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Clin Med3: Womens Health > complications of pregnancy > Flashcards

complications of pregnancy Flashcards

(102 cards)

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1
Q

what is pregnancy implantation that occurs at a site other than the endometrium

A

ectopic pregnancy

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2
Q

what population is more likely to die from ectopic pregnancy

A

black non-hispanic 6.8x more likely than white non-hispanic people

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3
Q

what are risk factors for ectopic pregnancies

A

prior ectopic pregnancy
assisted reproduction
damage to fallopian tube
birthing person aged 35-44y
smoking
congenital tube defect
IUD in place lowers the risk, BUT incidence of ectopic pregnancy is higher

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4
Q

what is the typical presentation of ectopic pregnancy

A

abdominal pain and vaginal bleeding -> 7 weeks after LMP

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5
Q

how is ectopic pregnancy diagnosed

A

TVUS and positive serum beta HCG test
sometimes serial US and/or serum beta HCG levels are required to confirm diagnosis

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6
Q

if a gestational sac is not visualized in uterus, what needs to be investigated

A

ectopic location for pregnancy

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7
Q

what is the treatment for ectopic pregnancy

A

medical management: (early diagnosis and stable patient)
-methotrexate (MTX) outcomes comparable to surgery
surgical: laparoscopy salpingostomy - tube saving procedure or Laparotomy - unstable patients

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8
Q

what is the goal of treatment with ectopic pregnancies

A

prevent death, facilitate rapid recovery and help preserve future fertility, while keeping costs low

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9
Q

how many pregnancies end in miscarriage

A

1 in 4

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10
Q

what is a non-viable intrauterine pregnancy with either an empty gestational sac or a gestational sac with an embryo without evidence of cardiac activity within the first 12 6/7 weeks gestation

A

spontaneous pregnancy loss

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11
Q

what are signs and symptoms of spontaneous pregnancy loss

A

vaginal bleeding and uterine cramping
- same symptoms can occur in normal, ectopic and molar pregnancies

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12
Q

when is the most common time during the pregnancy to have a spontaneous pregnancy loss

A

first trimester 80%

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13
Q

what are risk factors for spontaneous pregnancy loss

A

advanced birthing person age
thyroid abnormalities
diabetes
obesity
anatomical abnormalities
trauma
autoimmune disease/antibodies to fetus
drugs/chemical/noxious agents
severe birthing person illness
infections
prior spontaneous pregnancy loss

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14
Q

what is the management options for spontaneous pregnancy loss

A

expectant
medical
surgical

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15
Q

what should be given in birthing person is RH NEG

A

Rhogam

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16
Q

what is the medical management of pregnancy loss

A

intravaginal misoprostol

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17
Q

what patients are not eligible for medical management of pregnancy loss

A

pts who prefer expectant or surgical management
embryonic age >10weeks
hemodynamically unstable
allergies to prostaglandins or NSAIDs
pts who are anticoagulated
signs of infection

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18
Q

what are the surgical management of pregnancy loss

A

surgical evacuation performed in the office - rarely need an OR - unless patient requests sedation/anesthesia

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19
Q

what is gestational trophoblastic disease

A

appears as a “cluster of grapes” on US, usually without evidence of embryo

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20
Q

what is the presentation of gestational trophoblastic disease

A

vaginal bleeding and enlarged uterus
abnormally high HcG levels and no evidence of HR
“cluster of grapes” on US

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21
Q

what are the risk factors for gestational trophoblastic disease

A

extremes of reproductive age, history of prior molar pregnancy, history of spontaneous pregnancy loss

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22
Q

what are the types of gestational trophoblastic disease

A

hydatidiform Mole (molar pregnancy)
gestational trophoblastic neoplasia

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23
Q

what is hydatidiform mole

A

tumor that develops in the uterus as a result of non-viable pregnancy
normally non-cancerous, but can become malignant

