Complications of Pregnancy Flashcards
(214 cards)
1
Q
Definition of abortion/spontaneous miscarriage
A
Termination/loss of pregnancy before 24 weeks gestation with no evidence of life
2
Q
Types of spontaneous miscarriage
A
threatned inevitable incomplete complete septic missed (early foetal demise)
3
Q
Definition of threatned miscarriage
A
Bleeding from the gravid uterus before 24 weeks gestation when there is a viable foetus and no evidence of cervical dilatation
4
Q
Definition of an inevitable miscarriage
A
Abortion becomes inevitable if the cervix has already begun to dilate
5
Q
Definition of incomplete miscarriage
A
Only partial expulsion of the products of conception
6
Q
What is there a risk of after an incomplete miscarriage?
A
Ascending infection into the uterus which can spread throughout the pelvis (septic abortion)
7
Q
Definition of complete miscarriage
A
Complete expulsion of all the products of conception
8
Q
Definition of septic miscarriage
A
After incomplete abortion then risk of ascending infection which can spread throughout the pelvis
9
Q
Presentation of threatened miscarriage
A
Vaginal bleeding and pain
Viable pregnancy
Closed cervix on speculum examination
10
Q
Presentation of inevitable miscarriage
A
Viable pregnancy
Open cervix
Bleeding that may be heavy +/- clots
11
Q
Presentation of missed miscarriage (early foetal demise)
A
No symptoms possibly
Bleeding/brown loss vaginally
Gestational sac seen on scan
No clear foetus (empty gestational sac) or a foetal pole with no foetal heart seen in the gestational sac
12
Q
Presentation of an incomplete miscarriage
A
Most of the pregnancy expelled out but some of the products remaining in the uterus
Open cervix
Vaginal bleeding (may be heavy)
13
Q
Presentation of complete miscarriage
A
Passed all products of conception
Cervix has closed
Bleeding has stopped
14
Q
Causes of spontaneous miscarriage
A
Abnormal conceptus (genetic, chromosomal, structural)
Uterine abnormality (congenital, fibroid)
Cervical incompetence (primary - born with it or secondary - treatment to the cervix due to a bad smear i.e. iatrogenic)
Maternal increasing age
Maternal diabetes
Maternal SLE
Maternal thyroid disease
Maternal infection e.g. appendicitis
Hormonal imbalances (corpeus luteum, progesterone level lower)
Unknown
15
Q
Treatment of missed miscarriage
A
Conservative
Prostaglandins (misoprostol)
SMM
16
Q
What does SMM stand for?
A
Surgical management of miscarriage
17
Q
Treatment of an inevitable miscarriage if the bleeding is really heavy
A
Evacuation
18
Q
Treatment of septic abortion
A
Antibiotics
Evacuate uterus
19
Q
Definition of ectopic pregnancy
A
Pregnancy implanted outside the uterine cavity
20
Q
Most common site of ectopic pregnancy
A
Ampulla
21
Q
How common is an ectopic pregnancy?
A
1 in 90 pregnancies
22
Q
Risk factors for ectopic pregnancies
A
History of PID Previous tubal surgery/scarring previous ectopic pregnancy Assisted conception (IVF) Mirena or copper coil
23
Q
Presentation of ectopic pregnancy
A
period of amenorrhoea (wih +ve urine pregnancy test)
vaginal bleeding
pain in abdomen
GI or urinary symptoms
If has ruptured, usually features of hypovolaemic shock
24
Q
Investigations of ectopic pregnancy
A
History and examination
- pain more prominent on one side
Serum BhCG levels
- increased levels in pregnancy by 66% ish and serially track levels over 48 hour intervals
USS
- No intrauterine gestational sac
- empty uterine cavity
- May see adnexal mass (outside uterine cavity)
- fluid in pouch of douglas
Serum progesterone levels
- viable IU pregnancy levels >25ng/ml
25
Treatment of ectopic pregnancy
Methotrexate
Surgical - mostly laparoscopically (Salpingectomy)
Conservative
26
When is surgery indicated in the treatment for ectopic pregnancy?
