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Case 31 - Concerns During Pregnancy 2 > Early and Late Complications of Pregnancy > Flashcards

Early and Late Complications of Pregnancy Flashcards

(74 cards)

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1
Q

What is Hyperemesis Gravidarum?

A

it is extreme, persistent nausea and vomiting during pregnancy

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2
Q

what can Hyperemesis Gravidarum lead to in pregnant women?

1)
2)
3)

A

It can lead to;

dehydration

weight loss

electrolyte imbalances

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3
Q

what is morning sickness?

A

mild nausea and vomiting that occurs in early pregnancy

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4
Q

what is the most common time period morning sickness occurs?

A

Most common during the first 3 months of the pregnancy

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5
Q

causes of moring sickness

A

not fully understood

potentially caused by rapidly rising blood level of a hormone called human chorionic gonadotropin (HCG)

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6
Q

what is HCG released by?

A

released by the placenta

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7
Q

what pregnancies are considered high risk to developing Hyperemesis Gravidarum?

1)
2)
3)
4)

A

in twin pregnancies

molar pregnancies

hyperemesis in previous pregnancies

motion sickness history

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8
Q

Hyperemesis Gravidarum management plan?

1)
2)
3)
4)

A

Hydration

Antiemetics

Multivitamin supplements

severe cases - steroid use

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9
Q

Hyperemesis Gravidarum can cause weight loss of more than 5% of body weight. True or False?

A

True

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10
Q

Bleeding in early pregnancy causes (5)

A

Implantation bleeding ( physiological)

Miscarriage

Ectopic Pregnancy

Cervical causes – Ectropion/polyp, rarely cancer

Molar pregnancy

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11
Q

define miscarriage?

A

miscarriage is the loss of a pregnancy during the first 22 weeks

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12
Q

list 5 causes of miscarriage?

A

Unknown

Chromosomal

Placental problems

Uterine anomalies

Cervical incompetence

Autoimmune conditions

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13
Q

What percentage of pregnancies end in miscarriage?

A

15% (1 in 8)

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14
Q

miscarriage signs and symptoms and what you’ll find on examination?

A 
Signs
normal observations
tachycardia
low BP
tender on abdominal examination (in suprapubic area)

Symptoms
Vaginal bleeding
Cramping + pain in lower abdomen

On Examination
Bleeding from the cervical os.
Cervical os can be open or closed
Products of conceptions might be seen on examination.

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15
Q

Name the types of Miscarriage

A

Threatened miscarriage -> pregnancy remains viable

Inevitable miscarriage

Incomplete miscarriage -> Products of conception partly expelled

Completed miscarriage ->Products of conception completely expelled

Missed miscarriage -> non-viable pregnancy

- Septic miscarriage
- Recurrent miscarriage -> three or more consecutive miscarriages (1%)
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16
Q

what reduces the chances of miscarriage?

A

abstain from

Alcohol

Smoking

illegal drugs

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17
Q

Can long term health conditions impact pregnancies? if yes then how?

A

yes

Several long-term (chronic) health conditions can increase the risk of having a miscarriage in the second trimester especially if they’re not treated or well controlled

e.g diabetes, high blood pressure, lupus

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18
Q

How is a miscarriage diagnosed?

A

Early pregnancy
USS ( transvaginal)
blood test for HCG

Ultrasound?
Checking for foetus heartbeat?

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19
Q

how is a miscarriage managed?

A

Medications used
Mifepristone ( Anti progesterone ) and Misoprostal ( potent uterine stimulant) tablets

Surgical
Evacuation of the uterus by suction evacuation/ curettage

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20
Q

What does Resus Negative blood group mean?

A

???????

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21
Q

If the woman blood group is Rh-ve what is she administered?

A

Anti–D is administered

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22
Q

why is Anti –D administered to women with the blood group Rh-ve?

A

prevents haemolytic disease of the foetus and newborn

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23
Q

What is an Ectopic Pregnancy?

A

when a fertilised egg implants outside of the uterus, usually in one of the fallopian tubes.

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24
Q

what is the Risk of ectopic pregnancy in UK?

