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Abnormal pregnancy Flashcards

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1
Q

Implantation to site other than endometrial cavity

A

Ectopic pregnancy

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2
Q

Implantation to site other than endometrial cavity

A

Ectopic pregnancy

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3
Q

Most common site of ectopic pregnancy

A

Ampulla of fallopian tube

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4
Q

When ampullary pregnancy raptures

A

8-12wks

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5
Q

When isthmic pregnancy raptures

A

6-8wks

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6
Q

Why is the incidence of ectopic pregnancy decreasing

A

Early detection and tx

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7
Q

Pathophys of ectopic pregnancy

A

Impaired ability of tube to transport gametes/embryo

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8
Q

pt presentation of ectopic pregnancy

A

Pelvic/abd pain
Bleeding
Unitlat. adnexal pain w/ spotting or amenorrhea

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9
Q

Diagnostic test of choice for ectopic pregnancy

A

Trans vaginal U/S

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10
Q

QhCG pattern in normal pregnancy

A

rise min of 58% over 48hrs

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11
Q

Serum progesterone that signifies abn pregnancy

A
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12
Q

Unequivocal progesterone range (non conclusive)

A

5-20

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13
Q

Unequivocal progesterone range (non conclusive)

A

5-20

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14
Q

Most common site of ectopic pregnancy

A

Ampulla of fallopian tube

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15
Q

When ampullary pregnancy raptures

A

8-12wks

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16
Q

When isthmic pregnancy raptures

A

6-8wks

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17
Q

Why is the incidence of ectopic pregnancy decreasing

A

Early detection and tx

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18
Q

Pathophys of ectopic pregnancy

A

Impaired ability of tube to transport gametes/embryo

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19
Q

pt presentation of ectopic pregnancy

A

Pelvic/abd pain
Bleeding
Unitlat. adnexal pain w/ spotting or amenorrhea

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20
Q

Diagnostic test of choice for ectopic pregnancy

A

Trans vaginal U/S

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21
Q

Tumor development from aberrant fertilization event derived from abnormal placental proliferation

A

Gestational trophoblastic disease

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22
Q

Serum progesterone that signifies abn pregnancy

A
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23
Q

Is an abn serum progesterone indicative of location

A

No

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24
Q

Unequivocal progesterone range (non conclusive)

