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Reproduction and Sexual Health > Early Pregnancy Complications > Flashcards

Early Pregnancy Complications Flashcards

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1
Q

define a miscarriage

A

removal of products of conception prior to 24 weeks gestation

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2
Q

what is the most common cause of early bleeding in pregnancy

A

miscarriage

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3
Q

outline some of the causes of miscarriage

A

infection
abnormal conceptus - chromosomal
uterine abnormalities - incompetent uterus
toxins - smoking, alcohol, drugs, infection
immune diseases
trauma - amniocentesis, coitus
IUCD

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4
Q

describe the features of a threatened miscarriage

A 
pregnancy test positive 
cervix is closed 
pain and bleeding
uterus = gestational age 
foetal heart beat present + foetal pole present
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5
Q

how is a threatened miscarriage managed

A

reassurance and rest

avoid coitus

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6
Q

what is an inevitable miscarriage

A 
pregnancy test positive
cervical os open 
foetal heart beat present 
pain and bleeding
choice of management is up to woman between conservative, medical or surgical
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7
Q

what is an incomplete miscarriage

A

some of the products of conception have passed whilst others remain in the uterus
cervical os open - products may be visible
woman usually in cervical shock with heavy bleeding
no foetal heartbeat

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8
Q

how does cervical shock present

A

occurs when there is incomplete emptying of conceptus
severe abdo pain
nausea/vomiting
sweating, faint, tachycardia
manage with fluids, uterotonics and remove products of conception

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9
Q

how is an incomplete miscarriage managed

A

blood transfusion if in shock
oxytocic
remove POCs
bimanual compression

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10
Q

what are the features of a complete miscarriage

A

all POC have passed
uterus is empty and small for gestational age
no foetal heart beat
may have pain, amenorrhoea

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11
Q

how is a septic miscarriage managed

A

antibiotics, resuscitation and evacuation of uterus

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12
Q

how many miscarriage must a woman have had before they are classified as recurrent

A

3 or more

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13
Q

how is a miscarriage managed conservatively

A

allow the pregnancy to run its natural course

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14
Q

how is a miscarriage managed medically

A

administration of misoprostol

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15
Q

how is a miscarriage managed surgically

A

evacuation of uterus

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16
Q

if a woman with recurrent miscarriage is found to have antiphospholipid syndrome or thrombophilia, what drugs can help her pregnancy

A

low dose aspiring and daily fragmin injections

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17
Q

what is a molar pregnancy

A

a non-viable fertilised egg is made with overgrowth of placental tissue - swollen fluid appearing with grape like clusters

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18
Q

describe a partial molar pregnancy

A

one set of DNA from the egg and 2 from the sperm - fertilised egg causes triploidy
foetus may be present

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19
Q

describe a complete molar pregnancy

A

no DNA from the egg and 2 sets from the sperm causing diploidy
no foetus is present, just overgrowth of placental tissue

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20
Q

a complete mole carries a small risk of what cancer

A

choriocarcinoma

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21
Q

how does a molar pregnancy present

A

extreme hyperemesis
fundus is large for dates
heavy bleeding which may appear like frogspawn

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22
Q

describe the HCG and USS findings seen with molar pregnancy

A

HCG - unusually high for dates hence hyperemesis

USS - snow storm appearance

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23
Q

how is a molar pregnancy managed

A

surgical evacuation irrespective of type, tissue is sent to histology to determine type of mole
women are followed up at specialist centres