If it Is close to rupture
27
Salpingectomy vs Salpingotomy
```
Salpingectomy = removal of one or both fallopian tubes
Salpingotomy = incision on the tube, remove pregnancy tissue and leave the tube
```
28
Definition of antepartum haemorrhage
Haemorrhage from the genital tract after the 24th week of pregnancy but before the delivery of the baby
29
Antepartum definition
Before delivery
30
Causes of antepartum haemorrhage
```
Placenta praevia
Placental abruption
(APH of unknown origin)
Local lesions of the genital tract (including cervical or vaginal e.g. cervix erosions and polyps or thrush infections)
Vasa praevia
Uterine rupture
```
31
Placenta praevia definition
Placenta is attached to the lower segment of the uterus
32
Placental abruption definition
Placenta starts to separate from uterine wall before the birth of the baby and is associated with retroplacental clot
33
Vasa praevia definition
Rupture of foetal blood vessels that sit near the internal opening of the uterus. Blood loss from the foetus can be catastrophic
34
Treatment of antepartum haemorrhage
Sometimes just settles
Attempting vaginal delivery
C section
35
Treatment for antepartum haemorrhage depends on...
Amount of bleeding
General condition of mother and baby
Gestation
36
Incidence of placenta praevia
1 in 200 pregnancies
37
Placenta praevia is more common in …..
multiparous women
multiple pregnancies
previous C section
38
Classification of placenta praevia
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 = i.e. completely covering the surface of the cervix
39
Pathology of placenta praevia
Separation of the placenta causes bleeding as the lower uterine segments forms and the cervix effaces. the blood loss from the venous sinuses in the lower segment
40
Presentation of placenta praevia
```
Painless PV bleeding (APH) recurrent
Malpresentation of the foetus
soft, non-tender uterus
Maternal condition correlates with amount of bleeding PV
Incidental by USS
```
41
Investigations of placenta praevia
Transvaginal USS to locate placental site
| MRI (if USS not confirmatory)
42
What should NOT be done in placenta praevia
Vaginal exam
43
Treatment of placental praevia depends on.....
Gestation at presentation
| Severity of blood loss
44
Treatment for placenta praevia
Caesarean section
| Watch for PPH!
45
Treatment for PPH
```
Medical (to contract the uterus)
- oxytocin
- ergometrine
- carbaprost
- tranexamic acid
Balloon tamponade
Surgical (sutures)
- B lynch culture
- Ligation of uterine
- Iliac vessels
- Hysterectomy
```
46
Placental abruption is associated with
Retroplacental clot
47
Pathology of placental abruption
Placenta is in an abnormal site but there is separation from the wall and so bleeding behind the placenta
48
Factors associated with placental abruption
```
Pre-eclampsia/hypertension
Multiple pregnancy
Polyhydramnios
Smoking
Cocaine use
Increasing age
Parity
Previous abruption
```
49
Types of placental abruption
Revealed
Concealed
Mixed
50
What is a revealed placental abruption?
Major haemorrhage is apparent externally as blood released escapes through the cervical OS
51
What is a concealed placental abruption?
Haemorrhage occurs between placenta and uterine wall. Uterine contents increase in volume and fundal height is larger than would be consistent for gestation
52
What can a concealed placental abruption result in?
Couvelaire uterus
53
What is a couvelaire uterus?
In concealed placental abruption, in some situations blood penetrates the uterine wall and the uterus appears bruised
54
What is a mixed placental abruption?
Concealed and revealed types together
55
What type of placental abruption is seen in the majority?
