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PAR3031 - MATERNITY > WEEK 3 > Flashcards

WEEK 3 Flashcards

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1
Q

what is Antepartum haemorrhage?

A

defined as
bleeding from the genital tract in the second half of
pregnancy, remains a major cause of perinatal mortality and maternal morbidity in the developed world.

In approximately half of all women presenting
with APH, a diagnosis of placental abruption or placenta praevia will be made; no firm diagnosis will be made
in the other half even after investigations.

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2
Q

What is Hyperemesis Gracidarum (HEG)

A

Sever vomiting in pregnancy

persistant vomiting leading to fluid and electrolyte depletion, marked ketourinea and nutritional deficience and rapid weight loss

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3
Q

What causes Hyperemesis Gracidarum (HEG)?

A

Unknown, thought to be endocrine in origin

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4
Q

WHen does Hyperemesis Gracidarum (HEG) usually start?

A

Usually around 6/40

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5
Q

What history based questions should you ask with Hyperemesis Gracidarum (HEG)?

A
  • characteristic of the vomit
  • this pregnancy - gestation problems
  • Last time to toilet
  • Previous pregnancy - problems G’s P’s
  • previous medical history
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6
Q

What are potential causes of Early PV bleeding?

A
  • impantation bleed
  • cervical lesions
  • miscarraige
  • ectopic pregnancy
  • incompetent cervix
  • hydatidiform mole
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7
Q

what is a hydatidiform mole?

AKA molar pregnancy

A

characterised by rapid growth of trophoblastic tissue

where chorion villi become fluid filled, with no viable embryo

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8
Q

WHat are the two types of hydatidiform moles?

A
  • complete (no fetal tissue, develops from empty egg)

- incomplete

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9
Q

what are some causes of hydatidiform moles?

A
  • poor nutrition
  • advanced age >40
  • young age <18
  • mexican and asian decent increased risk
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10
Q

What are signs & symptoms of hydatidiform moles?

A
    • preggo test
  • ## nausea etcPartial signs: signs consistent with incomplete miscarriage

Complete signs: dark brown vaginal bleeding

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11
Q

Define a miscarriage?

A

Expulsion of the products of conception from the uterus via the birth canal before the 20th week

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12
Q

what are the 2 classifications of misscarriage?

A
  • spontaneous

- induced

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13
Q

What re the causes of misscarriage?

A
  • Foetal
  • Genital tract
  • Maternal
  • Trauma
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14
Q

What are the foetal causes of miscarriage?

A

– Foetal abnormality
(chromosomal)
– poor implantation
– Abruption of the ovum

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15
Q

What are the maternal causes of miscarriage?

A

– Diseases-rubella, influenza,
acute fever, renal disease,
hypertension, – Age – ABO incompatibility, – Drugs- anaesthetics,
chemotherapy, toxic – Psychological- stress, anxiety

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16
Q

What are the Genital tract causes of miscarriage?

A

– Retroverted uterus
– Bicornuate uterus
– Myomas
– cervical incompetence

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17
Q

What are the trauma tract causes of miscarriage?

A

– MCA – Direct blow – criminal interference – abdominal surgery

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18
Q

what are the classifications of spontaneous miscarriage?

A
  • missed
  • threatened
  • inevitable
  • complete
  • incomplete
  • septic
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19
Q

What is the definition of a threatened spontaneous miscarriage?

A

cervix closed, membrane in tact

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20
Q

what is the presentation of threatened spontaneous miscarraige?

A

Pain
– Slight →severe; cramps;
– lower abdominal/back

Vaginal bleeding
– Nil → Slight → Heavy

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21
Q

What is the Inevitable of a threatened spontaneous miscarriage?

A

cervix is open

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22
Q

what is the presentation of inevitable spontaneous miscarraige?

A

– Free vaginal bleeding,
– ? ruptured membranes -amniotic fluid seen
– Foetal sac & contents protruding through dilating
cervical os
– More acute abdominal pain-rhythmic

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23
Q

What is the Missed of a threatened spontaneous miscarriage?