A

5-20

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25
What does pregnancy of unknown location signify
Ectopic pregnancy. find it
26
QhCG for normal intrauterine pregnancy (IUP)
1500-2000
27
Complete mole
Grape like vessicles/snow storm appearance higher QhCG levels Larger uterus than expected 45XX (46XX) or 46XY
28
How do you follow a pregnancy of unknown location
TV U/S Serial QhCG levels q 48h +/- laparoscopy/MRI
29
Partial mole
Less advanced milder focal changes and complications but fetal /embryonic structures present 69XXX or 69XXY
30
Surgical tx for ectopic pregnancy
Laparotomy vs laparoscopy | Salpingectomy vs salpingostomy (incr chance of ectopic pregnancy)
31
What do maternal genes influence
fetal growth
32
What is the biggest consideration in the decision for medical vs surgical mgt for ectopic pregnancy
Reliable follow up (if unreliable = surgical)
33
Tumor development from aberrant fertilization event derived from abnormal placental proliferation
Gestational trophoblastic disease
34
Tumor marker for GTD
hCG
35
Classifications of GTD
Hydatidiform mole (benign) Choriocarcinoma Gestational trophoblastic neoplasia Placental site trophoblastic tumor
36
Most common form of GTD
Hydatidiform mole
37
Risk factors for hydatidiform mole
age 35 | Prev GTD
38
xtics of hydatidiform mole
abnormalities of chorionic villi and prolif and edema of villous stroma
39
Complete mole
Grape like vessicles/snow storm appearance higher QhCG levels Larger uterus than expected
40
Complications of complete mole
Gestational HTN (
41
Partial mole
Less advanced milder focal changes and complications but fetal /embryonic structures present
42
What do paternal genes influence
Placental growth
43
What do maternal genes influence
fetal growth
44
Definitive tx for hydatidiform mole
Evacuation of uterine contents/hysterectomy
45
for how long QhCG be monitored
6-12mos; if persistent, treat for choriocarcinoma
46
Chronic HTN in pregnancy
HTN present before pregnancy or before 20 wks
47
Gestational HTN
HTN after 20 wks w/out proteinuria
48
Pre-eclampsia
HTN after 20wks w/out prev hx of HTN + Proteinuria
49
Eclampsia
Pre-eclampsia w/ new onset of convulsions
50
Superimposed pre-eclamsia/eclampsia
Pre-eclampsia/eclampsia in woman w/ pre-existing chronic HTN
51
HELLP syndrome
Hemolysis Elevated Liver enzymes Low plateletes
52
How do you follow HELLP syndrome
CBC/CMP
53
Signs and sys of Pre-eclampsia
``` HTN Proteinuria Edema H/A N/V, hyper-reflexia, Oliguria, Blurred vision, scotoma, epigastric pain ```
54
Mild pre-eclampsia
BP >140/90 on 2 occasions at least 6hrs apart | 300mg proteinuria on 24hr urine (2+ on dipstick)
55
Severe pre-eclampsia
BP > 160/110 on 2 occasions at least 6hrs apart 5g proteinuria on 24hr urine Signs/sxs of end organ damage Fetal growth restriction
56
Definitive tx for pre-eclampsia
Delivery
57
Pre-eclampsia mgt
Reduced activity Labs (CBC/CMP/Uric acid) Glucocorticoids if
58
Intrauterine growth restriction (Fetal growth restriction)
Birth weight or estimated fetal weight
59
At what percentile is neonatal death significantly decreased
≤3rd percentile
60
Maternal etiology for IUGR
Extremes of age (35) smoking, substance abuse, HTN , anemia, DM, SLE, malnutrition, renal dz
61
Placental etiology for IUGR
1˚ placental disease, uterine abnormalities
62
Fetal etiology for IUGR
Multiple gestation, genetic disorders, teratogens, infection: TORCH (toxoplasmosis, Other-Varicella, Syphillis,Rubella, CMV, HSV
63
Diagnostics for IUGR
Fundal height measurements U/S (confirmatory) *doppler velocimetry of umbilical artery: helpful after *mean cerebellar artery doppler: most diagnostic
64
IUGR mgt
Fetal surveillance *NST: -ve predictive value for acidosis *Biophysical profile w/ UA doppler: fetal tone, movt, breathing, NST, amniotic fluid vol (2 pts. each) 1-2x/wk Glucocorticoids if
65
Normal BPP values
≥8
66
how do you decide when to deliver in the mgt of IUGR
Risk of fetal death > risk of neonatal death
67
Hallmark of GDM
Insulin resistance
68
Risk factors for GDM
FH of DM, BMI>30 ,age >25, Hx of macrosomia, PCOS, Hx of unexplained still birth, Prior hx of GDM, HTN
69
Maternal and fetal complications of GDM
Pre-eclampsia, still birth, macrosomia, shoulder dystocia, C-section
70
Infant complications of GDM
Hypoglycemia, Hyperbilirubinemia, Hypocalcemia, RDS, obesity, glucose intolerance
71
When do you do the GDM screen
24-28 wks; screen earlier of +ve risk factors
72
GDM screen
50g 1hr OGTT (+ve if >130-140)
73
GDM Dx
100g 3hr OGTT (+ve if >130-140): 2 or more elevated values
74
When do you not need to do a 3hr OGTT to dx GDM
if 1hr OGTT is >200
75
GDM glucose goal
70-95 fasting glucose
76
GDM nutrition goal
1800-2400 calorie diet
77
Initial mgt of GDM
Tight glycemic control Nutrition control Exercise
78
Pharmacologic mgt of GDM
Insulin +/- Glyburide
79
When should pts. w/ GDM hv a 2hr 75g OGTT
6wks post partam
80
What considerations need to be made for Class A2 GDM or higher
if est. weight >4500g consider C/S to avoid shoulder dystocia
81
Preterm labor
Regular contractions after 20wks but before 37 wks resulting in cervical changes
82
etiology for preterm labor
- Following PPROM | - Deliberate intervention (eclampsia)
83
Diagnostics for pre-term labor
R/O ROM Digital cervical exam U/S for cervical length UA w/ C&S GBS culture +/- vaginal culture for CT, GC, BV +/- NST Fetal fibronectin (High glycoprotein levels in maternal blood and amniotic fluid before term - measured at 24 wks
84
Absent fibronectin at 24 wks
no pre-term labor for 2wks (-ve predictive value)
85
Positive fibronectin at 24 wks
Risk for pre-term labor, give Betamethasone (corticosteroids)
86
Mgt pre-term labor
Hospitalization Corticosteroids (24-34wks) Tocolytics (Beta-mimetic: terbutaline, CCB, Indomethacin, Mag sulfate: neuroprotective against cerebral palsy)
87
How to prevent pre-term labor
Smoking cessation | Progesterone supplementation in pts. w/ prev preterm birth starting at 16-20 wks to 36wks

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