Pregnancy Complications

Question 1

List the 5 causes of maternal death

Answer 1

1. PPH- Severe bleeding (sometimes called hemorrhage)
2. Infections.
3. Blood pressure disorders of pregnancy, including preeclampsia and eclampsia.
4. Complications of labor and delivery.
5. Unsafe abortion.

Question 2

Define spontaneous miscarriage

Answer 2

Spontaneous loss of pregnancy prior to viability

Question 3

List the causes of spontaneous miscarriage (6)

Answer 3

chromosomal abnormality
Maternal Diseases
Drugs
Uterine Abnormalities
Infection
Cervical incompetence ( second trimester )

Question 4

Define threatened miscarriage

Answer 4

Vaginal bleeding in the presence of a viable pregnancy with a closed os

Question 5

Define Inevitable Miscarriage

Answer 5

Open cervical os with a viable pregnancy ( point of no return )

Question 6

Define incomplete miscarriage

Answer 6

Open cervical os pregnancy associated tissue already passed, however some still left behind

Question 7

Define missed miscarriage

Answer 7

Miscarriage occurring in the absence of symptoms or minimal symptoms with the pregnancy still present in utero

Question 8

Define complete miscarriage

Answer 8

Cessation of bleeding with a closed os and empty uterus after miscarriage

Question 9

State the 25 mm 7mm rule in gynaecology (25/7)

Answer 9

25 mm hold sac should have a fetal pole
7mm fetal pole should have a heart

Question 10

Discuss the management of Miscarriage

Answer 10

Medical:
Misoprostol

Surgical
EVAC
Hysterectomy

Question 11

List the complications/Risks of EVAC

Answer 11

Perforation
Bleeding
Infection
Asherman Syndrome

Question 12

List the risk factors of an ectopic pregnancy (5)

Answer 12

Prev ectopic
Prev pelvic surgery/ C-section
IUD
PID esp chlamydia
Smoking

Question 13

Outline the clinical presentation of an ectopic pregnancy (5)

Answer 13

Pain - localised or general
PV bleeding
Haemorrhagic shock
GIT irrritability -nausea , vomiting &diarrhoea

Question 14

Discuss the management of an ectopic pregnancy

Answer 14

Make sure pt is haemodymamically stable

Medical:
Methotrexate 1mg/kg IMI
Criteria needs to be met

Surgical
Laparotomy
Salpingectomy

Expectant (wait for them to deliver it)

Question 15

List the clinical presentation/ sx of a gestational trophoblastic disease

Answer 15

Pain in pelvic area
PV bleeding
Hyperremesis gravidum
Uterus larger than dates
Thyrotoxicosis

Question 16

What investigations would you do in a pregnant pt presenting with uterus larger than dates & extreme vomiting

Answer 16

Bloods
- FBC
- CEU
- LFTs
- TSH
Urine mc & s
USS
IV fluid rehydration + Vitamin B
Anti-emetic +/- antibiotic if infective course
NPO
Address social issues

Question 17

Discuss the management of a molar pregnancy

Answer 17

Medical
Bloods
- FBC
- CEU
- LFTs
- TSH
Urine mc & s
USS
IV fluid rehydration + Vitamin B
Anti-emetic +/- antibiotic if infective course
NPO (nothing by mouth)
Address social issues

Surgical
EVAC under general anaesthetic
-Suction curettage under US

High risk of bleeding
Requires follow up for up for atleast 1year

Question 18

Define hyperemesis gravidam

Answer 18

Nausea and vomiting that causes dehydration and ketonuria

Question 19

What conditions do you need to exclude if a pt presents with near sea and vomiting that causes dehydration and ketonuria

Answer 19

Infection
Multiple pregnancy
GTD
TSH and T4
‘Wanted’ pregnancy