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Y4 GOSH obs CCs > Obstetric complications > Flashcards

Obstetric complications Flashcards

1
Q

What risk factors are there for pre-term labour?

A

NB 1/3 of cases are medically indicated, 2/3 are spontaneous
-Multiple pregnancy
-Pre-eclampsia
-IUGR
-OHx of preterm delivery
-OHx of miscarriage in 2nd trimester
-Cervical surgery
SCREENING = cervical length measurement (if <15mm –> intervention)

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2
Q

What can cause preterm labour to occur?

A

-Stretch of the myometrium and foetal membranes
-Cervical weakness
-Ascending infection

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3
Q

What key factors dictate the decision-making in the management of pre-term labour?

A
  1. Is the pregnancy viable? (>24 weeks)
  2. Have the membranes ruptured?
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4
Q

How is pre-term labour managed differently in pregnancies before vs after the point of viability?

A

<24 weeks
-Unlikely to be viable
>24 weeks
-Consider antenatal steroid for foetal lung maturation
-Consider tocolysis (magnesium sulphate, nifedipine, COX inhibitors)
-Consider transfer to tertiary NNU

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5
Q

How is pre-term labour managed differently in pregnancies where the membranes have vs haven’t ruptured?

A

Membranes ruptured
-May indicated infection –> erythromycin / ben-pen
-Not appropriate to use tocolysis
Membranes intact
-Tocolysis (if no sign of infection)

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6
Q

How is antepartum haemorrhage defined?

A

-Bleeding in pregnancy after 24 weeks
–If <24 weeks = threatened miscarriage)
-Minor = <50ml, major = >50ml

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7
Q

What can cause APH?

A

UTERINE CAUSES
-Placental abruption (separates from wall of uterus)
-Placenta praevia (sits in lower portion of uterus, in-between foetus and cervix)
-Vasa praevia (foetal blood vessels are within the foetal membranes and travel across the internal cervical os - when ROM occurs –> rupture of vessels)
-Marginal bleed
CERVICAL
-“Show” - loss of mucus plug from cervix
-Cervical cancer
-Cervical polyps / ectropion
VAGINAL
-Trauma
-Infection

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8
Q

When does placental abruption most commonly occur?

A

-25 weeks
-Outcome depends on degree of separation and amount of blood loss

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9
Q

What risk factors are there for placental abruption?

A

OBSTETRIC
-Pre-eclampsia
-PROM
-IUGR
-Polyhydramnios
-Multiple pregnancy
-PMHx of abruption
MATERNAL
-Smoking
-Increased maternal age
-Hypertensive disorders
-Thrombophilias
-Cocaine use
-Trauma

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10
Q

How does placental abruption present?

A

-Vaginal bleeding, usually dark red
-Abdominal pain
-Backache
-Uterine contractions
-Hyperreflexia
-Severe uterine tenderness and tension
-Foetal distress on CTG

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11
Q

What is the distinction between a low-lying placenta and placenta praevia?

A

-5% will have a low-lying placenta on USS at 16-20 weeks
-Most rise away from the cervix so incidence of placenta praevia at delivery is only 0.5%

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12
Q

What risk factors are there for placenta praevia?

A

-Multiparity
-Multiple pregnancy
-Fibroids
-Previous C-section (scarring in lower section)
-IVF pregnancies

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13
Q

How does placenta praevia present?

A

-Painless bright red vaginal bleeding
-Hypovolaemic shock in severe cases
-Foetus rarely affected unless massive haemorrhage

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14
Q

How is placenta praevia classified?

A

Stage I = placenta in lower segment but not internal os
Stage II = placenta reaches internal os but does not cover it
Stage III = placenta covers internal os before dilation but does not cover when dilated
Stage IV = placenta completely covers internal os

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15
Q

How is APH managed?

A

-Mother’s wellbeing is the priority
-CTG and establish foetal site
-Delivery if necessary to save mother’s life
-ABCDE
–IV access, left lateral position, bloods
-Anti-D if Rh-

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16
Q

Where do DVTs commonly occur in pregnancy?

