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Pregnancy Complications

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Threatened miscarriage (abortion) Complete abortion. Incomplete abortion with retained products ... Abortion attempts. Hx of tubal surgery, PID, IUD. History ... – PowerPoint PPT presentation

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Title: Pregnancy Complications


1
Pregnancy Complications
  • Anna Mae Smith, MPAS, PA-C
  • Lock Haven University of PA
  • Physician Assistant Program

2
FIRST TRIMESTER
  • Characterisitcs
  • Abdominal Pain
  • Vaginal Bleeding
  • Uterus smaller than expected
  • Uterus larger than expected
  • Fetal heartbeat not audible with hand held
    doppler after 10-12 weeks

3
Differential Diagnosis Of 1st Trimester Pain or
Bleeding
  • Pregnancy related
  • NORMAL IUP
  • Threatened miscarriage (abortion)
  • Complete abortion
  • Incomplete abortion with retained products
  • Subchorionic hemorrhage
  • Missed Ab, embryonic demise, embryonic absorption
  • Blighted ovum
  • Hydatiform mole
  • Ectopic pregnancy

4
Non-Pregnancy Related
  • Appendicitis
  • Adnexal torsion
  • Tubo-ovarian abscess/infection
  • Ureteral stone with colic
  • Cystitis or pyelonephritis
  • Ruptured ovarian cyst
  • Corpus luteum cyst

5
History
  • LMP PMP
  • Previous preg. History
  • OCP use
  • Meds
  • Febrile illness
  • Abortion attempts
  • Hx of tubal surgery, PID, IUD

6
History
  • Onset, severity, duration of pain
    bleeding…generalized pain or pain referred to the
    shoulder may signal a ruptured pregnancy with
    hemoperitoneum
  • Any tissue passed
  • Rubella titer?
  • Blood type Rh
  • General health

7
Physical Exam
  • Vitals, tilt test
  • HLA
  • Pelvic with rectal!!
  • Note amount of blood
  • Cervical OS
  • Posterior fornix bulging
  • Cervical cultures GC chlamydia
  • Vag/perineal culture for Gp. B strep.

8
Testing
  • Ultrasound - Cardiac activity by 6 weeks with
    the crown rump length 5-8mm…definitely seen by
    crown-rump length of 14mm
  • Heart rate at first is 100b/min…demise likely!!

9
hCG human chorionic gonadotropin
  • Quantitative level of 1800-2000 mIU/mL should see
    an embryonic sac!
  • Quant levels of 5000 should reveal a yolk sac

10
Complications After the First Trimester
  • GDM
  • HTN
  • Multiple Gestation
  • Bleeding
  • IUGR
  • Small Large for dates
  • Oligohydramnios
  • Polyhydramnios

11
Vaginal Bleeding
  • Second trimester miscarriage
  • Cervical/vaginal causes
  • Cervicitis/vaginitis
  • Cervical polyp
  • Cervical or vaginal laceration
  • Cervical carcinoma
  • Coagulopathy either pre-existing or pregnancy
    related

12
Vaginal Bleeding
  • Intrauterine causes
  • Molar pregnancy
  • Placenta previa
  • Abruptio placentae
  • Marginal sinus rupture
  • Uterine leiomyomata

13
Diagnostic Approach
  • Minimal Bleeding
  • May occur after intercourse
  • May need U/S
  • Can remain outpatient if no other risks involved!
  • No intercourse
  • RTO ASAP for increased bleeding, pain, decreased
    fetal movement or labor symptoms!

14
Heavy Bleeding…OB emergency!! Find that Placenta!!
  • Placenta Previa occurs when the placenta
    partially or completely covers the cervical
    opening
  • 1/20 common on early U/S
  • 1/10 patients cont with previa after 30 wks of
    pregnancy…placental migration
  • Common between 27-32 weeks

15
Risk Factors of Placenta Previa
  • Previous uterine surgery/scar
  • Multiple gestation
  • Previously abnormal placental implantation
  • Advanced maternal age
  • Increasing parity

16
Complications of Placenta Previa
  • IUGR
  • Velamentous cord insertion
  • Postpartum hemorrhage
  • Placenta Accreta

17
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18
Abruptio Placenta
  • Premature separation (partial or complete) of the
    placenta from the uterine wall
  • 2 of pregnancies with 0.2 resulting in fetal
    demise
  • Usually present with pain!
  • May hide the bleeding!

19
Risk Factors for abruption
  • HTN disorders
  • Substance abuse
  • Sudden decompression of uterine cavity
  • Trauma

20
Small-for-Dates
  • Prior to 20 weeks may be hard to gage! By 20
    weeks should measure to the umbilicus!
  • 20-32 weeks measurements should correlate well
    with gestational age!

21
Why?
  • Wrong dates…??LMP
  • Improper measurement
  • Transverse lie
  • IUGR, oligohydramnios, or both
  • Small baby!

22
IUGR
  • 5 in general population but higher rates in at
    risk populations
  • AIUGR Assymetric head bones grow at a
    normal rate but the viscera abdomen do not
  • Associated with long-term problems…learning
    disablities, ADD

23
SIUGR (symmetrical)
  • Refection of early insult to fetus ie infection
    or chromosomal abnormality
  • May want amnio, TORCH titers
  • Both SIUGR AIUGR are associated with all
    pregnancy complications!

24
Large-For-Dates
  • Obesity
  • Very short patient
  • Uterine enlargement
  • Wrong dates
  • Polyhydramnios
  • Fetal macrosomia
  • Multiple gestation
  • Structural abnormalities of the uterus
  • Molar pregnancy

25
OLIGOHYDRAMNIOS
  • Placental insufficiency or abnormalities
  • Preeclampsia
  • Twin-to-twin transfusion
  • IUGR
  • Postdates pregnancy
  • Renal agenesis
  • Pulmonary hypoplasia
  • Implies a deteriorating pregnancy status!!

26
POLYHYDRAMNIOS
  • DM
  • Fetal macrosomia without maternal DM
  • Rh other isoimmunization
  • GI anomalies usually upper that prevent
    swallowing
  • Esoph/duoden/intestinal atresia
  • Diaphragmatic hernia
  • Omphalocele
  • Gastroschisis

27
POLYHYDRAMNIOS
  • IDIOPATHIC
  • CNS
  • Neural tube defects
  • Hydrocephalus
  • Intrauterine infections
  • CMV
  • Varicella
  • Parvovirus
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