Complicated Pregnancy 1 (Early labour and ectopic pregnancy)

Question 1

How common is an ectopic?

Answer 1

1 in 90 pregnancies so pretty common

Question 2

What are the most common locations for an ectopic?

Answer 2

97% tubal:

• Mainly Ampullary
• Some Isthmus
• Rarely Intramural

1% Ovarian

0.1% Cervical

Rarely Fimbrial

Question 3

In what women would we be particularly wary of ectopics?

Answer 3

Risk factors include:

• PID
• Tubal surgery
• Previous ectopic
• Assisted conception e.g. IVF

Question 4

How would you tell an ectopic pregnancy?

Answer 4

• Period of ammenorhoea
• +/_ Vaginal bleeding
• +/_ Pain abdomen
• +/_ GI or urinary symptoms

Question 5

How do we test to confirm an ectopic?

Answer 5

First do an US, you should see:

• No intrauterine sac
• Possibly an adnexal mass
• blood in the pouch of Douglas

Serum BHCG

Progesterone

Question 6

What does Serum BHCG tell us about an ectopic

Answer 6

Serially tracked over 48 hours it increase by atleast 66%

However an ectopic will rise sub-optimally (aka <66%)

Question 7

How can you treat an ectopic pregnancy?

Answer 7

1) Conservative (if she’s stable it may shrink on its own)
2) Medical - Methotrexate
3) Surgical - Laparoscopic salpingectomy if there’s a risk of rupture and/or very unstable

Question 8

Define preterm labour and its grades?

Answer 8

Preterm means onset <37wks/259days

Mildly preterm = 32-36wks
Very Preterm = 28-32 wks
Extremely Preterm = 24-28wks

Preterm labour can be both spontaneous or Induced

Question 9

Is preterm labour more common in single or multiple pregnancies?

Answer 9

Multiple

6% in singles and 35% in multiples

Question 10

Most Preterm Labours are Idiopathic!!!

But what are the common causes?

Answer 10

• Multiple pregnancy
• Polyhydramnios: XS amniotic fluid in amniotic sac
• APH
• Pre-eclampsia
• Infection e.g. UTI
• Premature membrane rupture

Question 11

How do we spot if someone’s in pre-term labour?

Answer 11

Just like normal labour:

1) Are they contracting?
2) Is there cervical change on VE?

Important to then consider why, look for signs of infection, hypertension or enlarged uterine volume

Question 12

How do we go about managing a pre-term labour?

Answer 12

Firstly involve the family and neonatologist in decisions as there’s a high risk of failure and disability

• Tocolysis- prevents uterine contractions
• Steroids
• NICU
• Vaginal Delivery

Question 13

What is Tocolysis and when do we use it?

Answer 13

Tocolysis encompasses labour suppressant meds.

You can use it for up to 24hrs in order to transfer the patient to a facility with a NICU & to give steroids

Question 14

Why give steroids in pre-term labour?

Answer 14

Speeds up surfactant development allowing the baby to survive outside the womb (i.e. to fuckin breathe)

Question 15

What are the common complications of prematurity?

Answer 15

• Resp Distress Syndrome
• Intraventricular HAemorrhage
• Cerebral Palsy
• Jaundice
• Infections
• Visual or hearing impairment
• Hypothermia
• Hypoglycaemia