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Additional Flashcards

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1
Q

Most common sx in eclampsia (antecedent)

A 
HIV + proteinuria
HA
Visual changes
RUQ/Epigastric pain
Ankle clonus
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2
Q

When does eclampsia occur?

A 
#1 Antepartum
#2 Intrapartum
#3 ≤ 48hrs post-partum
#4 > 48hrs post-partum
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3
Q

Finding on neuroimaging in eclampsia

A

Reversible posterior leukoencephalopathy syndrome

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4
Q

What is seen in Reversible posterior leukoencephalopathy syndrome?

A

Patchy T2/FLAIR hyperintensity in subcortical white and gray matter of parietal + occipital cortex

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5
Q

MCC death s/p eclampsia

A

Cerebral hemorrhage

 - Petechial
 - Occipital
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6
Q

Eclampsia DDx

A 
Tumor
Ruptured aneurysm
TTP/HUS
Cerebral vein thrombosis
Metabolic, toxic, ID, trauma
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7
Q

Why give anti-HTNs in eclampsia?

A

Prevent stroke

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8
Q

Anticonvulsive DOC in eclampsia

A

Mg sulfate

Prevents recurrent seizures

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9
Q

Complications in subsequent pregnancies for eclampsia pts

A

Abruptio placenta
Preterm delivery
IUGR
Perinatal mortality

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10
Q

Indications for diagnostic D&C

A

Biopsy showing high risk for endometrial CA
Endometrial hyperplasia where CA must be excluded
Not enough tissue in office bx
Cervical stenosis prevents office bx
Hysteroscopy/Laparoscopy is also needed

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11
Q

Therapeutic indications for D&C

A

Incomplete/inevitable/missed/septic/induced abortions
Molar pregnancies
Prolongued/excessive vaginal bleeding (failed hormonal therapy)
Suction curettage for potpartum hemorrhage due to retained products

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12
Q

Features of pre-eclampsia

A

New onset HTN
Proteinuria/End organ dysfunction
Last 1/2 of pregnancy (>20wks)

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13
Q

HELLP

A 
Hemolysis
Elevated
Liver enzymes
Low
Platelets
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14
Q

Features of pre-eclampsia on pre-existing HTN

A

New onset proteinuria/end organ dysfunction
> 20 weeks
Already have HTN

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15
Q

Gestational HTN

A

HTN w/o proteinuria or pre-eclampsia sx @ >20wks

Resolve by 12 wks post-partum

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16
Q

Suspected gestational HTN resolves postpartum

A

Transient HTN of pregnancy

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17
Q

Suspected gestational HTN continues >12wks post-partum

A

Chronic/Pre-existing HTN

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18
Q

Pre-eclampsia RFs

A 
Primagravida
Hx pre-eclampsia
FHx pre-eclampsia
DM
HTN (≥100, ≥110) <20wks
Anti-phospholipid Abs
BMI ≥26.1
CKD
Twins
Old mom
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19
Q

Sign and Sx in pre-eclampsia

A 
Severe HTN
Persistent/Severe HA
Vision abnormalities
Abd pain (upper/epigastric)
N/V
Dyspnea
Retrosternal CP
Change in MS
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20
Q

Lab changes in Pre-eclampsia

A

MHA
Thrombocytopenia
↑ Cr
↑ LFTs 2x ULN

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21
Q

Pre-eclampsia < 20wks indicates:

A

Complete/Partial Molar Pregnancy

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22
Q

15% of pts with HELLP present with what

A

HTN or proteinuria

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23
Q

What is delayed/post-partum pre-eclampsia

A

Signs/Sx leading to readmission >2 days, <6wks after delivering

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24
Q

Edema clues in pre-eclampsia

Study These Flashcards
A

Facial edema

Sudden, rapid weight gain (>5lb/wk)

25
What always results in complete resolution of signs/sx or pre-eclampsia?
Delivery of placenta
26
What constitutes severe pre-eclampsia?
SBP ≥ 160/DBP ≥110 x2 ≥4hrs apart
27
Diagnosis of proteinuria in pre-eclampsia
``` ≥0.3g in 24hr sample OR 1+ on dipstick (persistent) OR Random protein:Cr ≥0.3 ```
28
Severe renal disease in pre-eclampsia
Cr > 1.1 or Doubling of Cr
29
Most common coagulation abnormality in pre-eclampsia
Thrombocytopenia
30
What is seen in significant liver disease in pre-eclampsia
PT/PTT changes
31
Clues for microangiopathic hemolysis in pre-eclampsia
``` Schistocytes Helmet cells ↑ Helmet cells ↑WBC ↓ Hct ```
32
Clues for pre-eclampsia HA
Persistence w/ OTC analgesics
33
What percentage of pregnancy associated strokes are caused by pre-eclampsia?
36%
34
New onset HTN in pregnancy?
Assume pre-eclampsia until proven otherwise
35
Pre-eclampsia Dx criteria
``` SBP ≥ 140 or DBP ≥ 90 AND Proteinuria > 0.3 or Protein:Cr ≥ 0.3 in 24hrs OR End organ dysfunction - Platelets 1.1 or doubled - ↑ AST/ALT 2x ULN ```
36
Pre-eclampsia DDx
Underlying Renal Disease Acute fatty liver disease of pregnancy TTP/HUS Lupus exacerbation
37
Category I tracings definition
``` Baseline rate 110-160 Moderate FHR variability (6-25) No late/variable deceleration ± Early decels ± Accels ```
38
Category III tracings definition
``` Absent baseline FHR variability AND any of: Recurrent late decels Recurrent variable decels Bradycardia OR A sinusoidal pattern ```
39
In utero resuscitation methods to improve uteroplacental perfusion and materal/fetal oxygenation
``` Reposition pt on L or R side Administer O2 Administer IV bolus (NS or LR) Discontinue uterotonic drugs Administer tocolytic drug Give alpha-agonist to reduce SNS blocade ```
40
What does repositioning pt on L or R side do?
Decreases cord compression
41
Can O2 alone correct fetal acidemia
NO
42
Category II tracings definition
Anything that's not category I or III
43
What is the purpose of scalp stimulation
Provokes FHR acceleration | Probability or fetal acidosis = <10%
44
ST ↑/↓ on fetal EKG is suggestive of what?
Fetal hypoxemia
45
Is there any reason to get O2 sat of the fetus?
NO
46
When do you see fetal hypoxia leading to late decels?
``` Uterine tachysystole Maternal hypotension Maternal hypoxia Maternal vasculopathy Placental disorders associated with placental insufficiency ```
47
What is moderate variability strongly associated with?
Umbilical pH >7.15
48
What are spontaneous/elicited accels strongly associated with?
Umbilical pH >7.10
49
Major causes of fetal tachycardia
``` Maternal-fetal infection Meds Maternal hyperthyroidism Placental abruption Fetal hypoxia Elevated maternal catecholamines ```
50
When is fetal tachy associated with acidemia?
``` When accompanied by: Recurrent decels OR Absent accels OR Minimal/absent variability ```
51
When do variable decels occur?
Cord compression
52
2nd line for cord compression
Amnioinfusion
53
Most common meds decreasing FHR variability
Mg sulfate | Maternal Opioids
54
Causes of prolongued decel or fetal brady
``` Rapid fetal descent Cord prolapse Placental abruption Maternal hypotension Uterine rupture Tachystole ```
55
When do you start PAP smear screening?
Age 21
56
When do we start treating cervical dysplasia?
CIN II and higher
57
How often should PAPs be done?
Every 3 years until 30, then every 5
58
What is labor?
CTX with cervical changes

OB/GYN (3 decks)

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