CaseFiles_3 Flashcards
(41 cards)
What are risk factors for placental abruption? (x9) What are the three main risk factors?
1) HYPERTENSION
2) COCAINE USE
3) TRAUMA
4) short umbilical cord
5) uteroplacental insufficiency
6) submucosal leiomyomata
7) sudden uterine decompression (hydramnios)
8) cigarette smoking
9) preterm premature rupture of membranes
Bleeding into the myometrium of the uterus giving a discolored appearance to the uterine surface is known as
Couvelaire uterus.
Associated with abrupt placentae
What is a “concealed abruption”?
When the bleeding of placental abruption occurs behind the placenta with no external bleeding noted
When placental abruption causes fetal death, it causes the complication of _________, which is secondary to hypofibrinogenemia, in 1/3 of the cases. The fibrinogen level would be below _____ mg/dL
coagulopathy
fibrinogen 100-150 mg/dL (normal 200-400)
The Kleihauer-Betke test is used to test which phenomenon common with placental abruption?
fetal to maternal hemorrhage
Many women who deliver due to placental abruption will manifest what after volume replacement (keeping Hct 25-30% and urine output 30 mL/hr at least)?
hypertension or preeclampsia, necessitating mag sulfate for eclampsia prophylaxis
T/F: Ultrasound is sensitive in diagnosing placental abruption.
FALSE! The clot in the placenta is the same sonographic texture as the placenta itself.
T/F: A prior cesarean delivery can predispose a patient to placenta pre via with an associated accrete in future pregnancies.
True
What is the most significant fetal risk associated with breech presentation?
Cord prolapse, which can lead to significant oxygen deprivation to the fetus
Placenta accreta is abnormal adherence of the placenta to the uterine wall due to an abnormality of which layer of the uterus?
decidua basalis (of the endometrium)
WHat is the difference between placenta accrete, increta, and percreta?
penetration into the uterus!
accreta: into uterine wall
increta: into myometrium
percreta: into myometrium to the serosa (bladder involvement with “blue tissue” is not uncommon!)
What are risk factors for placental adherence? (x5)
1) low-lying or anterior placentation or placenta previa
2) prior C section or uterine curettage
3) prior myomectomy (but not if only on the serial surface!)
4) fetal down syndrome
5) age >35y
IF a patient refuses hysterectomy, then what is the best management for placenta accreta? What are 2 major complications?
Ligation of the umbilical cord as high as possible and IV MTX therapy. Hemorrhage and infection (necrotic placenta can be a nidus for infection) are two major complications.
Where is the pain associated with appendicitis in pregnant women and why is it different than in the general population?
Not in the RLQ, but superior and lateral to the McBurney point. This is due to enlarged uterus pushing on the appendix to move it upward and outward toward the flank, at times mimicking pyelonephritis.
What is the most frequent and serious complication of a benign ovarian cyst?
ovarian torsion
Patients with known or newly diagnosed large ovarian masses are at risk for
ovarian torsion
What is the leading cause of maternal mortality in the first and second trimesters?
ectopic pregnancy
Corpus luteum cyst rupture (associated with unilateral cramping and lower abdominal pain fora few weeks before sudden onset of pain) usually occurs between days ___ and ___ of the menstrual cycle.
days 20 and 26
What is the timeline with regards to the main source of progesterone in pregnancy? WHat does this mean if the corpus luteum is removed prior to 10-12 weeks of gestation?
first 7 weeks: corpus luteum (hCG maintains the luteal function)
weeks 7-10: corpus luteum and placenta
10 weeks on: placenta
If the corpus luteum is removed before 10-12 weeks of gestation, exogenous progesterone is needed to sustain the pregnancy. IF it is removed afterwards, no supplemental progesterone is required.
Right abdominal pain that radiates to the right shoulder with nausea and vomiting is classic for what in pregnancy?
cholelithiasis
Pain associated with ovarian torsion is associated with pain that is (constant/colicky).
Colicky
What is a degenerating leiomyoma and what does it present with?
A degenerating leiomyoma is due to a fibroid outgrowing its blood supply (due to rapid growth via the estrogen levels in pregnancy). It presents with localized tenderness over the fibroid.
What is the earliest indicator of hypovolemia?
Decreased urine output
What is Pruritic Urticarial Papules and Plaques of Pregnancy?
unique to pregnancy (and rare! <1% of pregnancies) characterized by intense prutitus and erythematous papules on the abdomen and extremities; spreads from abdomen to buttocks. negative for IgG and complement levels.
Usually occurs in first pregnancy around 35-36 weeks, but does NOT recur!