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24
Q

what are the types of hydatidiform mole pregnancy

A

complete molar pregnancy or partial molar pregnancy

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25
what is gestational trophoblastic neoplasia
rare forms of cancer -choriocarcinoma aka invasive mole
26
what is the treatment for molar pregnancy
surgical evacuation with D&C (even if fetus present with partial) chemo/radiation therapy older pts may undergo hysterectomy
27
what are hypertensive disorders of pregnancy
gestational hypertension preeclampsia eclampsia Hemolysis, Elevated Liver enzymes, and Low Platelet count syndrome (HELLP) chronic HTN chronic HTN with superimposed preeclampsia
28
after molar pregnancy, how long do patients have to wait to get pregnant after treatment
at least 1 year
29
what are antihypertensive management options during pregnancy
for BP persistently above 160/110 : methylopa, labetalol, hydralazine or nifedipine
30
what medications for HTN are contraindicated during pregnancy
ACE inhibitors - cause renal injury to developing fetus in 2nd and 3rd trimester
31
what are antenatal fetal surveillance
non-stress test US screening for fetal growth restriction biophysical profile if: required antiHTN therapy, superimposed pre-eclampsia, fetal growth restriction
32
what is the most common cause of intrauterine growth restrictions (IUGR)
chronic HTN
33
what is chronic HTN during pregnancy
gestational BP elevation before the 20th of gestation HTN diagnosed for the first-time during pregnancy and does not resolve postpartum
34
what is gestational HTN
transient HTN - returns to normal by 12 weeks into post partum period defined as HTN without proteinuria or severe features that develops after 20 weeks of gestation
35
what does gestational HTN increase your risk for
preeclampsia especially if HTN diagnosed before 35 weeks
36
what is preeclampsia
new onset HTN with proteinuria diagnosed after 20 weeks of pregnancy OR in absence of proteinuria, new-onset HTN diagnosed after 20 weeks with 1 or more severe features
37
what are the signs and symptoms of preeclampsia
Severe HA, swollen face, visual disturbances, high BP, swollen hands and fingers, epigastric (chest) pain, proteinuria/oliguria, swollen feet and legs
38
how can at risk patients at risk of preeclampsia treat preventatively
low dose ASA after 12 weeks gestation
39
what are high risk factors for preeclampsia
preeclampsia in prior pregnancy multiple gestation chronic HTN type 1 or 2 diabetes renal disease autoimmune disease
40
what are other risk factors for preeclampsia
birthing person > 35yo nulliparity family hx obesity poor outcome in prior pregnancy assisted reproductive technology
41
what is the management of preeclampsia
deliver is the only cure (get placenta out)
42
what is HELLP syndrome
Hemolysis elevated liver enzymes low platelets - variant of preeclampsia: antepartum or postpartum associated with poor birthing person outcomes; increased risk for pulmonary edea and acute renal failure
43
what is the treatment of preeclampsia with severe features or HELLP
magnesium therapy
44
what is eclampsia
new onset of grand mal seizures in a patient with preeclampsia
45
what needs to be ruled out with eclampsia
hx of seizure disorder head trauma ruptured aneurysm arteriovenous (AV) malformation
46
what is the management of eclampsia
stablilize, safety measures typically see fetal bradycardia during seizures control convulsions/keep airway open- magnesium sulfate: 4-6mg loading dose delivery when patient is stable antiHTN meds if persistent pressures >160/110
47
what are indications for delivery
indicated for unstable birthing person or fetal condition mode determined by fetal gestational age, presentation, cervical status, and birthing person/fetal condition
48
what is the post partum management of HTN
monitor BP at least 72 hours postpartum re-evaluate BP 7-10 days after deliver postpartum HTN most likely to persist if higher urinary protein, serum uric acid, and BUN
49
what are some causes of vaginal bleeding in late pregnancy
placenta abruption placenta previa cervical trauma vaginal infection "bloody show"
50
what is placental abruption
premature seperation of normally implanted placenta from uterus
51
what are the US findings with placental abruption
adherent retro-placental blot with depression or disruption in underlying tissue
52
what are the triad of clinical findings with placental abruption
external or occult bleeding (dark blood) uterine hyper-tonus/hyperactivity/uterine pain fetal distress/death
53
what are increased risk factors for placental abruption
advanced birthing are or parity, smoking, poor nuturtion, use of cocaine, chorioamnionitis birthing person HTN blunt external abd trauma (MVA/DV) abruption in prior pregnancies
54
what is the hallmark presentation time of placental abruption
3rd trimerster
55
what is the management of placental abruption
rule out placenta previa (r/o other causes first) precautions: 2 large bore IV, 4 unites PRBCs available, coagulation studies/lab draw, continuous fetal monitoring
56
what are the abruption deliveries
if birthing person and fetal are stable - initiation of labor (IOL) if unstable/deteriorating, expedited delivery via cesarean
57
what is placenta previa
impantation of placenta over cervical os -total, partial, marginal
58
what is the leading cause of 3rd trimester painless, bright red bleeding
placenta previa
59
what are risk factors for placenta previa
previa in prior pregnancy birthing person > 35 yo minority race prior cesarean cocaine and tobacco
60
when is the diagnosis of placenta previa typically made
during the 2nd trimester with the anatomy scan
61
what is the management of placenta previa
depend on gestational age; amount of bleeding; fetal condition and presentation previa often causes malpresentation if preterm and stable: expectant management if>37 weeks: c-section
62
what is the birthing person at a greater risk for with placenta previa
hemorrhage - blood should always be available
63
what is monozygotic
single fertilized ovum splits - same sex, genetically identical