A mixed placental abruption
56
Presentation of placental abruption
```
Pain - severe abdominal pain
Vaginal bleeding (may be minimal)
Increased uterine activity
- tender and irritable uterus
- having contractions
Foetal lie is longitudinally with the presenting part fixed in the pelvis
```
57
Complications of placental abruption
Maternal shock, collapse (may be disproportionate to the amount of bleeding seen)
Foetal death
Maternal DIC, renal failure
PPH (couvelaire uterus)
58
Definition of Pre Term Labour
Onset of labour before 37 weeks completed of gestation (259 days)
59
Spectrum of pre term labour
32-36 weeks = midly preterm
28-32 weeks = very preterm
24-28 weeks = extremely preterm
60
Types of pre term labour
Spontaneous
| Induced (Iatrogenic)
61
Incidence of preterm labour in singletons vs multiple pregnancy
Singletons = 5-7%
| Multiple pregnancy = 30-40%
62
Predisposing factors to preterm labour
```
Multiple pregnancy
Polyhydramnios
APH
Pre-eclampsia
Infection e.g. UTI
Prelabour premature rupture of membranes
```
63
Treatment of preterm labour
Consider tocolysis to allow steroids/transfer
| Steriods unless contraindicated
64
What do tocolysis drugs do?
Slow down contractions
65
How long can tocolysis drugs be used for?
12-24 hours
66
What do steroids do in preterm labour?
Help the babys lungs cope better when it is born
| Also allows for transfer
67
Neonatal prematurity can result in …..
```
Respiratory distress syndrome
Intraventricular haemorrhage
CP
Nutrition
Temp control
Jaundice
Infections
Visual impairment
Hearing loss
```
68
Essential/chronic hypertension in pregnancy is commoner in which age of mothers?
Older mothers
69
Definition of Pre-eclampsia
Mild Hypertension on two occasions more than 4 hours apart or moderate to severe hypertension on one occasion
PLUS
Proteinuria >300mgm/s 24 hours
70
Risk factors for developing pre eclampsia
```
First pregnancy
Extremes of maternal age
Pre eclampsia in previous pregnancy
Pregnancy interval > 10 years
BMI > 35
FH of pre eclampsia
Multiple pregnancy
Underlying medical disorders (Chronic HTN, pre-existing renal disease, pre-existing diabetes, autoimmune disorders like SLE)
```
71
Maternal complications of pre-eclampsia
```
Eclampsia
Severe HTN leads to cerebral haemorrhage, stroke
HELLP
DIC
Renal failure
Pulmonary oedema and cardiac failure
```
72
What does HELLP stand for?
Haemolysis, elevated liver enzymes, low platelets
73
What does DIC stand for?
Disseminated intravascular coagulation
74
Foetal complications of pre eclampsia
Impaired placental perfusion
75
What does impaired placental perfusion lead to?
IUGR
Foetal distress
Prematurity
increased PN mortality
76
Symptoms/Signs of Pre eclampsia
```
Headache
Blurring of vision
Vomiting
Epigastric pain
Pain below ribs
sudden swelling of hands, face and legs
Severe HTN + >3 urine proteinuria
Clonus/brisk reflexes
Papilloedema
Reduced urine output
Convulsions (eclampsia)
```
77
Biochemical abnormalities of pre eclampsia
Raised liver enzymes
Bilirubin in HELLP present
Raised urea and creatinine
Raised urate
78
Haematological abnormalities of pre eclampsia
Low platelets
Low haemoglobin
Signs of haemolysis
Features DIC
79
Investigations for pre eclampsia
Frequent BP checks
Urine protein
Check symptomatology
Bloods (FBC, LFTs, RFTs, coagulation if needed)
Foetal investigations (scan for growth, CTG)
80
Only cure for pre eclampsia
Delivery of the baby and the placenta
81
Treatment of seizures/impending seizures in pre-eclampsia
Magnesium sulphate bolus + IV bolus
Control of BP - IV labetolol, hydralazine (if >160/110)
Avoid fluid overload - aim for 80ml/hr for fluid intake
82
Prophylaxis for pre eclampsia in subsequent pregnancy is …..
Low dose aspirin from 12 weeks until delivery
83
Women with pre eclampsia are at a higher risk of developing what later in life?