A

Products of conception not viable, retained in

the uterus & no signs of abortion

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24
Q

what is the presentation of missed spontaneous miscarraige?

A

 Physiological signs of pregnancy regress
 Any signs of pain & bleeding cease
→ brown discharge- +/- offensive → decay
 Blood coagulation disorders may develop
– if missed abortion of > 6 to 8 weeks

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25
What is the complete of a threatened spontaneous miscarriage?
Expulsion of all products of conception | – embryo, placenta and intact membranes
26
what is the presentation of complete spontaneous miscarraige?
 Usually occurs < the 8th week of gestation  Pain (A/A)  Vaginal loss – slight. → mod; bright red → brown
27
What is the incomplete of a threatened spontaneous miscarriage?
Not all products of conception are expelled. – Foetus usually expelled but part of placenta is retained
28
what is the presentation of incomplete spontaneous miscarraige?
 Usually occurs >8 weeks but < 20 weeks  Bleeding mod → profuse  Abdominal pain &/or backache ++++  Risk of cervical shock if foetus caught in cervix
29
What is the septic of a threatened spontaneous miscarriage?
Infection due to lack of removal of the products of | conception
30
what is the presentation of septic spontaneous miscarraige?
 History of abortion  Unwell, headache, nausea, sweating & shivering, flushed/hot skin, ↑ temp, abdo pain  Tender uterus- bulky, offensive vaginal discharge, may be pinkish in color
31
What are the general signs of miscarriage?
Pain- – central, in low abdomen, – intermittent backache Vaginal bleeding- blood stained discharge – brown spotting/bright red loss • Minimal → heavy May experience – Uneasiness prior to onset of symptoms
32
What is cervical shock?
where products of coneption partially caught in cervix - signs of shock not due to hypovolaemia
33
What are some risk factors of cevical shock?
- past Hx of miscarriage - potential miscarriage on ultrasound - smoking - obesity
34
What are some symptoms of cevical shock?
− Pain – cramps; signs of pregnancy ? Subsiding; PV loss; light or heavy bleeding – with jelly like clots; may have nausea or tender breasts − Level of shock out of proportion to blood loss
35
define ectopic pregnancy?
Fertilized ovum embeds outside the uterine cavity, usually in the fallopian tubes
36
WHat are the various possible implantation sites for ecotopic pregnancy? ON EXAMS
- cervical - peritoneal - interstitial - tubal (isthmus) - Tubal (ampullar) - Infundibular (osital) - Ovarian - Abdominal
37
What are the risk factors for ectopic pregnancy?
 Narrowing of the tube – ?oedema ?inflammation ?infection  Kinking of tube – ?adhesions ? Scarring  Damage to lining of tube – endometriosis or PID; smoking  Delay in transit of ovum; mini pill – Previous surgery;  IVF-tubal surgery
38
what are signs and symptoms of ectopic pregnancy?
- History of amenorrhea  Mild lower abdominal pain- – occasionally sharp, stabbing; ↑ intensity over a few days especially with bowels; tenderness on one side; rebound tenderness; adnexal tenderness  Shoulder tip pain (KEY MARKER)  Tachycardia  Postural hypotension  Dizziness and fainting  Nausea & diarrhoea  +/- bleeding or slight brown discharge  U/S: Uterus empty
39
what are signs and symptoms of Ruptured ectopic pregnancy?
 Sudden severe abdominal pain  Profound shock- collapse  Vaginal Bleeding - minimal  Referred shoulder tip pain
40
Define incompetent cervix?
Painless dilatation of cervix; the foetus, placenta & | membranes completely expelled
41
what causes incompetent cervix
Unknown - ? weakness of retaining sphincter | mechanism at the junction of the uterus & cervix;
42
what is the presentation of incompetent cervix?
Painless delivery of foetus b/n 16-23/40
43
where is the normal site for implantation?
endometrium of upper uterus
44
how much does the placenta weigh?
1/6 of baby weight
45
What does the placenta do?
transfer nutrients and excretory products via diffusion no mixingof maternal and foetal blood
46
what are 5 functions of the placenta?
