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Obs & Gynae > Late pregnancy problems > Flashcards

Late pregnancy problems Flashcards

(57 cards)

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1
Q

Definition of gestational hypertension

A

High blood pressure after 20 weeks gestation with no proteinuria over 0.3g/day

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2
Q

Definition of Pre-Eclampsia

A

High blood pressure during pregnancy plus proteinuria of greater than 0.3g/day. Occurs after 20week gestation.

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3
Q

Definition of eclampsia

A

Convulsions/seizures plus pre-eclampsia

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4
Q

Risk factors for pre-eclampsia

A 
Maternal age over 40yrs
Chronic HTN
CKD
Autoimmune conditions e.g. SLE, antiphospholipid syndrome
Previous pre-eclampsia
First pregnancy
Type 1 or 2 DM
High BMI
Multiple pregnancy
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5
Q

Pathophysiology of pre-eclampsia

A

Inadequate spiral artery invasion in the myometrium. This means less blood can get to the baby and so the mother’s body responds by increases the blood pressure to get more blood there.

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6
Q

Values for high blood pressure during pregnancy

A

HTN in pregnancy = SBP >140mmHg, DBP >90mmHg

Severe HTN = 160/110mmHg or more

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7
Q

Symptoms of pre-eclampsia

A

Severe headaches
Visual disturbance (blurred, double, floating spots)
Persistent epigastric or right upper quadrant pain.
Vomiting
Breathlessness
Swelling of hands, feet, face.
Brisk reflexes

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8
Q

HELLP syndrome

A

Haemolysis, Elevated Liver enzymes, and Low Platelets syndrome.

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9
Q

Treatment of mothers at high risk of pre-eclampsia

A

Daily aspirin (75mg) from 12 weeks gestation until birth and advice on lifestyle.
Those at high-risk =
Previous pre-eclampsia
DMT1 or T2
CKD
Chronic HTN
Autoimmune disease e.g SLE or antiphospholipid syndrome.

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10
Q

Management of established pre-eclampsia

A

Start med if BP over 150/100mmHg –> Labetalol, nifedipine
Monitor mum and baby!
ACEi contraindicated in pregnancy!!!!!
Monitor mum post-natally!

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11
Q

Management of eclampsia

A

ABCDE
IV magnesium sulphate - bolus dose then maintenance dose.
Fetal CTG
C-section delivery

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12
Q

Cut off gestational age for steroid use and commonly used steroid

A

Only use if less than 34 weeks gestation. Dexamethasone.

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13
Q

Complications of pre-eclampsia

A 
Maternal = Intracerebral haemorrhage/stroke, Eclampsia and seizures, pulmonary oedema, acute renal failure and hepatic failure.
Baby = placental abruption, IUGR, premature delivery, intrauterine death, PPH, oligohydramnios
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14
Q

Risk factors for venous thrombosis in pregnancy

A 
Previous VTE
maternal age over 35yrs.
High BMI
Smoker
Multiple pregnancy
Pre-eclampsia
Greater than 4 parity
Immobility
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15
Q

Why is VTE risk increased in pregnancy?

A

More blood stasis and altered protein balance.

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16
Q

Causes of an antepartum haemorrhage

A 
Placenta praevia - painless
Placenta abruption - painful
Vasa praevia - painless
Uterine rupture
Still birth?
Cervical poly
Cervical carcinoma
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17
Q

Definition of an antepartum haemorrhage

A

PV bleeding after 24weeks gestation.

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18
Q

Definition of placenta praevia

A

Placenta is implanted in the lower segment of the uterus, below fetal presenting part.

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19
Q

Types of placenta praevia

A 
Marginal = not covering but encroaching on os.
Major = partially or completly covering os.
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20
Q

Clinical features of placenta praevia

A

Painless and recurrent PV bleeding. Baby usually in abnormal presentation/lie

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21
Q

Diagnosis of placenta praevia

A

Transvag USS. In 2nd scan at 20 weeks, if low lying placenta is seen, book for third trimester (34weeks) scan to follow-up and diagnose.
Cross-match blood type.

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22
Q

Management of placenta praevia

A

Up to 34weeks gestation can offer corticosteroids.
Plan delivery for before 39weeks gestation via c-section
Prepare ant-D immunoglobulins and blood transfusion if appropriate.

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23
Q

Complications of placenta praevia

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A

PPH, placenta accreta or percreta.