Hypertension
84
Effects of diabetes in pregnancy
```
Insulin requirements of mother increase
Foetal hyperinsulinaemia occurs -> macrosomnia
More risk of neonatal hypoglycaemia
Increased risk of respiratory distress
Increased risk of foetal cardiac abnormalities
Miscarriage
Feotal macrosomnia, polyhydramnios
Operative delivery
Shoulder dystocia
Stillbirth
Increased risk of pre-eclampsia
Worsening of maternal nephropathy, retinopathy, hypoglycaemia, reduced awareness of hypoglycaemia
Infections
impaired lung maturity of neonatal
neonatal hypoglycaemia
Jaundice
```
85
Treatment of Diabetes in pregnancy - Pre-conception
Better glycaemic control
Folic acid 5mg
Diet
retinal and renal assessment
86
Treatment of diabetes during pregnancy
Optimise glucose control
Can continue oral diuretic agents (metformin) but may need to change to insulin for tighter control
Provide treatment for hypos
Labour induced usually 38-40 weeks
C section possible if macrosomnia
Early feeding of baby to reduce neonatal hypoglycaemia
Insulin requirements increase during pregnancy
87
Risk factors for gestational diabetes
Increased BMI > 30
Previous macrosomia baby >4.5kg
Previous GDM
FH of DM
High risk groups for developing DM e.g. Asians
Polyhydramnios
Big baby currently in pregnancy
Recurrent glycosuria in current pregnancy
GDM associated with some increased in maternal or foetal complications
88
Screening for gestational diabetes
If risk factor
HbA1c
OGTT
89
Treatment for gestational diabetes
Control blood sugars (diet, insulin, metformin)
Post delivery - check OGTT 6 to 8 weeks
Yearly check of HbA1c/blood sugars as increased risk for developing DM
90
Virchows triad
Stasis
Vessel wall injury
Hypercoagulability
91
Why is there a risk of thrombo-embolism in pregnancy?
It is a hypercoagulable state (to protect the mother against bleeding post delivery)
92
What happens in the blood to make pregnancy a hypercoagulable state?
Increased fibrinogen, factor VIII, VW factors, Platelets
Decrease in natural anticoagulants -> antithrombin III
Increase in fibrinolysis
93
Vircows triad in respect to pregnancy
1. STASIS - progesterone and effects of enlarging uterus cause increases stasis
2. HYPERCOAGULABILITY - hypercoagulable state in pregnancy
3. VESSEL WALL INJURY - maybe vascular damage at delivery/ caesarean section
94
Increased risk of VTE seen in …..
```
Older mothers
Increasing parity
smokers
IVDU
PET
increased BMI
Dehydration - hyperemesis
Decreased mobility
Infections
FH of VTE
Sickle cell disease
Operative delivery/prolonged labour
Haemorrhage, blood loss > 2L
Previous VTE not explained by predisposing factors
Those with thrombophilia
```
95
Prophylaxis of VTE in pregnancy
TED stockings
Increased mobility
Hydration
Prophylactic anticoagulation if increased risk factors
96
Presentation of VTE
```
Pain in calf
Increased girth of affected leg
Calf muscle tenderness
Breathlessness
Pain on breathing
Cough
Tachycardia
Hypoxic
Pleural rub
```
97
Investigations of VTE
ECG
Blood gases
Doppler V/Q lung scan
CTPA
98
Treatment of VTE
anticoagulation
99
Effects of progesterone on the uterus
Thickens the lining
Changes the cells
Turns the endometrium into decidua
100
What happens when the endometrium is turned into a decidua?
Increases vascularity
Between glands and vessels the stromal cells enlarge and become procoagulant -> stops bleeding
Monthly shredding occurs here and is akin to falling of leaves from a decidual tree
101
Another name for the egg
Chorion
102
Where are trophoblast cells found?
On the outside of a fertilised egg
103
What do trophoblast cells produce?
Beta human chorionic gonadotrophin (B-hCG)
104
Function of BhCG
It is to keep and stimulate the corpeus luteum to produce progesterone throughout pregnancy, and stops the decidua from shredding
105
Clinical implication of BhCG
Forms the basis of pregnancy tests
106
What do trophoblast cells do once the fertilised egg is buried into the decidua?
Stem off to invade mothers blood vessels and (eventually) link those vessels up with those of the foetus, so try to turn into placental cells to form the placenta
107
Where are the decidual stromal cells found?