A

1%

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25
what are the symptoms of an ectopic pregnancy?
Positive pregnancy test and other signs of pregnancy  Lower abdominal pain, more on one side/localised Vaginal bleeding or a brown watery discharge Shoulder tip pain Discomfort while micturating or opening bowels.
26
what are investigations and management for an ectopic pregnancy?
Investigations: USS and blood test ( FBC and B-HCG) Management: Medical management with Methotrexate Surgical management with salpingectomy
27
is missing an ectopic pregnancy dangerous?
yes - if missed or not managed appropriately can be life threatening
28
Miscarrige VS Ectopic pregnancy differences
Miscarriage Ectopic Pregnancy WITHIN the uterine cavity Pregnancy OUTSIDE the uterine cavity Pain is more in the suprapubic area Pain localized to one side Bleeding can be moderate to heavy Bleeding is minimal Pregnancy can continue and it’s safe Continuing pregnancy is unsafe No adnexal tenderness on examination Adnexal tenderness positive
29
what is a Hydatiform mole?
A hydatidiform mole is a growing mass of tissue inside your womb (uterus) that will not develop into a baby. It may cause bleeding in early pregnancy and is usually picked up in an early pregnancy ultrasound scan
30
what are Hydatiform mole pregnancy symptoms?
nausea and vomiting can be occasionally profound
31
how is Hydatiform mole pregnancy diagnosed and confirmed? how is it treated?
Diagnosis: USS and high levels of beta- HCG Confirmed by histology Treatment: surgical evacuation Notify molar pregnancy register Biochemical follow up – till B HCG is negative Avoid COCP as it delays the return of B- HCG
32
basic causes of abdominal pain?
``` Heart burn Constipation Musculo- Skeletal Appendicities Cholecystitis Renal colic IBS Ovarian cyst accidents ```
33
what are the physiological changes in pregnancy in the urogenital tract?
Bladder volume increases and detrusor tone decreases. Ureteric dilatation due to combination of progestogenic relaxation of ureteric smooth muscle and pressure from the expanding uterus. Relative sparing of the left ureter because of protection from the sigmoid colon and upper rectum. The net effect - is increased urinary stasis, compromised ureteric valves and vesicoureteric reflux. Facilitates bacterial colonisation and ascending infection
34
are UTI's common in pregnancy? are they asymptomatic or symptomatic? how is it diagnosed?
yes can be either Mid stream sample (MSU) is sent for culture and sensitivity (C/S) at booking
35
In pregnancy -the overall incidence of UTI is approximately.......% The incidence of asymptomatic bacteriuria in pregnant women is ......% Escherichia coli accounts for --------% of infections
.....8% ......2-5% ......80-90%
36
what is Asymptomatic Bacteriuria associated with?
Preterm delivery and low birthweight Increased risks of preeclampsia Anaemia Chorioamnionitis Postpartum endometritis Fetal growth restriction
37
Asymptomatic Bacteriuria treatment?
appropriate antibiotics for 7 days based on C/S
38
what are the symptoms and treatment for Acute Cystities?
Symptoms: are dysuria, frequency, urgency and suprapubic pain in the absence of systemic illness. Treatment is hydration and antibiotics
39
what % of women does acute cystitis affect?
Affects approximately 1% of all pregnant women.
40
what % of women with asymptomatic bacteriuria develop acute cystitis during their pregnancy.
30% of women
41
what is Pyelonephritis? how serious is in in pregnancy?
is an infection of a renal papilla, which if untreated can spread to multiple papillae and occasionally to the renal cortex Serious type of urinary infection in pregnancy
42
what are the symptoms, investigations and treatment for Pyelonephritis in pregnancy?
Symptoms: sepsis ( tachycardia, tachyapnoea, pyrexia) loin pain urinary symptoms ``` Investigation: MSU,USS of the renal tract, FBC Renal function tests blood culture CRP ``` Treatment: Antibiotics for 10-14 days.
43
when do most of the cases of pyelonephritis occur during pregnancy?
last two trimesters
44
what are the risks of developing Recurrent Urinary Tract infection during pregnancy?
The risks of developing pyelonephritis and its potential consequences are the same as for the primary infection.
45
what is the treatment for Recurrent Urinary Tract infection during pregnancy?
Long-term, low dose antimicrobial cover or single postcoital doses for the remainder of the pregnancy.
46
what is anaemia?
Anaemia is having lower than normal Haemoglobin.
47
what are the Haemoglobin cut offs in each trimester before being considered anaemic?
1st and 2nd trimester – minimum of 110g/dl 3rd trimester it is 105g/dl
48
what are the symptoms of anaemia during pregnancy? | what are the investigations and treatment?
Symptoms: Feeling tired and exhausted Palpitations Breatlessness Investigation: FBC, Ferritin, Folic acid and Vit B12 levels Treatment: oral /injectable iron &/or Vit B12 &/or Folic acid
49
what is Antepartum Haemorrhage?
Is defined as bleeding from the genital tract after the 22nd week of pregnancy Extras Complicates 2-5% of all pregnancies. Associated with fetal and maternal morbidity and mortality.
50
what are the causes of Antepartum Haemorrhage?
