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Obstetric Complications Flashcards

(59 cards)

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1
Q

pregnancy that implants outside uterine cavity

A

ectopic pregnancy

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2
Q

MCC place for ectopic pregnancy

A

fallopian tubes - Ampulla

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3
Q

leading cause of maternal death in first trimester

A

ruptured ectopic pregnancy

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4
Q

risk factors for ectopic pregnancy**

A
  • history of PID - fallopian tube scarring
  • history of STI
  • previous ectopic pregnancy
  • tubal scarring (surg, TB, etc)
  • current IUD use
  • congenital malformation
  • smoking
  • assisted reproductive technology
  • in utero DES exposure
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5
Q

diagnosis of ectopic pregnancy

A
  • urine hCG to start
  • speculum and bimanual exam
    • adnexal mass, bleeding
  • US (transvaginal best)
    • no intrauterine sac
    • ectopic sac or cardiac activity
    • complex adnexal mass
    • fluid in cul de sac
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6
Q

chemical diagnosis of ectopic pregnancy**

A
  • inadequate rise of hC
    • <66% q48h in first 6-7 weeks
  • progesterone < 5 ng/mL
    • 5-25 ng/mL unclear
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7
Q

management of ectopic pregnancy

A
  • ensure pt. hemodynamically stable
  • determine if ruptured
  • give RhoGAM if pt. D-
  • medical vs. surgical
    • methotrexate
      • hemodynamically stable
      • < 3.5 cm
      • compliant for follow-up
      • intrauterine pregnancy ruled out
    • surgical
      • laparotomy (unstable)
      • laparoscopy (stable)
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8
Q

salpinectomy vs. salpinostomy

A

complete or partial removal of fallopian tube

vs.

removal while sparing tube

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9
Q

relative contraindications of methotrexate

A
  • fetal cardiac activity
  • hCG > 15,000
  • > 3.5 cm
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10
Q

absolute contraindications of methotrexate

A
  • hemodynamically unstable/rupture
  • leukopenia
  • thrombocytopenia
  • active renal/hepatic dz
  • active peptic ulcer dz
  • possible concurrent viable uterine pregnancy
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11
Q

antepartum hemorrhage

A
  • placenta previa
  • placenta acreta
  • abruption placentae
  • uterine rupture
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12
Q

postpartum hemorrhage

A
  • uterine atony
  • retained placental tissue
  • genital tract trauma
  • uterine inversion
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13
Q

dystocia

(dysfunctional or difficult labor)

A
  • uterine contractility/expulsive forces
  • cephalopelvic disproportion
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14
Q

obstetric complications

A
  • premature/preterm labor
  • premature rupture of membranes
  • intrauterine growth restriction
  • posterm pregnancy
  • intrauterine fetal demise
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15
Q

triad of maternal death

A

obstetrical hemorrhage

hypertension

infection

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16
Q

single most important cause of maternal death worldwide

A

hemorrhage

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17
Q

placenta implants of cervical os

A

placenta previa

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18
Q

types of placenta previa

A

complete, partial, marginal

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19
Q

Dx and Tx of placenta previa

A
  • Dx
    • US
    • painless bleeding
  • Tx
    • pelvic rest
    • low-lying placenta safe for labor, vaginal birth
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20
Q

abnormally implanted, invasive, or adhered placenta

A

placenta accreta

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21
Q

premature separation of placenta from uterine wall

A

placental abruption

(leading cause of hemorrhage in 2nd and 3rd trimester)

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22
Q

S/s and Tx of placental abruption

A
  • S/s
    • back discomfort
    • abdominal cramping
    • vaginal bleeding
    • abdominal pain
  • Tx
    • expedited birth - c-section mostly
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23
Q

2 types and classifications of uterine rupture and Tx

A
  • types
    • primary - no prior scarring
    • secondary - preexisting incision, injury
  • classes
    • complete - all layers separated
    • incomplete - visceral peritoneum intact (aka uterine dehiscence)
  • Tx
    • immediate delivery (MC by laparotomy)
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24
Q