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24
Q

what is hyperemesis

A

excessive and prolonged vomiting

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25
list some complications of hyperemesis
``` dehydration ketosis electrolyte disturbance nutritional imbalance weight loss altered LFTs ```
26
how is hyperemesis managed
IV fluids and anti-emetic (oral if possible)
27
state the first and second line antiemetics used for hyperemesis
first line - cyclizine and prochlorperazine | second line - ondansetron and metaclopramide
28
give some examples of sensitising events requiring Anti-D immunisation
``` placental abruption abdo trauma amniocentesis/CVS foetal death vaginal bleeding from 12 weeks TOP ectopic pregnancy delivery of Rh+ve baby ```
29
outline some of the risk factors for developing hypertension in pregnancy
``` increasing maternal age BMI >30 FH of hypertension parity previous hypertension African origin medical conditions such as renal disease, diabetes, connective tissue diseases and thrombophilia ```
30
what BP measurements warrant hospital admission
>170/110 mmHg | >140/90 with significant proteinuria
31
what are the 3 types of hypertension to be aware of during pregnancy
pre-existing hypertension pregnancy induced hypertension pre-eclampsia
32
what are the features of pregnancy induced hypertension
usually develops in second trimester resolves within 6 weeks postnatally no additional features such as proteinuria and headache
33
what is the blood pressure target for someone with hypertension in pregnancy
140/90mmHg
34
which antihypertensives are safe to use in pregnancy
labetolol nifedipine hydralazine methyldopa
35
which antihypertensive is contraindicated in asthma
labetolol
36
which antihypertensive is contraindicated in depression
methyldopa
37
are ACEi/ARBs safe in pregnancy
no as can causes renal agesis
38
what is pre-eclampsia
pregnancy induced hypertension with proteinuria and oedema
39
what causes pre-eclampsia to develop
failure of trophoblastic invasion of spinal arteries leaving them vasoactive hypertension is a compensatory mechanism
40
what are the risk factors for developing pre-eclampsia
``` increasing maternal age BMI >35 CKD autoimmune disease diabetes existing hypertension or previous pre-eclampsia pregnancy interval >10 years first pregnancy ```
41
how is pre-eclampsia screened for
uterine artery doppler
42
outline some of the clinical features of pre-eclampsia
``` hypertension headache - cerebral oedema Hyperreflexia and clonus proteinuria visual disturbance ```
43
what is one of the complications of pre-eclampsia
HELLP syndrome
44
what is eclampsia
pre-eclampsia + tonic clonic seizures
45
when is the highest change that eclampsia will develop
post-partum
46
what are the effects on the foetus with eclampsia
bradycardia | reduced variability on CTG
47
what drug is given to prevent seizures with eclampsia
IV magnesium sulphate
48
what is HELLP syndrome
haemolysis elevated liver enzymes low platelets
49
what are the clinical features of HELLP syndrome
nausea/vomiting fatigue RUQ pain
50
what is the HbA1C target for pregnancy and what level should pregnancy be avoided
target - 48 mmol/l | avoid - >86 mmol/l
51
outline several parts of the antenatal care plan that differ for women with existing diabetes
``` high dose folic acid low dose aspirin regular eye checks for retinopathy growth scans every 4 weeks from 28 weeks safety advice about hypos ```
52
what is the main change in diabetes medication for women with existing diabetes
switch any oral hypoglycaemic agents to metformin and insulin
53
when should delivery be planned for in a woman with existing diabetes
aim for 38 weeks, opt for c-section if foetal weight >4.5kg
54
what are some of the complications of a child with maternal diabetes
``` macrosomia shoulder dystocia polyhydramnios still birth vaginal trauma in labour ```
55
what is the screening tests for gestational diabetes
high risk women screened at booking | oral glucose tolerance test - fasting and then 2 hour after 75g of glucose
56
what are the diagnostic values for GDM
fasting - >5.1mmol/l | 2 hour - >8.5mmol/l
57
what is pre-term pre-labour rupture of membranes
breakage of the amniotic sac before the onset of labour
58
what causes PPROM
infection - weakens the tensile strength of membranes cervical incompetence over-distention eg multiple pregnancy and polyhydramnios placental abruption
59
list some of the adverse effects of baby's born before 26 weeks
``` risk of cerebral palsy walking problems blindness profound deafness reduced IQ ```
60
how is PPROM managed
monitor for chorioamnionitis give antibiotics to prevent ascending infection - erythromycin first line tocolytics to prevent contraction such as nifedipine
61
what is the most severe complication of anti-D crossing to the baby
hydros fetalis
62
what are the features of a foetus with hydros fetalis
``` extensive oedema causing ascites, pleural or pericardial effusion hepatosplenomegaly progressive anaemia CNS signs jaundice ```
63
list some pre-existing causes for VTE in pregnancy
``` previous VTE BMI >30 smoking age >35 varicose veins thrombophilia ```
64
list some obstetric causes for VTE in pregnancy
``` multiple pregnancy c-section pre-eclampsia prolonged labour PPH ```
65
list some transient causes for VTE in pregnancy
``` hyperemesis ART/IVF systemic infection admission and immobility wound infection ```
66
what investigation is carried out if suspicion of DVT is high
duplex ultrasound
67
state the findings for PE on ECG
``` sinus tachycardia T wave inversion right axis deviation right bundle branch block atrial arrhythmias ```
68
what are the advantages and disadvantages of CTPA and V/Q in pregnancy
CTPA is preferred but increases breast cancer risk V/Q slight risk of childhood cancer in foetus mother must be informed of the risks
69
how is VTE in pregnancy managed
LMWH until 3 days postnatally, then can be swapped for warfarin due to teratogenicity risks and PPH risk until 3 days post party must be continued until 6 weeks postnatally
70
what are the 3 types of breech presentation
complete - legs folded to level of bum footling - one of both legs hanging down so feet emerge first frank - legs above bum so bum is delivered first
71
what are the risk factors for a breech baby
``` idiopathic uterine abnormalities prematurity oligohydramnios foetal abnormalities placenta praevia ```
72
how is breech position swapped to cephalic
external cephalic version - manually turn the baby into cephalic presentation if vaginal delivery is planned
73
what must a breech baby be screened for after birth
hip dislocation at 6 weeks | Klumpkes palsy

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