’s body with feet near the head

Footling: one or both feet down (deliver that way)

Question 6

factors associated with breech presentations

treatment?

Answer 6

prematurity is a major factor associated with breech presentations

• most breech presentations (except footling) are delivered via cesarean to decrease:
• umbilical cord prolapse
• head entrapment
• birth asphyxia
• birth trauma

Question 7

How do we deliver a…
brow presentation?
shoulder/transverse
face

Answer 7

how do we deliver a…
brow presentation: can be delivered if the chin moves to the chest. c-section if it doesn’t
Shoulder/transverse: c-section (no way for the baby to move through the birth canal)
face:*vertex position can usually be delivered

Question 8

Cesarean Delivery

• Types
• Indications
• can the mom have a regular vaginal birth after having a c-section?

Answer 8

Cesarean Delivery- maternal morbidity is increased due to infections, hemorrhage, and thromboembolism
-types: Low transverse, Classic- midline just below belly button (higher risk of rupture), and low vertical.

they are indicated with placenta previa or if the mother has had a previous classic c-section

VBAC is possible unless it was a classic c-section