Obstetric complications

Question 1

What are the four causes of antepartum haemorrhage?

Answer 1

Placental abruption
Uterine rupture
Cord prolapse
Placenta praevia

Question 2

What is placenta praevia?

Answer 2

The placenta is attached to the lower uterine segment

Question 3

What are the two types of placenta praevia?

Answer 3

Minor: low lying placenta, but not covering the internal cervical os
Major: placenta lies over the internal cervical os

Question 4

What are the RF for placenta praevia?

Answer 4

BIGGEST: previous C-section 
Previous placenta praevia
Maternal age 40+
Multiple pregnancy
PID
Curettage to endometrium

Question 5

How might placenta praevia present?

Answer 5

Painless vaginal bleeding (from spotting to massive haemorrhage)

Question 6

How is placenta praevia diagnosed?

Answer 6

USS

Question 7

How is placenta praevia managed?

Answer 7

C-section delivery recommended

Question 8

How is placenta praevia monitored?

Answer 8

Once discovered - repeat scan at 32 and 36 weeks and assess if has moved superiorly. If not - plan for delivery

Question 9

What is placental abruption?

Answer 9

A portion/all of the placenta separates from the wall of the uterus prematurey, causing rapid foetal compromise

Question 10

What are the risk factors for placental abruption?

Answer 10

Previous placental abruption
Pre-eclampsia or gestational hypertension
Abnormal lie
Polyhydramnios
Abdominal trauma
Cocaine use
Multiple pregnancy

Question 11

How would placental abruption present?

Answer 11

Antepartum haemorrhage
Abdominal pain
Woody and tender abdomen

Question 12

How is placental abruption managed?

Answer 12

USS, FBC, clotting screen

Question 13

How is placental abruption managed?

Answer 13

If foetal compromise or unwell mother: emergency C-section

If mother and foetus well: induce labour

Question 14

What are the two types of uterine rupture?

Answer 14

Complete: peritoneum torn, uterine contents can enter the uterine cavity
Incomplete: peritoneum intact, uterine contents remain in the uterus

Question 15

What are the RF for uterine rupture?

Answer 15

Previous C-section
Previous uterine surgery
Induction or augmentation of labour
Obstruction of labour
Multiple pregnancy
Multiparity

Question 16

How might a woman with uterine rupture present?

Answer 16

Sudden severe abdominal pain, persisting between contractions
Shoulder tip pain
Vaginal bleeding
Signs of hypovolaemic shock
Collapse

Question 17

How is uterine rupture diagnosed?

Answer 17

USS

CTG: shows foetal bradycardia and decelerations

Question 18

How is uterine rupture managed?

Answer 18

Group and save and crossmatch
ABCDE approach
C-section delivery
Uterine repair OR hysterectomy

Question 19

When should women be risk assessed for VTE risk?

Answer 19

At booking visit
At all intrapartum midwife visits
Post-natally

Question 20

When is VTE prophylaxis given?

Answer 20

4 RF in first 2 trimester
3 RF in 3rd trimester
2 RF n post partum period

Question 21

Should VTE prophylaxis be continue post-partum?

Answer 21

Yes, until at least 6wks PP

Question 22

What VTE prophylaxis should be given to women who have had a C-section?

Answer 22

10 day course of LMWH

Question 23

What single factor indicates that a woman should be given VTE prophylaxis?

Answer 23

Previous VTE

Question 24

What are the RF which decide if VTE prophylaxis is given?

Answer 24

Obesity (BMI 30+)
Age 35+
Parity 3+
Smoker
Varicose veins
Pre-eclampsia
Immobility
1st degree FH of VTE
Low risk thrombophila
Multiple pregnancy
IVF

Question 25

What three LMWH are used in pregnancy as VTE prophylaxis?

