W04: Complications in Pregnancy; APH; PPROM Flashcards
Outline the basis of symptoms, main causes, dx, and mgmy of miscarriage
- spontaneous loss of pregnancy before reaching viability until 24w. 15% incidence
- multifactorial
- vaginal bleeding, pain
- asymptomatic possible in missed miscarriages (no clear fetus)
Threated
> conservative
Inevitable
> Evacuation if heavy bleeds
Missed
> conservative
> medical: prostaglandins (misoprostol)
> sx
Septic
> abx + evacuation
Outline the basis of symptoms, main causes, dx, and mgmy of pregnancy of unknown location
- nil pregnancy visualised either inside or outside the womb despite + preg test, abdo pain/ vag. bleeding
*? ectopic, miscarried, too early to dx
BUT PERSISTENT PUL (bHCG)
> conservative, waiting
> methotrexate injection = resorption of pregnancy
> sx. if emergency
Outline the basis of symptoms, main causes, dx, and mgmy of ectopic pregnancy
pregnancy implantation outside the uterine cavity
- commonly tubal implantation
- RF: pelvic inflamm. disease; prev tubal sx; prev. ectopic; assisted conception
- period of ammenorhoea
- vag. bleeding, abdo pain, GI/ urinary symptoms
- scan: nil sac, potentially adnexal mass, fluid in PoDouglas
- serum BHCG: 48hr interval (normal early preg increases levels 66%)
> methotrexate
sx: laparoscopy - salpingectomy (remove the tube); salpingotomy (remove embryo)
Outline the basis of symptoms, main causes, dx, and mgmy of molar pregnancy
gestational trophoblastic disease (GTD)
* inability to develop into normal preg.
* unstable chromosome
=> complete molar = 2 sperm empty egg etc.
=> partial molar = 3 sets
=> invasive molar preg (neoplastic)
- common to experience irregular or heavy vaginal bleeding in early pregnancy.
- USS
- abn high bHCG
- sent for biopsy (miscarriage or post-removal)
> sx removal
Identify Antepartum haemorrhage
24w+ haemorrhage but before delivery
- grave emergency, signficiant morbidity and mortality
- placenta praevia
- placental abruption: retroplacental clot
- APH of unknown origin
- local lesions in genital tract
- vasa praevia: small amt of loss from baby yet catastrophic
Initial mgmt of APH
a
Threated Vs Inevitable Miscarriage
Threatened = Bleeding from gravid , no evidence of cervical dilatation
Inevitable = Cervix has begun to dilate
Placenta praevia
1/200 pregos
implantation in lower uterine segment
risk:
multiparous women
multiple pregnancies
prev c-sect
Grade I to IV = describes placental approach/covering of os
or alternatively
low-lying vs full placenta previa
- painless PV bleeding
- malpresentation
- incidental
- USS; avoid vaginal examination
> c-sect
PPartum Haemorrhage Mgmt
> Oxytocin, ergmetrine, carboprost, tranexemic acid
Balloon tamponade
Sx: b lynch cutre, ligation of uterine and iliac vessels, hysterectomy
Placental abruption
Haemorrhage resulting from premature separation of the placenta before the birth of the baby
*retroplacental clot
* RF: pre-eclpsia, multiple preg., polyhydramnios, smoking, age, parity, prev. abruption, cocaine use
- revealed abruption = blood vis.
- concealed abruption = internal
- mixed abruption
- PAIN, PV BEEDING, INCREASED UTERINE ACTIVITY
! maternal shock, collapse, fetal distress and death, maternal DIC, renal failure, PPHaemorr.
Preterm Labour
Onset of labour before 37weeks
* spontaneous or induced
Preterm delivery:
* contractions with evidence of cervical change via VExam.
* Fetal fibronectin test: +ve thus increased risk
?consider abruption, infection
> consider tocolysis (DRUGS PREVENTING UTERINE CONTRACTIONS) to allow steroids/transfer
steroids
transfer
aim for vaginal delivery
Neonatal morbidity resulting from prematurity
- respiratory distress syndrome
- intraventircular haemorrhage
- cerebral palsy
- nutrition
- temperature control
- jaundice
- infections
- vis. impairment
- hearing loss
Recognise and describe initial management of hypertensive disorders in pregnancy
Pre-preg care
* CI anti-hypertensives: RAMIPRIL / ENALOPRIL
- ARBs (tans)
- antidiuretics
- lower dietary Na
- aim for BP <150/100 via LABETOLOL, NIFEDIPINE, METHYLDOPA
- monitoring
List the complications of hypertensive disorders
- higher risk of placantal abruption
- systemic organ disorder with pre-eclampsia
- seizures
- severe HT = cerebral haemorr., stroke
- HELLP: hemolysis, elevated liver enzymes, low platelets
- DIC
- renal failure
- pulm oedema
- fetal impaired placental perfusion
List the complications associated with diabetes in pregnancy
- higher risk of neonatal hypoglc. and increased risk of resp distress
- fetal congenital abn.
- miscarriage
- shoulder dystocia
- stillbirth
- maternal end organ dmg.
+ increased risk of pre-eclampsia
+ infections
