Placental Problems in Pregnancy Flashcards
(51 cards)
What are the stages of pregnancy?
Antepartum
Intrapartum (in labour)
Postpartum (delivery of fetus up to 6 weeks later)
How long is antepartum?
24 weeks
< 24 weeks = early pregnancy
> 24 weeks = late pregnancy
What is hyperemesis Gravidarum?
- poorly understood
- hCG effects
What are the symptoms of hyperemesis Gravidarum?
- severe nausea/vomiting
- electrolyte imbalance
- weight loss
- hospital admission
What usually happens when there is bleeding in pregnancy?
- 50% will settle
- 50% miscarry, ectopic, gestational trophoblastic disease
What is the definition of a spontaneous miscarriage?
Fetus dies/delivers dead < 24 weeks
What are the types of miscarriage?
- threatened
- inevitable
- incomplete
- complete
- septic
- missed
What is threatened miscarriage?
- light/painless bleeding from vagina
- fetus alive
- cervical os closed
- 25% go on to miscarry
What is an inevitable miscarriage?
- bleeding heavier than threatened
- fetus may be alive
- cervical os open
- miscarriage about to occur
What is an incomplete miscarriage?
- only some fetal parts passed
- cervical os open
- PV bleeding continues
What is a complete miscarriage?
- all fetal tissue passed
- bleeding diminished
- uterus no longer enlarged
- cervical os closed
What is a septic miscarriage?
- uterus contents infected = endometritis
- tender uterus
- fever may be absent
- may progress to pelvic infection
What is a missed miscarriage?
- fetus not developed and died in utero
- cervical os closed
What investigations do you do in a miscarriage?
- US scan (location/viability, restrained fetal tissue)
- serum bHCG (increases >66% in 48hrs if pregnancy viable)
- bloods (FBC and Rhesus)
How do you manage a miscarriage when it is expectant?
- wait for spontaneous resolution
- resuscitation if substantial blood loss
How do you medically manage a miscarriage?
- removal of fetal tissue
- use PG
How do you surgically manage a miscarriage?
Curettage
- scraping instrument/surgical aspiration
What is a recurrent miscarriage?
3 or more consecutive
in 1% of couples
What are the causes of miscarriage?
- autoimmune disease
- chromosomal defects
- hormonal factors
- anatomic factors
- infection
- others - obesity, smoking, maternal age, drug abuse
How do you investigate causes of recurrent miscarriage?
Autoimmune and thrombophilia screen
Karyotyping (parents and products of conception)
How do you manage recurrent miscarriages?
Depends on cause:
- anticoagulation therapy
- genetic counselling
- metformin
- cervical cerclage
What is an ectopic pregnancy?
Implantation of fertilised ovum outside endometrial cavity
- 70% of women have successful pregnancy if ectopic
What are the risk factors of EP?
STIs Emergency Contraception Assisted conception Pelvic surgery Failed sterilisation
What is the clinical presentation of EP?
- women of reproductive age with PV bleeding
- lower abdominal pain
- collapse
- amenorrhoea (4-10 weeks)
- tachycardia
- uterus smaller than expected gestation
- cervical os closed
