Pregnancy Issues

Question 1

When is rupture of membranes pre-term (P-PROM)?

what is the main adverse risk factors to foetus?

Answer 1

• less than 37 weeks gestation

- sepsis, pulmonary hypoplasia, prematurity

Question 2

how is P-PROM diagnosed?

what tests can be done? (2)

Answer 2

• presence of a pool of fluid makes amniorrhexis very likely
• if not seen then ILGF-1 or Alpha micro globulin test

Question 3

What other clinical suspicions should you have when diagnosing P-PROM? What is its management?

when might you consider delivery?

Answer 3

• chorioamnionitis
• erythromycin (250mg QDS 10 days) or until labour
• antenatal corticosteroids
• consider delivery if >34 weeks gestation

Question 4

what is the symptoms of chorioamnionitis?

Answer 4

> maternal pyrexia
> tachycardia
> leucocytosis 
> offensive vaginal discharge 
> uterine tenderness
> foetal tachycardia on CTG

Question 5

What 3 things might bleeding in 1st trimester indicate?

Answer 5

• ectopic pregnancy
• miscarriage
• gestational trophoblastic disease (rare tumour)

Question 6

What is presentation of ectopic pregnancy?

Answer 6

• Pain and PV bleeding is ectopic until proven otherwise
• unilateral adnexal pain
• shoulder tip pain
• collapse

Question 7

What investigations would you do for ectopic pregnancy?

Answer 7

• USS: donut sign next to uterus
• serum progesterone <20nmol/L suggestive of ectopic
• serial HCG: 48 hours apart to exclude ectopic pregnancy, if >63% increase then likely to have viable IUP

Question 8

What is the management of ectopic pregnancy?

Answer 8

• systemic methotrexate:(IM single dose 50mg/m2)
  > for those with no significant pain, enraptured adnexal mass <35mm
  hCG <1500
  > No IUP

- surgery: 
> significant pain or adnexal mass >35mm 
> foetal heartbeat visible on USS 
> serum hCG 5000 
> salpingectomy

Question 9

What should you do for ruptured ectopic?

Answer 9

• 6 units of blood cross matched
• 2 large bore cannula
• IV fluids
• ABCDE

Question 10

what 2nd trimester pregnancy issues are there commonly (5)

Answer 10

• PPROM
• miscarriage before 20 weeks
• placenta praevia/ abruption
• cervical incompetence
• pre-eclampsia

Question 11

What 3rd trimester issues are there?

Answer 11

• gestational diabetes
• pre-eclampsia
• preterm labour
• PPROM
• placental abruption/ preavia
• malpresentation
• APH
• IUD

Question 12

from what gestations do you get antepartum haemorrhage?

what are the two main causes?

Answer 12

• 24 weeks until birth

- placenta praaevia and placental abruption

Question 13

what is the risk factors for placenta praaevia?

Answer 13

• advanced age
• previous C-sections
• multiparity
• smoking

Question 14

what is the management of placenta praevia?

Answer 14

• admission for women with bleeding
• stay in hospital until delivery date due to risk of massive haemorrhage
• if <34 weeks, IM corticosteroids
• delivery by c-section at 39 weeks

Question 15

what is the main risk in placenta praevia and why?

When could you consider vaginal delivery?

Answer 15

• PPH much higher as lower segment doesn’t contract as well following delivery
• marginal placenta praaevia and foetal head past the lower edge on USS.

Question 16

what makes abruption more likely than placenta praevia?

Answer 16

• bleeding inconsistent with shock
• blood is dark, as opposed to red and diffuse
• very tender and painful hard uterus

Question 17

what is vasa praevia?

what is the complication?

Answer 17

• foetal blood vessels run in membrane in front of presenting part
• rupture causes profuse bleeding and foetal death