UQ tutorial - 3/19 Obstetric Complications

Pre-conception and Antenatal Care

  • Address modifiable risk factors such as smoking, alcohol consumption, weight, diet, and exercise.
  • Optimize management of medical co-morbidities.
  • Offer serial cervical length monitoring from 12 to 28 weeks gestation for high-risk pregnancies.

Screening in Pregnancy

  • Universal screening tests:
    • Blood tests at booking: FBC, Hep B/C serology, Syphilis, Rubella, blood group and antibodies.
    • Genetic carrier screening (Cystic Fibrosis, Fragile X, SMA).
    • Screening for chromosomal abnormalities (CFTS at 11+0 - 13+6 weeks; NIPT from 10 weeks).
    • Morphology scan at 18-22 weeks to check for fetal anomalies.
    • Gestational diabetes screening at 24-28 weeks.

Complications in Pregnancy

  • Obstetric emergencies:
    • Postpartum hemorrhage, cord prolapse, uterine rupture, severe perineal injury.
    • Significant maternal health complications including mental health issues related to perinatal care.
  • Fetal conditions:
    • Fetal Growth Restriction (FGR), Small for Gestational Age (SGA), Large for Gestational Age (LGA).
    • Neural tube defects, and congenital or chromosomal disorders.

Risk Factors

  • Current pregnancy:
    • Multiple pregnancy, anemia, antepartum hemorrhage, pre-eclampsia, gestational diabetes, obstetric cholestasis.
  • Previous pregnancy:
    • History of SGA, macrosomia, preterm birth, stillbirth, pre-eclampsia, or gestational diabetes.

Screening for Chromosomal/Genetic Abnormalities

  • CFTS:
    • Maternal blood tests for PAPP-A and free beta-hCG, followed by nuchal translucency ultrasound.
  • NIPT: Non-invasive prenatal testing to evaluate the risk of chromosome abnormalities.
    • Diagnostic tests (CVS and amniocentesis) are offered following high-risk screening results.

Pre-eclampsia

  • Definition: New onset of hypertension (140/90) and proteinuria or other end-organ damage after 20 weeks.
  • Pathogenesis: Involves defective placentation, oxidative stress, and angiogenic imbalance leading to endothelial damage.
  • Treatment: Delivery is the definitive treatment; aspirin is recommended for high-risk women to prevent pre-eclampsia.
  • Long-term risks: Increases chances of cardiovascular and renal disease later in life.

Preterm Birth (PTB)

  • Defined as birth occurring at <37 weeks of gestation.
  • Complications of PTB:
    • Neonatal mortality, sepsis, chronic lung disease, cerebral palsy, and developmental delays.
  • Risk Factors: Young/old maternal age, smoking, obesity, rural residence, prior preterm birth, and lack of antenatal care.

Gestational Diabetes Mellitus (GDM)

  • Characterized by new onset of diabetes during pregnancy, typically diagnosed via oral glucose tolerance test (OGTT) at 24-28 weeks.
  • Risk Factors: Previous GDM, high BMI, age >40, family history, and certain ethnic backgrounds.
  • Management: Key is glycemic control; diet, exercise, and possibly medication needed for control.

Small for Gestational Age (SGA) & Fetal Growth Restriction (FGR)

  • SGA: Defined as weight <10th percentile for gestational age.
  • FGR: A pathological condition where the fetus does not achieve its potential growth, often leading to serious complications.
  • Consequences: Increased risk of neonatal morbidity/mortality and long-term growth and developmental issues.

Larger for Gestational Age (LGA)

  • Defined as weight >90th percentile, often associated with risks such as shoulder dystocia, delivery complications, and long-term health problems like obesity and metabolic syndrome.

Perinatal Mental Health

  • Includes depression, anxiety, and pregnancy-related conditions; screening via tools like the EPDS.
  • Protective factors include a supportive environment and planned pregnancy. Risk factors involve history of mental illness and stress during pregnancy.

Anticipating Complications in Pregnancy

  • Regular monitoring of risk factors and symptoms (e.g., decreased fetal movements) is crucial.
  • Prophylactic measures such as low-dose aspirin for pre-eclampsia risk.
  • Interdisciplinary referrals to specialists when needed (e.g., obstetricians, neonatologists, etc.).

Conclusion

  • Ongoing assessments and tailored management strategies are crucial to ensure the best outcomes for both mothers and infants, identifying and managing potential complications early in the pregnancy journey.