greatest risk for uterine rupture

Study These Flashcards
A

prior c-section

25
blood loss \> 500mL in vaginal delivery
postpartum hemorrhage * early postpartum - during first 24h after delivery * late postpartum - 24h to 6w after delivery
26
myometrium cannot contract causing bleeding (MCC postpartum hemorrhage)
uterine atony
27
most important step in controlling atonic hemorrhage
immediate bimanual uterine compression 20-30 min
28
pharm agents for uterine atony
* first line * **oxytocin** 10-20mL/min IV until bleeding controlled, then 1-2mL/min until transfer * second line * methylergonovine 0.2mg IM
29
cause of 5-10% of postpartum hemorrhages associated with placenta accreta
retained placental tissue
30
prolapse of fundus through cervix - shock and hemorrhage prominent w/ considerable pain (what type associated w/ tumors)
uterine inversion | (nonpuerperal w/ polypoid leiomyomas)
31
difficult or problematic birth
dystocia
32
3 majors causes of dystocia
* inadequate cervical dilation or fetal descent * fetopelvic disproportion * ruptured membranes w/out labor
33
slower than normal labor
labor protraction disorder
34
complete cessation of labor progress
arrest disorder
35
measurement of inadequate uterine contractions
\< 180 Montevideo units
36
#1 cause of neonatal morbidity and mortality
premature labor
37
known causes of premature labor
1. infection (cervical-vaginal-urinary) 2. placental (vascular) 3. psychosocial stress/work strain (fatigue) 4. uterine stretch (multiple gestations) also: smoking, cocaine, cervical malformation/incompetence, HTN, DM, obesity
38
reasons for preterm birth
* pre-eclampsia * fetal distress * small for gestational age * placental abruption
39
steps to prevent premature labor
* aggressive control of chronic conditions * education about smoking, drug abuse * probiotic * assess cervical competence * vaginal progesterone in weeks 20-36 if short cervix * prior preterm labor: * vaginal progesterone weeks 16-36 * IM weekly
40
definition of pre-term labor
uterine contractions 4/20min or 8/60min and cervix with 2cm dilation or 80% effacement * NOT * cervical changes absent contractions * regular contractions absent cervical change (Braxton Hicks) * late s/s: * watery/bloody show, mucus plug passage, painless contractions, menstrual-like cramps, low back pain
41
Dx and Tx of pre-term labor
* Dx: * US of cervical length (normal is 4cm @ 24w) * fetal fibronectin secretions * labs: vaginal cultures, UA, C&S, CBCd * Tx * lateral decubitus position and reassess * obs, bed rest, hydration, abx, steroids * **Tocolytics** to stop contractions
42
Uterine Tocolytics
* magnesium sulfate (first line) * CCB * Nifedipine * prostaglandin synthase inhibitor * Indomethacin * higher fetal effects
43
PROM
premature rupture of membranes at least 1 hour before active labor before 37 weeks
44
Dx of PROM
* Nitrazine test- alkaline if amniotic fluid * Ferm test- detects salt crystals in amniotic fluid
45
PROM after 37 weeks - Tx
IP, fetal monitoring, monitor mother for infection, induce labor to decrease infection risk consider c-section
46
PROM \>34 weeks - Tx
IP, fetal monitoring, strict bedrest, induce labor/c-section if indicated
47
PROM \<34 weeks - Tx
IP, fetal monitoring, steroids (betamethasone or dexamethasone), antibiotics, Tocolytics to inhibit uterine contraction, indiction/c-section if indicated
48
PROM \<24 weeks - Tx
antibiotics, education of risks, consider termination
49
PROM - indications for immediate delivery
* chorioamnionitis fetal distress * placental abruption * advanced/prolonged labor * cord prolapse
50
estimated fetal weight \< 10th percentile for gestational age on US
intrauterine growth restriction (IUGR)
51
Risks of IUGR
* meconium aspiration * asphyxia * polycythemia * hypoglycemia * mental retardation
52
Causes of IUGR
maternal, placental, fetal * maternal * poor nutrition, smoking, drugs, EtOH, CVS disease, HTN, DM, obesity * placental * inadequate substrate transfer: HTN, obesity, CKD, PIH * fetal * intrauterine infection (listeriosis, TORCH), congenital anomalies
53
Types of IUGR
* symmetric (20%) * organs decreased proportionally * MC w/ infections and anomalies * asymmetric (80%) * organs decreased disproportionally (abdomen \> head)
54
Dx of IUGR
* fundal height 1' screening tool * US (GOLD standard) * abdominal circumference most effective
55
Management of IUGR
* pre-pregnancy: education, prevention * antepartum: modifiable risk factors * smoking, nutrition, etc * labor & delivery: low threshold for c-section
56
name for 42+ weeks from onset of LMP
post-term pregnancy
57
Complications of Post-term Pregnancy
post-maturity syndrome * loss of SQ fat * long fingernails * dry skin * abundant hair * macrosomia * birth weight \> 4000g * incr. shoulder dystocia, birth trauma, c-sect.
58
fetal death after 20 weeks but before labor onset
intrauterine fetal demise
59
Dx and Tx of Intrauterine Fetal Demise
* Dx * absence of fetal movements * uterus small for dates * fetal heart tones not detected * US to confirm these * Tx * watchful expectancy * 80% spontaneous labor in 2-3 weeks of demise * labor induction

OB/GYN (7 decks)

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