64
what is dizygotic
two separate ova are fertilized, same or opposite sex, genetically distinct children
65
what are the twin types
monochorionic-monoaminionic monochorionic-diamnionic dichorionic-diamnionic
66
what is monochorionic-monoamnionic twins
one placenta, one sac, always monozygotic - increased risk for twin to twin transfusion syndrome (TTS)
67
what is monochorionic-diamnionic
one placenta, two sacs; blood vessel communication between fetal circulation, increased risk for TTS, usu. monozygotic
68
what is dichorionic-diamnionic
two sacs, two placentas (sometimes 2 separate placentas intertwine); occurs in almost all dizygotic twins, lowest mortality rate
69
what is carbohydrate intolerance that starts during pregnancy
gestational diabetets
70
how often should glucose be checked per day with gestational diabetes
4x/day
71
when is insulin started with gestational diabetes
>4 abnormal values/day, or noticing trends
72
what are the complication risks associated with GDM
gestational HTN preeclampsia premature delivery large for gestational age/shoulder dystocia/cesarean delivery stillbirth 7x increase for developing diabetes later in life
73
what is postpartum care for GDM
6-12 week postpartum: 75mg load, 2 h postprandial lab draw encourage weight loss to normal BMI range breast feeding increased risk of T2DM
74
what is an incompetent cervix
inability of the uterine cervix to retain a pregnancy in the second trimester, in the absence of uterine contractions
75
what are risk factors for incompetent cervix
prior second trimester pregnancy loss short cervix identified on TVUS associated with prior second trimester pregnancy loss fetal fibronectin testing + short cervical length helps to predict preterm delivery
76
what is the presentation of incompetent cervix in a pt who has had a previous second trimester pregnancy loss with the following:
-painless cervical dilation and bulging fetal membranes in second trimester -preterm premature rupture of membranes -rapid delivery of a pre-viable infant -rare or absent contraction
77
what is the presentation of incompetent cervix of a patient who has NOT had a previous second trimester pregnancy loss
painless cervical dilation on PE in second trimester
78
what is the management of cervical insufficiency
cervical cerclage
79
what are contraindications of cerclage
lethal fetal anomaly intrauterine infection active bleeding preterm labor ruptured membranes retal demise
80
what is a spontaneous rupture of fetal membranes before onset of labor
premature rupture of membranes
81
what is the most common presentation of premature rupture of membranes
gush of fluid from vagina followed by persistent, uncontrolled leakage
82
what is premature preterm rupture of membranes (PPRoM)
spontaneous rupture of membranes prior to onset of labor and prior to 37 weeks gestation -evidence of associated infection
83
what is the presentation of P-PRoM
gush of fluid followed by uncontrollable leaking or slow steady trickle
84
how do you diagnose P-PRoM
sterile speculum exam digital exam should be avoided
85
what is ferning
when allowed to dry on clean slide, amniotic fluid produces microscopic cystralization in a 'fern pattern"
86
what is the management of P-PRoM
US for amniotic fluid volume indications for immediate delivery should be ruled out first principle indication for delivery is chorioamnionitis
87
what is the most dangerous risk of P-PRoM
umbilical cord prolapse
88
what is shoulder dystocia
obstetrical emergency anterior shoulder stuck or needs significant manipulation to pass below pubic symphysis
89
when is shoulder dystocia diagnosed
when shoulders do not deliver shortly after the fetal head
90
what are risk factors of shoulder dystocia
shoulder dystocia in pervious pregnancy GDM obesity induction of labor long labor forceps or vacuum assisted delivery fetal weight; but most cases occur in babies under 9lbs
91
what is the management of shoulder dystocia
prompt reduction of shoulder and delivery helps reduce adverse outcomes - call for HELP -suprapubic pressure -obstetrics maneuvers for reducing shoulder -manual delivery of posterior arm -episotomy -last resort - intentionally fracture fetal clavicle
92
what are the maneuvers for reducing shoulder dystocia
McRoberts Maneuver (hip hyperflexion) and suprapubic pressure Wood's corkscrew:180 degree rotation of poterior shoulder
93
what do more maneuvers for shoulder dystocia increase
chance of success and increased risk for fetal injury
94
what are fetal complications of shoulder dystocia
brachial plexus injury diaphragmatic paralysis facial nerve injury horners syndrome clavicle fracture hypoxic ischemic encephalopathy (HIE) death
95
what are birthing person complications of shoulder dystocia
lacerations: bladder, urethra, vagina, anal sphincter, rectum lateral femoral cutaneous neuropathy postpartum hemorrhage separation of the pubic symphysis uterine rupture
96
how quickly does the body need to be delivered with shoulder dysocia
<5min or risk of Hypoxic ischemic encephalopathy (HIE)
97
what is postpartum hemorrhage
>1000mL blood loss OR blood loss associated with signs or symptoms of hypovolemia
98
what do postpartum hemorrhages usually require
transfusion
99
what are risk factors for postpartum hemorrhage
prolonged labor, augemented labor, rapid labor history of PPH over distended uterus operative delivery chorioamnionitis preeclampsia
100
what is the prevention of postpartum hemorrhage
correct anemia avoid routine episiotomy infant to breast after delivery routine use of medicine after delivery of placenta active management of the third stage of labor
101
what are the casues of early postpartum hemorrhage
uterine atony genital tract trauma retained placental tissue coagulation disorder
102
what is the management of uterine atony
deliver the placenta uterine massage to help tone uterus removal of clots give uterotonics: oxytocin, misoprostol, methergine and hemabate bimanual compression possible D&C for retained products

Clin Med3: Womens Health (13 decks)

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