Answer 25

Enoxaparin Dalteparin Tinzaparin

Question 26

Describe 1st, 2nd, 3rd and 4th degree tears

Answer 26

1st: skin graze 2nd: perineal muscle involvement 3a: less than 50% of anal sphincter torn 3b: more than 50% of anal sphincter torn 4th: rectal muscle involvement

Question 27

Define miscarriage?

Answer 27

Loss of pregnancy before viability (pre-24wks)

Question 28

What are the causes of miscarriage?

Answer 28

``` Chromosomal abnormalities Structural malformation Acute pyrexial illness Uterine malformation Chronic maternal disease ```

Question 29

How might a miscarriage present?

Answer 29

Vaginal bleeding Abdominal pain Regression of pregnancy symptoms May be an incidental finding at a routine antenatal appointment

Question 30

How is a miscarriage diagnosed?

Answer 30

``` Pregnancy test (urinary and serum) USS + doppler + foetal HR Speculum ```

Question 31

What are the types of miscarrage and status of the cervical os?

Answer 31

``` Threatened: closed os Inevitable: open os Complete: closed os Incomplete: open os Missed: closed os ```

Question 32

Define a threatened miscarriage

Answer 32

Any PV bleeding pre-24wks

Question 33

How is a threatened miscarriage managed?

Answer 33

Nil required

Question 34

Define an inevitable miscarriage?

Answer 34

Symptoms of bleeding and pain presenting in the process of miscarriage with an open cervical os

Question 35

How is an inevitable miscarriage managed?

Answer 35

Watchful wait - ensure no retained products

Question 36

Does a threatened miscarriage have implications for the rest of the pregnancy?

Answer 36

No

Question 37

Define complete miscarriage

Answer 37

Bleeding and foetal loss which has now lessened or resolved

Question 38

How is a complete miscarriage managed?

Answer 38

Nil required, check for ectopic

Question 39

Define incomplete miscarriage

Answer 39

Heavy and increased vaginal bleeding with lower abdominal pain. There are some retained products.

Question 40

How is incomplete miscarriage managed?

Answer 40

Medical or surgical management to complete miscarriage

Question 41

What is a missed or delayed miscarriage?

Answer 41

Retention of the entire gestation sac with no foetal heartbeat or further foetal growth.

Question 42

What bleeding pattern is there in missed or delayed miscarriage?

Answer 42

Minimal bleeding

Question 43

How is missed/delayed miscarriage managed?

Answer 43

Medical or surgical termination of pregnancy

Question 44

Describe an expectant approach to managing miscarriage

Answer 44

Allow the body to miscarriage naturally. This is unpredictable and can take weeks

Question 45

Describe a surgical approach to miscarriage

Answer 45

Vacuum aspiration OR dilation and evacuation

Question 46

Describe a medical approach to miscarriage

Answer 46

Misoprostol to induce contractions to expel remaining products

Question 47

What is molar pregnancy?

Answer 47

Aka hydatidiform mole; gestational trophoblastic disease

Question 48

What is the cause of a molar pregnancy

Answer 48

Imbalance of chromosomes from each gamete

Question 49

What are the types of molar pregnancy?

Answer 49

Complete: all genetic material comes from the father. There is no foetus, only placenta. Incomplete: the foetus develops with 3 sets of chromosomes and there is an abnormal placenta

Question 50

How might a molar pregnancy present?

Answer 50

Usually positive pregnancy test and pregnancy symptoms

Question 51

How might a molar pregnancy appear on examination of the abdomen?

Answer 51

Uterus may be large for dates and be boggy in consistency

Question 52

What are the risk factors for molar pregnancy?

Answer 52

Previous molar pregnancy OCP use Maternal age under 20 or above 35

Question 53

What tests are diagnostic for a molar pregnancy and how might they appear?

Answer 53

USS: snowstorm appearance | Histology shows trophoblastic disease

Question 54

How is a molar pregnancy managed?

Answer 54

Surgical: manual vacuuum aspiration or dilation and evacuation

Question 55

What are the complications of a molar pregnancy

Answer 55

Distress Malignant potential Haemorrhage