Between the vessels (foetal and maternal)
108
What is the function of the decidual stromal cells?
The cells are procoagulant and stop the trophoblast cells causing too much bleeding when they invade the mothers blood vessels
109
How is the forerunner of the placenta eventually formed?
Chorionic villi, covered by trophoblast cells, are bather in the mothers blood, forming the forerunner of the placenta
110
Why are ectopic pregnancies predisposed to haemorrhage and rupture?
Lack of decidual layer
| Small size of tube
111
A major anomaly of Downs Syndrome
Duodenal atresia
112
What does macrosomnia of babys in mothers with DM predispose the baby to?
Intrauterine death (IUD)
113
Acute chorioamnionitis definition
Acute inflammation with neutrophils present in the membranes (chorioamnionitis), cord and foetal plate of the placenta
114
Pathology of acute chorioamnionitis
Perineal or perianal bacteria ascend vaginally and get into the amniotic sac
115
Presentation of acute chorioamnionitis
```
Mother
- ill
- fever
- raised neutrophils
- can be well
Baby
- IUD
- ill in first days of life
- CP later on in life
```
116
How does the ascending infection in acute chorioamnionitis affect the babys brain?
Neutrophils produce 'cytokine storm' which activates some brain cells, which then get damaged by the normal hypoxia of labour
117
When does the withdrawal hit the baby is the mother is on heroin vs methadone?
Heroin => immediate withdrawal
| Methadone => later withdrawal
118
When the mother is addicted to opiates, the pregnancy often proceeds well if the mother does what?
If she eats properly
119
Conditions associated with cyclical abdominal pain
Endometriosis
| Imperforate Hymen
120
What heart rate is defined as foetal tachycardia?
> 160bpm
121
Most common cause of PPH
Uterine atony
122
Definition of uterine atony
The uterus fails to contract after the delivery of the placenta
123
What heart rate is defined as fetal bradycardia?
<100 bpm
124
What is the cervical os?
Opening in the lower part of the cervix between the uterus and the vagina
- internal os
- external os
125
Definition of recurrence miscarriage
3 or more miscarriages
126
What is the most common cause of miscarriage?
Foetal chromosomal abnormality
127
If someone is passing clots, what does this indicate?
A miscarriage
128
If someone is passing small amounts of blood, what does this indicate?
An ectopic pregnancy
129
If you can see the foetal heart on transvaginal scan, what is the chance of miscarriage?
< 50 %
130
How to tell difference between ectopic pregnancy or complete miscarriage on scan
BhCG levels
| - redo after 48 hours and if the levels have come down = complete miscarriage
131
If the serum progesterone is < 20, what does this indicate?
Likely to be a failing pregnancy
132
What on the scan indicates a delayed/missed miscarriage?
Foetal pole but no heart OR
| Foetal sac but no foetus
133
What is the most important aspect in the management of miscarriage?
Psychological help
134
Types of management of miscarriage
1. SMM
2. Medical
3. Expected
135
Which of the types of management of miscarriage have the highest rate of infection?
SMM
136
What are the risks of having an increased age of mum?
```
Increased risk of foetal chromosomal abnormalities
Increased risk to the mother
- placenta praevia
- pre eclampsia
- DVT
Contractions in labour not as effective
Stillbirth risk
```
137
What BhCG level indicates a viable foetus on USS?
> 1500
138
What is a heterotopic pregnancy?
A rare complication of pregnancy in which both extra-uterine (ectopic pregnancy) and intra uterine pregnancy occur simultanoeusly
139
Risk factors for heterotopic pregnancy
Same for ectopic pregnancy
140
Treatment of heterotopic pregnancy
Salpingectomy or salinpingotomy
141
What is a molar pregnancy?
An abnormal form of pregnancy in which a non viable fertilized egg implants in the uterus and will fail to come to term. It grows into a mass in the uterus that has swollen chorionic villi
142
What is the growth grown in molar pregnancy called?
