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REPRO II Exam 2 > Dunn OB/GYN VI > Flashcards

Dunn OB/GYN VI Flashcards

1
Q

heavy bleeding and terrible nausea/vomiting

previous vaginal births
miscarriage

tissue at cervical os
enlarged ovary

ultrasound - snowstorm
very high HCG**

A

gestational trophoblastic neoplasm

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2
Q

first trimester US

A

best for determining length of pregnancy

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3
Q

tx of gestational trophoblastic neoplasm

A

D and C

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4
Q

gestational trophoblastic disease

A

abnormal proliferation of trophoblast of placenta

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5
Q

benign non-neoplastic trophoblastic lesions

A

exaggerated placental site

placental site nodule

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6
Q

most common cause gestational trophoblastic disease

A

hydatidiform mole
-80%

complete, partial, and invasive

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7
Q

gestational trophoblastic neoplasia

A

GTN

  • true neoplasia
  • potential for invasion / mets

choriocarcinoma
placental site trophoblastic tumor
epithelioid trophoblastic tumor

curable 85-100% cases**

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8
Q

chorioadenoma sestruens

A

invasive hydatidiform mole

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9
Q

complete mole

A

46, XX

XY - if fertilized two sperm

all paternal chromosomes

haploid sperm fertilize empty ovum

no fetal tissue**

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10
Q

incomplete mole

A

69 XXY

fertilization of ovum with haploid maternal chromosome by two sperm

fetal tissue present**

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11
Q

maternal genes

A

fetal growth

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12
Q

paternal genes

A

placental growth

excess - trophoblastic grwoth

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13
Q

incidental finding on endometrial curettage or hysterectomy

A

benign nonneoplastic trophoblastic lesion

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14
Q

genomic imprinting

A

certain genes expressed in parent of origin specific manner

DNA methylation, histone mods

occurs in moles

  • heterozygote - two sperm
  • homozygote - duplicated DNA sperm
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15
Q

complete molar pregnancy

A

fertilization of empty ovum by two sperm or one duplicated sperm

can become choriocarcinoma

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16
Q

partial molar pregnancy

A

fertiliation of haploid ovum by two sperm or one duplicatd sperm

presence of fetal tissue

less likely malignant

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17
Q

molar pregnancy complications

A

most due to very high HCG levels

large overies
hyperemesis gravidarum
preeclampsia
hyperthyroid
hemorrhage
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18
Q

asian women and latin american countries

A

gestational trophoblastic disease

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19
Q

partial mole

A

less dangerous

small uterus for dates

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20
Q

complete mole

A

46 XX

no fetal tissue

large uterus for dates

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21
Q

risk fx for GTD

A

40yo

diet deficient in folate or beta carotene

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22
Q

1st trimester painless bleeding, uterine large, hyperT, hyperemesis gravidarum, preeclampsia

A

gestational trophoblstic disease

23
Q

hyperemesis gravidarum

A

severe nausea and vomiting

-during pregnancy

24
Q

very high beta-HCG, enlare ovaries, grapelike clusters in vagina, US snowstorm

A

GTD

25
Q

Tx for GTD

A

D and C

  • scrape tissue out
  • follow beta-hcg levels
  • plateau and go up
  • repeat D and C or chemotherapy
26
Q

persistent disease

A

15-20% after complete
3-5% after partial

theca lutein cyst, large uterus age >40, initial hCG >100,000

follow hCG levels

27
Q

hcg<5 for 3 weeks

A

ok to resume pregnancy attempts

28
Q

23yo F taking OCP

  • daily spotting since period
  • LMP 1 month ago

cervix - blood from os
tender right ovary

beta-hCG positive

A

ectopic pregnancy

29
Q

break through bleeding

A

diagnosis of exclusion

don’t know cause

30
Q

normal pregnancy

A

hCG doubles every 48 hours

first trimester bleed

31
Q

abnormal pregnancy

A

hCG stay same, decrease, or increase minimally

32
Q

threatened abortion

A

1st trimester bleeding in normal pregnancy

33
Q

risk with 1st trimester bleeding

A

miscarriage
abnormal placental implantation
IUGR - intrauterine growth restriction

34
Q

abnormal pregnancy - in uterus

A

missed, complete, incomplete abortion

molar pregnancy

35
Q

incomplete abortion

A

patient to ER - bleeding heavily

36
Q

missed abortion

A

got pregnant

didn’t grow - and haven’t passed tissue yet

37
Q

complete abortion

A

get pregnant - but hCG goes down

38
Q

risk factors for spontaneous abortion

A 
age 45yr 80% risk
previous abortion
prolonged time to implantation interval
prolonged time to conception
smoking
alcohol
cocaine
NSAIDs
caffeine
low folate
fever
celiac disease
39
Q

chromosomal abnormalities

A

50% of spontaneous abortions

most commonly - aneuploidies - trisomy, monosomy, etc.

congenital abnormalities and trauma also causes

40
Q

maternal cause of spontaneous abortion

A

uterine structural issue
acute maternal infection
maternal endocrinopathies
hypercoagulable state

41
Q

vaginal bleeding, pelvic pain, absence of fetal movement, incidental US findings

A

symptoms for spontaneous abortion

42
Q

work up for spontaneous abortion

A 
1 - doppler - fetal heart sounds
2 - pelvic exam
3 - pelvic US
4 - hCG level - more than one
5 - blood type antibody - Rh
6 - serum progesterone
43
Q

CRL >7 no cardiac activity

A

spontaneous abortion

44
Q

absence of embryo heartbeat >2weeks after without yolk sac

A

spontaneous abortion

45
Q

threatened abortion

A

diagnostic criteria for spontaneous not met

vaginal bleeding occured and closed os

up to 50% will miscarry

tx - bed rest and expectant management

46
Q

inevitable abortion

A

vaginal bleeding, cramphy pelvic pain, dilated cervix

products of conception felt or visualized

tx - medical abortion - misoprostol

D and C surgical abortion

47
Q

misoprostol

A

medical abortion tx

48
Q

complete abortion

A

hCG has gone down

cervix closed and uterus small

> 12 weeks gestation - common

49
Q

missed abortion

A

got pregnant - os closed

then did not feel pregnant anymore

misoprostol or D and C tx

50
Q

ectopic pregnancy

A

outside the uterus
-cervix, fallopian tube, ampulla, ovary, abdomen

ampulla - most common

51
Q

methotrexate

A

folic acid inhibitor

tx for ectopic pregnancy

52
Q

risk fx for ectopic pregnancy

A 
previous
PID ** chlamydia
assisted reproductive technology
history of peritonitis
smoking
previous tubal ligation
53
Q

tx of ectopic pregnancy

A

methotrexate - folic acid inhibitor

surgical - removal

same fertility with either tx**

REPRO II Exam 2 (21 decks)

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