Lecture 14 Complications in Pregnancy

Question 1

The cervix in a threatened miscarriage is (closed/open)

Answer 1

Closed

Question 2

The cervix in an inevitable miscarriage is (closed/open)

Answer 2

Open

Question 3

What may be seen during a scan when a missed miscarriage is suspected

Answer 3

Empty gestational sac

Foetal pole with no foetal heart

Question 4

What is an incomplete miscarriage

Answer 4

Most of pregnancy is expelled out
Some products of pregnancy remaining in the uterus
Open cervix
Heavy bleeding

Question 5

What is a complete miscarriage

Answer 5

Passed all products of conception

Cervix closed

Question 6

What abnormal conceptus causes of spontaneous miscarriage

Answer 6

Chromosomal
Genetic
Structural

Question 7

What uterine abnormalities causes spontaneous miscarriages

Answer 7

Congenital

Fibroids

Question 8

What maternal factors can cause a spontaneous miscarriage

Answer 8

Increasing age
Diabetes
Hormonal imbalance
SLE
Thyroid disease
Infection

Question 9

How is a threatened miscarriage managed

Answer 9

Conservative- just wait

Question 10

How are inevitable miscarriages managed

Answer 10

If bleeding heavy may need evacuation

Question 11

How are missed miscarriages managed

Answer 11

Conservative
Medical- Prostaglandins (misoprostol)
Surgical

Question 12

How is a septic miscarriage managed

Answer 12

Antibiotics and evacuate uterus

Question 13

What is an ectopic pregnancy

Answer 13

Pregnancy implants outside the uterine cavity

Question 14

What’s the most common site in the Fallopian tube for an ectopic pregnancy

Answer 14

Ampullary

Question 15

What are the risk factors for ectopic pregnancy

Answer 15

Pelvic inflammatory disease
Previous tubal surgery
Previous ectopic
Assisted conception

Question 16

What is the clinical presentation of ectopic pregnancy

Answer 16

Period of ammenorhoea
Vaginal bleeding
Pain abdomen
GI or urinary symptoms

Question 17

What are the investigations for an ectopic pregnancy

Answer 17

Scan

Serum BHCG

Question 18

How is ectopic pregnancy managed

Answer 18

Methotrexate

Salpingectomy, Salpinotomy

Question 19

What is Grade I Placenta Praaevia

Answer 19

Encroaching on the lower segment but not the internal cerivcal os

Question 20

What is Grade II Placenta Praaevia

Answer 20

Placenta reaches the internal os

Question 21

What is Grade III Placenta Praaevia

Answer 21

Eccentrically covers the os

Question 22

What is Grade IV Placenta Praaevia

Answer 22

Central placenta praaevia

Question 23

What are the clinical features of placenta praaevia

Answer 23

Soft, non-tender uterus

Foetal malpresentation

Question 24

How is placental praaevia diagnosed

Answer 24

US scan to located placental site

NO VAGINAL EXAMINATION

Question 25

How is Placental Praaevia managed?

Answer 25

C-section (watch for PPH) Medical (oxytocin, ergometrine, crab-Prost, transgenic acid) Balloon tamponade Surgical (B lymph suture, ligation of uterine, iliac vessels, hysterectomy)

Question 26

What factors are associated the placental abruption

Answer 26

``` Pre-eclampsia Chronic hypertension Polyhydramnios Smoking, increasing age, parity Previous abruption Cocaine use ```

Question 27

What are the 3 clinical types of placental abruption

Answer 27

Revealed (see blood) Concealed (bleeding but not visible) Concealed

Question 28

What is the clinical presentation of placental abruption

Answer 28

Pain Vaginal bleeding (may be minimal) Increased uterine activity

Question 29

How are preterm deliveries managed

Answer 29

Test foetal fibronectin

Question 30

Define mild hypertension

Answer 30

Diastolic BP 90-99 | Systolic BP 140-49

Question 31

Define moderate hypertension

Answer 31

Diastolic BP 100-109 | Systolic BP 150-159

Question 32

Define severe hypertension

Answer 32

Diastolic >110 | Systolic BP>160

Question 33

Define pre-eclampsia

Answer 33

Mild HT on two occasions more than 4 hours apart

Question 34

Describe the clinical presentation of pre-eclampsia

Answer 34

``` Seizures Cerebral haemorrhage Stroke Haemolysis Elevated liver enzymes Low platelets DIC Renal failure Pulmonary oedema Cardiac failure ```

Question 35

Name the symptoms and sign of severe PET

Answer 35

``` Headache Blurry vision Epigastric pain Pain below ribs Vomiting Swelling of hands and face Urine proteinuria Clonus Reduce urine output Convulsions ```

Question 36

The only cure for PET is_____

Answer 36

delivery of the baby and placenta

Question 37

How are seizures/impending seizures treated

Answer 37

Magnesium sulphate bolus + IV infusion | IV labetolo, hydralazine