Pregnancy complications Flashcards
(43 cards)
What is eclampsia + how common is pre-eclampsia?
Seizures - usually following pre-eclampsia but can occur without HTN or proteinuria
10% pregnancies get pre-eclampsia
RF for pre-eclampsia
Nulliparity Chronic HTN Extremes of age Multiple pregnancy Assisted conception Obesity Pre-existing disease Molar pregnancy FHx pre-eclampsia Hx of placental abruption
HELLP syndrome - what is it, S+S, complications, management
Haemolysis, elevated liver enzymes + low platelets
Epigastric/ RUQ pain, N+V, HTN, dark urine DIC, liver failure may occur
Deliver + give magnesium sulphate
High dose steroids
Oxytocin to be used in 3rd stage (not Syntometrine as this increases BP)
Uterine rupture - S+S, risk factors, management, risk of rupture in VBAC + induction
Risk with multiparous women on uterine stimulants
S+S: fresh vaginal bleeding, haematuria, fetal distress, constant severe abdo pain
Immediate laparotomy to save baby
Risk of rupture is 0.3% if VBAC, 3% if induced
Uterine inversion - risk factors, S+S, management
Associated with grand multips + incorrect management of 3rd stage
Presents as vasovagal shock: pale, clammy, hypotensive, bradycardic
Mass at introitus
Manage with O’Sullivans method - reduce inversion by hydrostatic technique
VTE - when is it likely to occur?
Antepartum DVT more common than postpartum VTE higher intrapartum
Cerebral vein thrombosis = usually in intrapartum period (seizures, fever, vomiting, photophobia)
VTE - why does it occur in pregnancy?
Pregnancy = hypercoagulable state
Blood clotting factors X, VII + fibrinogen increased
Protein S activity decreased
Suppression of fibrinolysis
Blood flow altered by obstruction + immobility
VTE pre-existing RF
Previous VTE
Thrombophilia
Age >35
Obesity
Parity >4
Gross varicose veins
Paraplegia
Sickle cell
Inflammatory disorders
Medical disorders
New onset VTE RF
Ovarian hyperstimulation syndrome
Hyperemesis
Dehydration
Long haul travel
Severe infection
Immobility
Pre-eclampsia
Prolonged labour
Instrumental delivery
Excessive blood loss
S+S VTE
DVT: leg pain, swelling, tenderness, fever, erythema, elevated WCC
PE: SOB, collapse, chest pain, haemoptysis, raised JVP
Cerebral vein thrombosis: seizures, fever, vomiting, photophobia
VTE investigation + prevention
CXR - if normal = V/Q
If abnormal = CTPA
LMWH for prophylaxis
Score >4 = LMWH from 12 wks + PP
Score 3 = LMWH from 28 weeks + PP
Score 2 = LMWH for 10 days PP
Risk assessment for VTE prophylaxis in CS
Low risk (hydration + mobilisation) Elective CS, uncomplicated pregnancy, no RF
Moderate risk - prophylaxis Age >35, obesity, parity >4, labour >12 hrs, infection, pre-eclampsia, immobility, emergency CS
High risk - heparin >3 moderate RF, pelvic surgery, personal or fam hx of VTE, antiphospholipid antibody syndrome
Hyperemesis gravidarum - risk factors, S+S
Excessive vomiting, severe enough to cause dehydration, weight loss, electrolyte disturbance
High risk with multiples + molar
Complications of hyperemesis
Liver/ renal failure Hyponatraemia - then rapid reversal = central pontine myelinosis Thiamine deficiency = leading to Wernicke’s encephalopathy IUGR
Causes metabolic hypocholoraemic alkalosis
Management of hyperemesis
Admit, give fluids (500ml NaCl) + thiamine
Diagnose with ++ketones in urine
Daily U+Es
Antiemetics if needed - prochlorpramazine
Prolonged pregnancy risks
>42 weeks Placental function declines.
Increased risk of intrapartum deaths
Risk: meconium aspiration, oligohydraminos, macrosomia, shoulder dystocia, cephalhaematoma, hypothermia, hypoglycaemia, polycythaemia
Cephalhaematoma
Common injury during forceps delivery or prolonged labour
Swelling of scalp due to bleeding
Fetal postmaturity syndrome - S+S
Post term infants who have malnutrition
Scaphoid abdomen, little SC fat, peeling skin, anxious look
Skin stained with meconium
Risks of PPROM
Chorioamnionitis
Cord prolapse
Absence of liquor = pulmonary hypoplasia, postural deformities
Prematurity
Infection
Chorioamnionitis S+S, management + prophylaxis
Fever, abdo pain, vaginal discharge, tachycardia, uterine tenderness
Give steroids, cefuroxime + metronidazole
Prophylaxis = erythromycin
Spontaneous, threatened + inevitable miscarriage
Spontaneous = fetus dies before 24 weeks
Threatened = fetus still alive but there is bleeding, os closed
Inevitable = bleeding, os open
Incomplete, complete, septic + missed miscarriage
Incomplete = some fetal parts have passed, os open
Complete = fetus has passed, os closed
Septic = endometritis caused by contents, offensive vaginal discharge
Missed = USS finds dead fetus, os closed
Management of miscarriage
Conservative if no signs of infection
Medical: misoprostol
Medical termination of pregnancy
Mifepristone
