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Flashcards in Complications of Pregnancy Deck (89)
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1

Complications during first trimester

-Hyperemesis gravidarum
-Spontaneous abortion
-Recurrent Abortion
-Ectopic pregnancy
-Gestational trophoblastic disease

2

Hyperemesis gravidarum

-Extreme end of nausea/vomiting of pregnancy
-Diagnosis of exclusion
-Weight loss of > 5%
(Ketonuria, Electrolyte abnormalities, Liver abnormalities, Thyroid)
-Unknown cause
(Psychogenic, hCG, Estrogen?)

*HCG is higher when pregnant with multiples (hyperemesis, think multiples possibly)

3

Treatments for Hyperemesis gravidarum

-Pyridoxine (vit B6): WORKS WELL
-Doxylamine (antihistamine): WORKS WELL
-Ondansetron
-Metoclopramide
-Promethazine
-Corticosteroids
-IV fluids, parenteral nutrition, enteral tube feedings

4

Complications of Hyperemesis gravidarum for mom

Hyperemesis gravidarum

5

Spontaneous abortion may occur at _______

6

KNOW CHART WITH TYPES OF SPONTANEOUS ABORTIONS FOR TEST AND BOARDS

slide 7
(screen shot in exam folder)

7

Treatment for spontaneous abortion

-Hemodynamically stable: misoprostone +/- mifepristone

-Hemodynamically unstable: D&C (Dilation and curettage)

-If >12 weeks: D&E

8

Recurrent abortion is defined as

3+ spontaneous abortions

-Abnormalities can be found in

9

Things to check on a patient with recurrent abortions

-Karyotype
-Uterine assessment (look for septums, etc)
-Anticardiolipin antibody, lupus anticoagulant
-Thombophilia assessment: (Factor V Leiden, Prothrombin gene mutaation, Antithrombin III, homocystine, protein S and C)
-Thyroid function

10

Ectopic pregnancy

-pregnancy outside the uterine cavity
-98% tubal
-Risk factors to having this: infertility, PID, prior tubal surgery
-10% risk of recurrence

11

S/S of Ectopic pregnancy

-lower abdominal pain and bleeding
-Need to check hCG and CBC
-Need ultrasound
-May do Culdocentesis
or Laparoscopy

12

Treatment for Ectopic Pregnancy

1. Medical: Methotrexate
(ONLY IF emodynamically stable,

13

Gestational Trophoblastic disease consists of

-Hydatidiform mole (partial or complete)
-Invasive mole
-Choriocarcinoma (cancer)
-Placental site trophoblastic tumor (cancer)

14

Partial Hydatidiform mole facts

-Karyotype: 69XXY or 69 XYY or 69 XXX (less commonly)
-hCG elevated
-2 sperm fertilize 1 egg
-Fetal tissue PRESENT
-Focal swelling of chorionic villi
-Focal trophoblastic hyperplasia
-Rarely see theca lutein cysts on ovaries
-rarely malignant sequelae
-rarely medical complications

15

Complete Hydatidiform mole facts

-Karyotype: 46XX or 46 XY (all paternal, EMPTY OVUM)
-hCG VERY ELEVATED!
-ABSENT fetal tissue
-Diffuse swelling of chorionic villi
-Diffuse trophoblastic hyperplasia
-May see theca lutein cysts in ovaries (15-25%)
-May have malignant sequelae (6-23%)
-May have medical complications (

16

S/S of hydatidiform mole

-Bleeding
-Large uterus (bc of swelling)
-Hyperemesis
-HTN
-Extremely elevated hCG
-Placental vesicles on ultrasound (“grape-like clusters”)
-Can get hyperthyroidism due to high hCG

17

Ultrasound finding of complete mole

“Snow storm” pattern

18

Ultrasound finding of partial mole

can see fetal pattern but also snowstorm pattern

19

Treatment of hydatidiform mole

-D&C
-CXR

20

ALWAYS order this if pt has hydatidiform mole

CXR- always get chest xray bc you CAN have metastasis to chest

21

Medical follow up for hydatidiform mole

-Birth control!!
-Weekly hCG until 3 negatives
-hCG every 1-3 months for 6 months (monitor for at least 6 months to make sure hCG stays neg)

22

Post molar gestational trophoblastic disease

-malignancy
-Ways to diagnose why hCG not going down properly:

1. hCG plateau 4x over 3 weeks
2. hCG increase >10%, 3x over 2 weeks
2. Persistence of hCG after 6 months

23

Treatment for Post molar gestational trophoblastic disease

Methotrexate chemo

24

Choriocarcinoma

-Persistent bleeding or hCG after delivery/D&C

-Metastasis: vagina, lung, liver, brain
-Metastasis looks like black dots
-Chemotherapy: MTX (methotrexate) or actinomycin

25

Complications in 2nd and 3rd trimesters

1. Pre-eclampsia or eclampsia
2. Acute fatty liver of pregnancy
3. Gestational diabetes
4. Preterm labor/Preterm rupture of membranes
5. Oligo- or Poly-hydramnios
6. Bleeding (Placental abruption, Placenta previa, Vasa previa)
7. Cholestasis of Pregnancy

26

Pre-eclampsia

Elevated blood pressure + proteinuria

-Treatment: delivery
-Risk FActors: multiple gestations, CHTN, DM, kidney disease, collagen-vascular disorders, autoimmune disorders, GTN

27

Eclampsia

pre-eclampsia (HTN, proteinuria) PLUS seizures (5%)

**obstetric emergency**

28

Timeline to qualify as pre-eclampsia

Only after 20 weeks gestation to

29

Mild pre-eclampsia/eclampsia

140-160/ 90-110
Proteinuria: 0.3-5g/24 hrs

30

Severe pre-eclampsia/eclampsia

>160/ >110
Proteinuria: >5 g/24 hrs