``` placental abruption placenta previa vasa previa cervicitis trauma vulvo-vaginal varicosities genital tumors infection ```
51
what is the management for Antepartum Haemorrhage?
*Depends on the cause, severity and gestational weeks* Admit to hospital Cannula and take bloods (FBC, G&S U&Es coagulation profile) Resuscitation (iv fluids, blood transfusion) Examination Ultrasound Rh –ve women needs anti D and Kleihauer test
52
define Placenta Praevia?
Defined as Placenta partly or completely inserted in the lower uterine segment
53
define and explain the different grades of placenta pravia?
insert picture????????????????
54
define placental abruption
It is bleeding following premature separation of normally situated placenta it can be Revealed or concealed??
55
what are the causes of placental abruption?
Majority of the cases the cause is unknown trauma polyhydramnios hypertension
56
define placental abruption diagnosis and management
Diagnosis – clinical presentation and examination, ultrasound Management depends on severity, gestational age, maternal and fetal condition
57
define preterm labour
the onset of labour before 37 completed weeks of gestation
58
list pre-term labour risk factors
Multiple pregnancies History of preterm labour Polyhydramnios Infectio
59
explain how pre-term labour diagnosis takes place
Diagnosis on clinical grounds, fetal fibronectin test and ultrasound
60
what is metal fibronectin (fFN)
it is a fibronectin protein produced by foetal cells. It is found at the interface of the chorion and the decidua (between the foetal sac and the uterine lining). It is like an adhesive/ biological glue that binds the foetal sac to the uterine lining.
61
how is pre-term labour managed?
Tocolysis – to slow labour for administration of steroids and in-utero transfer if needed Steroids – for fetal lung maturation Magnesium sulphate- for neuro protection till 34 weeks of gestation
62
# define Preterm Pre-labour rupture of membranes (PPROM) who is more at risk of PPROM?
Spontaneous rupture of membranes before 37 weeks of gestation in the absence of regular painful uterine contractions. Polyhydramnios previous history of PPROM uterine anomalies infections
63
what is the diagnosis and management of Preterm Pre-labour rupture of membranes (PPROM)
Diagnosis Examination swabs USS ``` Management tocolysis antibiotics steroids delivery ```
64
Define Intra uterine growth Retardation (IUGR)
Failure of the foetus to achieve the expected weight for a given gestational age
65
# define small for gestational age (SGA) how is it diagnosed and managed
Refers to fetus estimated birth weight (EFW) on USS is below the 10th centile for the given population. SGA : Constitutionally small or growth restricted. Diagnosis: Regular SFH, use of customized growth charts, USS Management: careful monitoring and appropriate intervention .
66
intra uterine growth retardation causes
chromosomal uteroplacental environmental
67
define Obstetric Choestasis
It is a multifactorial condition of pregnancy characterised by pruritus in the absence of a skin rash with abnormal liver function tests (LFTs),neither of which has an alternative cause and both of which resolve after birth.
68
Explain what the diagnosis, complications and treatment of Obstetric Choestasis are
Diagnosis: unexplained pruritus and abnormal liver function tests (LFTs) and/or raised bile acids occur in the pregnant woman and both resolve after delivery. usually involves palms and soles of the feet Postnatal resolution of symptoms and of biochemical abnormalities is required to secure the diagnosis. LFTS should be deferred 10 days following delivery Complications: meconium passage, small risk of stillbirth, premature birth (iatrogenic) Treatment: symptomatic management
69
what is pre-eclampsia?
Pre-eclampsia is a condition that typically occurs after 20 weeks of pregnancy. (6%) It is a combination of raised blood pressure (hypertension) and protein in urine (proteinuria)
70
what are the symptoms of pre-ecalmpsia?
asymptomatic headaches visual disturbance pain the right hypochondriac region edema
71
what are the risk factors of pre-ecalmpsia?
diabetes high blood pressure or kidney disease before starting pregnancy lupus or antiphospholipid syndrome personnel or FH of pre-eclampsia 1st pregnancy maternal age more than 40 High BMI PCOS multiple pregnancies
72
how is pre-eclampsia diagnosed and investigated?
The earlier the pre-eclampsia is diagnosed and monitored, the better the outlook for mother and baby. ``` Investigations: Bloods for FBC, U and Es Uric acid coagulation profile fetal monitoring urine ACR ```
73
how is pre-eclampsia monitored? what are the complications?
Management Regular BP monitoring and anti hypertensives Fetal growth monitoring Delivery ``` Complication Eclampsia- seizures – Magnesium sulphate Intracranial Haemorrhage Pulmonary edema HELLP syndrome Placental abruption Stillbirth IUGR ```
74
why should caution be maintained when prescribing NSAID's for pregnant women during the third trimester?
NSAIDs – in third trimester can lead to premature closure of ductus arteriosus)

Case 31 - Concerns During Pregnancy 2 (5 decks)

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