A

-Left leg above the knee - increased embolic risk
-Oedema is common in pregnancy so may be asymptomatic until progresses to a PE

17
Q

How are DVTs investigated in pregnancy?

A

-USS
-ECG/ABG
-Leg dopplers
-VQ scan (increased risk of leukaemia for baby)
-CTPA (increased risk of breast cancer for mum)

18
Q

How are DVTs managed in pregnancy?

A

-Heparins (do not cross placenta)
PREVENTION
-If previous PE –> LMWH for 6 weeks postpartum
-If recurrent PE / FH of PE –> LMWH antenatally + 6 weeks postpartum
->3 persisting RFs –> LMWH for 28 weeks
->4 persisting RFs –> LMWH immediately

19
Q

How are PEs managed in pregnancy?

A

-LMWH for remainder of pregnancy and postpartum

20
Q

What anti-hypertensives should be stopped in pregnancy?

A

-ACEi’s eg ramipril
-ARBs eg losartan
-Thizaide diuretics eg indapamide
(Labetalol, nifedipine and doxazosin are all safe)

21
Q

What groups of drugs should be avoided in pregnancy?

A

SWAB NOLS
-NSAIDs
–Block action of prostaglandins
–Cause closure of ductus arteriosus
–Delay in labour
-BETA-BLCOKERS
–IUGR
–Neonatal hypoglycaemia
–Bradycardia
-ACEis and ARBs
–Oligohydramnios
–Miscarriage or foetal death
–Hypocalvaria (incomplete formation of skull bones)
–Neonatal renal failure
–Neonatal hypotension
-OPIATES
–Neonatal abstinence syndrome ie withdrawal
-WARFARIN
–Foetal loss, congenital malformations
–APH, PPH, foetal intracranial bleeding
-SODIUM VALPROATE
–Neural tube defects and developmental delay
-LITHIUM
–Congenital heart abnormalities
-SSRIs
–1st trimester - congenital heart defects and malformations
–3rd trimester - persistent pulmonary HTN in neonate

22
Q

How is essential hypertension differentiated from pre-eclampsia?

A

-In essential hypertension, diastolic BP tends to be normal
-In pre-eclampsia, diastolic BP tends to be high (and presence of other symptoms)

23
Q

How are perineal tears classified?

A

1st degree = injury to the skin only
2nd degree = injury to perineum, involving perineal muscle (–> episiotomy)
3rd degree = injury to perineum, involving external anal sphincter
-3a = <50% of EAS torn
-3b = >50% of EAS torn
-3c = IAS torn
4th degree = injury to perineum involving EAS, IAS and anal epithelium

24
Q

What are the principles of perineal repair?

A

-Suture ASAP to reduce bleeding and infection risk
-PR exam to assess injury to anal sphincter complex
-Severe cases should be repaired in theatre
-Lithotomy position and adequate analgesia
-PR exam post-procedure to ensure no sutures have passed into rectum or anal canal

25
Q

What factors increase the risk of perineal tears?

A

-Forceps delivery
-Nulliparity
-Shoulder dystocia
-2nd stage >1hr
-Persistent OP position
-High birth weight
-Epidural anaesthesia
-IOL

26
Q

What is placenta accreta?

A

When the placenta implants deeper into the uterus through and past the endometrium
-Makes 3rd stage of labour more difficult and causes increased risk of PPH

27
Q

What is cord prolapse?

A

-When the umbilical cord descends below the presenting part of the foetus into the vagina
-Significant risk of the presenting part compressing the cord –> foetal hypoxia

28
Q

How is a cord prolapse managed?

A

-Confirmed on VE or speculum
-Suspected if foetal distress seen on CTG
-Emergency C-section
-Tocolytics to prevent contractions and compression of the cord

Y4 GOSH obs CCs (18 decks)

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