Hydatidiform mole
143
Types of molar pregnancy
Complete
| Partial
144
What is a complete molar pregnancy?
There is a mass of abnormal cells with NO foetal parts
145
What is a partial molar pregnancy?
An abnormal foetus starts to form but it cannot survive or develop into a baby
146
Presentation of molar pregnancy
```
Often asymptomatic
Vaginal bleeding / dark discharge
Swollen abdomen
Morning sickness
Hyperemesis
Pain
```
147
Investigations of a molar pregnany
High BhCG
| USS
148
Risk factors for molar pregnancy
> 35 y/o or < 20 y/o
| Previous molar pregnancy
149
Treatment of a molar pregnancy
Suction removal and evacuation
Methotrexate if persistent
Hysterectomy
150
What is a complication that can happen after a molar pregnancy? What is this called?
Some abnormal cells can be left in the womb
| It is called persistent trophoblastic disease
151
Treatment of persistent trophoblastic disease
Chemotherapy
152
What can develop if the cells left behind in a pregnancy become cancerous?
Choriocarcinoma
153
What type of molar pregnancy is a choriocarcinoma more common in?
Complete
154
A choriocarcinoma can occur after what?
```
Normal birth
Miscarriage
Ectopic pregnancy
Abortion
Molar pregnancy
```
155
What is the most common origin of a cholangiocarcinoma?
Molar pregnancy
156
Treatment of a cholangiocarcinoma
Chemotherapy
157
Pregnancy after treatment for a molar pregnancy
Should not get pregnant for 6 months
158
Contraception after treatment for a molar pregnancy
Cannot use IUD
| Can use any other form of contraception
159
Serum alpha-feto protein (AFP) can be raised in pregnancy due to what?
Foetal abdominal wall defects e.g. omphalocele
Neural tube defects e.g. mengiocele
Multiple pregnancy
160
In a women with severe pre-eclampsia or eclampsia, when should the IV magnesium infusion be stopped?
24 hours after last seizure
161
Presentation of acute fatty liver of pregnancy
```
Jaundice
Mild pyrexia
Hepatic LFTs
Raised WBC
Coagulopathy
Malaise
Fatigue
Nausea
```
162
Who is offered expectant management of ectopic pregnancy?
Low B-hCG
No symptoms
Tubal ectopic pregnancy < 35mm with no heartbeat
163
Treatment of thrush in pregnancy
Clotrimazole pessary
164
Another name for thrush
Vaginal candidadis
165
Risk factors for thrush
```
DM
Drugs
- antibiotics
- steriods
Pregnancy
Immunosuppression
- HIV
- Iatrogenic
```
166
Presentation of thrush
```
"Cottge cheese" Discharge
Non offensive discharge
Itch
Vulvitis
- dysuria
- dyspanureia
Vulval erythema, fissuring, satellite lesions may be seen
```
167
Treatment of thrush
```
Local treatment
- clotrimazole pessary
Oral treatment
- itraconazole or fluconazole
If pregnant then only local treatment can be used
```
168
What % of preterm deliveries are assosiated with pre term prelabour rupture of membrane?
40%
169
Complications of pre term pre labour rupture of membranes
```
Foetal
- prematurity
- infection
- pulmonary hypoplasia
Maternal chorioamniotiis
```
170
Management of pre term pre labour rupture of membranes
Admit
Regular observations to check chorioamniotitis is not occuring
Oral erythromycin for 10 days
Corticosteriods
Delivery should be considered at 34 weeks gestation
171
What does an ovarian torsion look like on USS?
Whirlpool sign
| Free fluid
172
Definition of oligohydramnios
Reduced amniotic fluid
- less than 500ml at 32 - 36 weeks
- AFI < 5th percentile
173
Causes of oligohydramnios
```
Premature rupture of membranes
Foetal renal problems e.g. renal agenesis
IUGR
Post term gestation
Pre eclampsia
```
174
What should be given to all women with premature prelabour rupture of membranes?
10 days erythromycin
175
What is the location of an ectopic pregnancy that has the biggest risk of rupture?
Isthmus
176
What is sensitisation?