 Nutritive – Amino acids; simple sugars  Respiratory – O & CO2 exchange  Excretory – Waste products  Endocrine – βHCG; HPL; Oestrogens, Progesterone,  Barrier – For most but not all
47
define antepartum haemorrhage?
 Bleeding from the birth canal in excess of 15mls from the 20th (approx) week of gestation to the birth of the neonate
48
what are the 3 main types of antepartum haemorrhage?
 Placenta Praevia  Placental abruption  Vaso praevia
49
what are the risk factors of antepartum haemorrhage?
* Maternal age >40 * Complex medical history prior to pregnancy * Multigravida * Known placenta praevia * History of abruption * Coagulopathies * Use of Crack Cocaine
50
What is placenta pravia?
Placenta partially or wholly | implanted in the lower part of the uterus.
51
with placenta pravia, when do bleeding signs start to show?
• Can start spotting from 28 weeks • more severe around 32-36 weeks
52
What are the 4 grades of placenta pravia?
 1 - placenta lies in lower segment but does not reach the internal os  2 - edge of placenta is attached to lower segment of uterus & reaches internal os  3 - edge just covers internal os -bleeds once cervix starts to dilate past 3-4cm  4 - placenta centrally covers the internal os - torrential haemorrhage is likely
53
What is the presentation of placenta pravia?
```  Painless recurrent bleed of various amounts – tends to be BRIGHT RED  Dx by transvaginal ultrasound  Premature labour  Shock  Foetal malpresentation ```
54
What is Vasa preavia?
 (type 1) Foetal vessels crossing or running in close proximity to the inner cervical os. ```  (Type 2) Vessels course within the membranes (unsupported by the umbilical cord or placental tissue) ```
55
what is the presentation of Vasa Preavia?
 Can be detected on transvaginal U/Sound – 2nd trimester  Painless Vaginal bleeding – fresh blood – Usually limited; non continuous – Usually when the membranes rupture  Lack of foetal movements – After membranes rupture  Usually late 3rd trimester of pregnancy – Associated with labour
56
What is placental abruption?
``` Premature separation of the placenta from the uterine lining (after 20 weeks) ```
57
how often does placental abruption occur?
 Occurs in 3-5% of all pregnancies
58
what is the process of placental abruption?
– bleeding from maternal venous sinuses into placental bed → further separates placenta → blood retained behind placenta → infiltrates myometrium → extravasation causing marked damage such as bruising & oedema
59
what are the risk factors for placental abruption?
```  Presence of complex medical disorders before pregnancy  Substance abuse especially methamphetamine use  Multi gravida  Maternal age over 40  Previous history of abruption  Hypertension  Pre-eclampsia  Trauma  Unknown ```
60
What are the 3 types of placental abruption?
• Central/concealed - Separation is in the middle • Revealed/marginal - Separation is near the edge of the placenta • Partially revealed - Combination of both of the above
61
what is the presentation of placental abruption?
 Vaginal bleeding may or may not occur (depending on type)  ↑ Pulse ↓ BP, hypovolaemic shock,  Abdo pain ++  Tender uterus  Anxious; “impending doom” → Concealed bleeding into uterine muscle → Causes uterine enlargement → Extreme pain & hard & rigid abdomen
62
What are some complications of placental abruption?
 Disseminated Intravascular coagulation (DIC)- – inappropriate coagulation within blood vessels  Post partum Haemorrhage (PPH)  Renal failure  Pituitary necrosis  Distressed baby  Foetal death in-utero (FDIU)
63
What is a uterine rupture?
 Tear in the uterus – often associated with prior caesarean section
64
What are the risk factors for uterine rupture?
 Previous caesarean section  Other uterine surgery or termination of pregnancy  Grand multiparity (>6)  Undiagnosed cephlopelvic disproportion  Macrosomic (large) baby  Placenta percreta  External cephalic version  Uterine abnormalities
65
What are the clinical signs of placental rupture?
 If in labour – Sudden cessation of contractions – Elevation of the presenting part  Severe constant pain  Foetal death (FDIU)  Maternal shock disproportionate with clinical signs – Concealed haemorrhage

PAR3031 - MATERNITY (11 decks)

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