24
Q

Risk factors for placenta praevia

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A 
Previous placenta praevia.
Previous c-section deliveries.
Advanced matermal age (over40).
Smoking.
Previous terminations of pregnancies.
IVF and assisted conception.
25
Placenta abruption definition
Premature detachment of placenta from the uterus and blood dissects under the placenta before delivery of the fetus.
26
Risk factors for abruption
``` Abruption in previous pregnancy. Pre-eclampsia IUGR polyhydramnios low BMI Advanced maternal age IVF Non-vertex presentation. Abdo trauma Substance misuse and smoking. ```
27
Clinical features of placenta abruption
Bleeding PV Constant abdo pain, pain and shock of mum may be disproportionate to visible loss of blood = concealed haemorrahge. Woody-hard, tense and tender uterus on palpation.
28
Investigations for placenta abruption
Fetal monitoring via CTG | Maternal TV USS, cross-match blood, FBC for anaemia, monitor urine output, urinalysis.
29
Management of placenta abruption
ABCDE Anti-D antibodies if appropriate and blood transfusion. Steroids may be given if below 34weeks gestation. If fetal distress C-section, if no distress vaginal delivery possible.
30
Vasa praevia definition
Fetal blood vessels lie on the membranes that cover the internal cervical os.
31
Complications of vasa praevia
When membranes rupture vessels can haemorrhage and rupture too - fetal blood loss!
32
Presentation and management of ruptured vasa praevia
Painless, PV beeding on membrane rupture. Fetal bradycardia. URGENT C-SECTION but fetal mortality is high
33
treatment of VTE in pregnancy and time of highest risk
Low molecular weight heparin. Warfarin can cross placenta. Monitor anti-Xa Most occur post-partum
34
Polyhydramnios defintion
Too much amniotic fluid in the amniotic sac
35
Pathophysiology of polyhydramnios
Poor swallowing of fluid by fetus, poor absorption of fluid inside baby, increased secretion of fluid by placenta.
36
Causes of polyhydramnios
``` Fetal malformation - spina bifida, atresia of GI tract in fetus. Multiple pregnancy Maternal diabetes mellitus. Fetal anemia. Infections such as rubella, CMV. ```
37
Clinical features of polyhydramnios
Over distended uterus Symphyseal-fundal height larger than dates Faint or indistinct fetal heart rate. Maternal dyspnoea, oedema.
38
Treatment of polyhydramnios
Amniocentesis (removing fluid) | Laser ablation of communicating vessels for twins.
39
Complications of polyhydramnios
Preterm labour Premature rupture of membranes Umbilical cord prolapse PPH
40
Oligohydramnios
Too little amniotic fluid in amniotic sac. Less than 500ml in 32-36weeks gestation.
41
Causes of oligohydramnios
``` Rupture of amniotic membranes. Fetal urinary tract malformations. IUGR Placenta abruption Maternal dehydration ```
42
Management of oligohydramnios
Delivery baby if poss. Consider prophylactic erythromycin. Amnioinfusion (only special circumstances!)
43
Complications of oligohydramnios
Pulmonary hypoplasia - wry neck, club foot. | Amniotic band syndrome.
44
Normal fundal height growth
After 24 weeks you would only expect the fundal height to increase by 1cm a week.
45
Antidote for magnesium sulphate induced respiratory depression
Calcium gluconate is first-line treatment
46
DIC
Disseminated intravascular coagulation
47
Causes of DIC in pregnancy
``` Placenta abruption Pre-eclampsia HELLP Amniotic fluid embolism Retained products of a dead fetus (after 20weeks gest) Placenta accreta Hydatidiform mole ```
48
Pathophys of DIC in pregnancy
Intravascular clotting consumes platelets and fibrin. Pathogenic release of thrombin and thromboplastin into circulation.
49
Investigations and results for DIC in pregnancy
``` Long APTT Long prothrombin time Low platelets Low fibrinogen High D-dimer and products of fibrin breakdown. ```
50
Management of DIC in pregnancy
``` O2 Blood crossmatch Blood transfusion (fresh) Platelet transfusion Consider calcium gluconate ```
51
Routine investigations for pre-eclampsia mum
Blood pressure (obvs) Urinedip (proteinuria) FBC (low platelets and haemolysis in HELLP) Renal function = U+E, protein-creatinine ration, GFR LFT (AST and transaminase for HELLP)
52
Pathophysiology of Rhesus disease
If mother is Rhesus -ve and father is Rhesus +ve then offspring can be Rhesus +ve. First pregnancy with a Rhesus +ve fetus in mother allows memory cells for Rhesus +ve antigen to be produced. These are IgG so can cross the placenta and affect future babies. However in first pregnancy the immune system only uses IgM antibodies which wont cross placenta.
53
What happens to babys with Rhesus disease
RBC haemolysis causes anaemia.
54
Prophylaxis for Rhesus disease
Anti-D. This destroys the anti-rhesus +ve antibodies in mother. Given at 28-34 weeks and after birth/
55
What does asymmetrical intrauterine growth restriction (normal head circumference with reduced abdominal circumference) suggest?
Placenta insufficiency however, if both the head circumference and abdominal circumference are low then more likely chromosomal abnormality.
56
Causes of antepartum haemorrhage
Placenta abruption Placenta praevia Vasa praevia Morbidly adherent placenta (accreta, increta, percreta)
57
Pathophysiology behind the seizures in pre-eclampsia
Proteinuria leads to hypoalbuminaemia. This causes oedema and fluid leves vessels (hypovolaemia). Brain is not adequately perfused = seizures.

Obs & Gynae (17 decks)

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