A process whereby foetal red blood cells (RhD-positive) enter the maternal circulation, when the mother is RhD-negative. The foetal maternal haemorrhage (FMH) can cause antibodies to form in the maternal circulation that can haemolyse foetal red blood cells
177
What is a complication of sensitization in subsequent pregnancies?
Haemolytic disease of the foetus and newborn
178
How is the risk of sensitisation is reduced in people at risk?
Anti-D immunoglobulin
179
What are the potentially sensitizing events in pregnancy?
```
Ectopic pregnancy
Evacuation of retained products of conception or a molar pregnancy
Vaginal bleeding < 12 weeks if heavy, painful or persistent
Vaginal bleeding > 12 weeks
CVS and amniocentesis
APH
Abdominal trauma
External cephalic version
IUD
Post delivery (if baby RhD positive)
```
180
In the abscence of a observable sensitising event, when is prophylactic anti-D given to mothers?
Previously non sensitised women at 28 and 34 weeks
181
Causes of bleeding in the 1st trimester
Spontaneous abortion
Ectopic pregnancy
Hydatiform mole
182
Causes of bleeding in the 2nd trimester
Spontaneous abortion
Hydatiform mole
Placental abruption
183
Causes of bleeding in the 3rd trimester
Bloody show
Placental abruption
Placenta praevia
Vasa praevia
184
Presentation of hydatiform mole
Bleeding in first or second trimester
Exagerated symptoms of pregnancy e.g. hyperemesis gravidarum
Uterus large for dates
Very high serum hCG
185
Define significant proteinuria
300 mg > 24 hours
Mild - 1 + on dipstick
Moderate - 2+ on dipstick
Severe - 3 + on dipstick
186
Definition of eclampsia
Seizure in the presence of PET
187
What is the issue with a pregnant women on their back?
Caval compression
188
What happens to your reflexs in severe PET?
Hyperreflexia
189
Blood results in PET
```
FBC
Urate
HELLP
- microangipathy
- haemolytic anaemia
```
190
What HTN value does it have to be in PET?
130 / 86
191
Common causes of proteinuria in pregnancy
UTI
| Vaginal discharge
192
Does PET have warning signs?
Yes
193
BP for severe PET
160 / 110
194
Features of severe PET
```
BP 160/110
3 + protein
Oliguria < 400ml
PO
PCO
CO
Cerebral neurologial symptoms
```
195
How does severe PET cause neurological symptoms?
Vasospasm due to HTN
196
Risk factors for miscarriage
```
Older age
Previous miscarriages
Chronic conditions e.g. uncontrolled diabetes
Uterine or cervical problems
Smoking / alcohol / drugs
Underweight / overweight
Invasive prenatal tests
```
197
What is placenta accreta?
Morbidly adherent placenta
198
What is the most common cause of APH?
Cervical ectropion
199
What is cervical ectropion a diagnosis of?
Exclusion
200
When is vasa praevia most common?
When rupturing the membranes
201
Causes of APH
```
Placenta praevia
Placental abruption
Early labour
Scar rupture
UTI
```
202
How much Rh is given and when?
1500 units at 28 weeks if Rh -ve
| Extra if sensitising events
203
Why are transvaginal USS scans done?
To look at the placenta
204
What do recurrent small bleeds require?
Growth scans
205
What is a marginal abruption?
Tiny bit of placenta breaks off
206
When is syntocin given?
C section
207
When is syntometrin given?
Delivery
208
What contraindication does syntometrine have and why?
High BP
| Ergometrine raised BP
209
Who in C sections gets given tranexamic acid?
EBL > 500
210
What does EBL stand for?
Estimated blood loss
211
If Lochia persists beyond 6 weeks, what should be done?
USS to investigate the possibility of RPOC
212
When can magnesium be stopped in eclampsia?
24 hours after delivery or 24 hours after last seizure
213
What test is given to rheus negative women after they get their 28 week dose of anti D?
Kleihaur test
214
Classic triad of vasa praevia
Rupture of membranes
Painless vaginal bleeding
Foetal bradycardia
