Pregnancy Complications Flashcards
(139 cards)
1
Q
pregnancy complications to know
A
abortion
ectopic
GDM
trophoblastic dz
incompetent cervix
placenta abruption
placenta previa
preeclampsia/eclampsia
pregnancy induced HTN
Rh incompatability
2
Q
5 types of abortion
A
spontaneous
threatened
incomplete
inevitable
missed
3
Q
expulsionof all or part of products of conception before 20 weeks gestation
A
spontaneous abortion
4
Q
-bloody vaginal d.c before 20 weeks gestation w. or w.o uterine contractions
-cervical os closed
A
threatened abortion
5
Q
-dilated cervical os
-some passage of products of conception before 20 weeks
A
incomplete abortion
6
Q
-dilated cervical os
-no passage of products of conception before 20 weeks gestation
A
inevitable abortion
7
Q
-death of the fetus before 20 weeks gestation
-no products of conception passed
-cervical os closed
A
missed abortion
8
Q
definition for reccurent spontaneous abortions
A
3 or more consecutive pregnancy losses
9
Q
80% of spontaneous abortions occur during the first _ weeks of pregnancy
A
12
10
Q
fetal RF for spontaneous abortion
A
chromosomal abnormalities
11
Q
2 chromosomal abnormalities mc associated w. spontaneous abortion
A
trisomy
monosomy X
12
Q
maternal rf for spontaneous abortion (lots!)
A
previous spontaneous abortion
smoking
infxn
anatomic anomalies (ex fibroids)
asherman syndrome
maternal dz
gravidity
fever
prolonged time to achieving pregnancy
BMI < 18.5 OR > 25
celiac
13
Q
3 sx of spontaneous abortion
A
vaginal bleeding
abd pain
lbp
14
Q
labs useful in spontaneous abortion (6)
A
b-hCG
CBC
blood type
abs screen
US
placentation
15
Q
management of spontaneous abortion < 13
A
expectant management
16
Q
management of spontaneous abortion > 13 weeks
A
medical abortion:
1. mifepristone (angioprogestin)
PLUS misoprostol (PG)
2. 1st trimester: D&C
3. 2nd trimester: dilation and evacuation
17
Q
32 yo f w. sudden onset LLQ pain that radiates to the back/scapula and vaginal bleeding - LMP was 5 weeks ago - hx PID and unprotected sex
A
ectopic pregnancy
18
Q
2 mc places for ectopic pregnancies
A
- fallopian tubes
- ampulla
19
Q
3 classic sx of ectopic pregnancy
A
abd pain
bleeding
adnexal mass
20
Q
mc cause of ectopic pregnancy
A
occlusion of tube 2/2 to adhesions
21
Q
6 rf for ectopic pregnancy
A
-previous hx
-previous salpingitis (PID)
-previosu abd/tubal surgery
-use of IUD
-assisted reproduction
-smoking
22
Q
5 sx of ruptured ectopic pregnancy
A
severe abd or shoulder pain
peritonitis
tachycardia
syncope
orthostatic HTN
23
Q
labs for ectopic
A
- bHCG > 1,500 w.o fetus in utero
- serial bHCG increases less than expected
- get baseline bHCG and f/u hormones in 48 hr -> if not doubling -> probs ectopic
24
Q
expected increase in bHCG
A
it should double q 2 days
25
at what bHCG level should you be able to see e/o developing intrauterine gestation on US
1,500
*if not, suspect ectopic*
26
imaging for ectopic
transvaginal US
*IUP should be visible by 5-6 weeks*
27
what is the ring of fire sign on US
hypervascular lesion w. peripheral vascularity -> ectopic
28
4 indications for MTX tx for ectopic
-hemodynamically stable
-hCG < 5,000
-ectopic mass < 3.5 cm
-no fetal cardiac activity
-ability to comply w. post tx/f.u
29
7 contraindications for MTX for ectopic
-current breastfeeding
-active pulmonary dz
-immunodeficiency
-blood disorder
-peptic ulcer
-impaired renal/hepatic fxn
-hypersensitivity to MTX
30
moa for MTX
folic acid antagonist -> inhibits DNA replication
31
surgical tx of ectopic
lparaoscopy salpingostomy
32
_ is crucial in consideration of tx for ectopic
ability of pt to f.u
33
t/f: GDM is a rf for T2DM post pregnancy
t!
34
mc complication of GDM
macrosomia
35
dx for GDM
1. first prenatal visit: random BG on all pregnant women
2. 24-48 weeks: non fasting 1 hr 50g OGTT serum glucose level 1 hr later
3. if 1 hr serum BG > 130 -> 3 hour 100 g OGTT
36
what indicates positive on a 3 hr 100g OGTT
BG >/= the following values at two or more time points:
-fasting: 95
-one hour: > 180
-two hour: > 155
-4 hr: > 140
37
when should pt's w. GDM check their BG
daily:
after fasting overnight
after each meal
38
indications for insulin w. GDM
-fasting BG > 105
-2 hr post prandial BG > 120
39
tx of choice for GDM
insulin
40
fasting BG goal for GDM
< 95
41
only oral DM med that is ok in pregnancy
glyburide
42
glyburide increases risk of
eclampsia
43
a macrosomic child should be delivered at _ weeks via _
38 weeks
c section
44
good control of GDM is described as 2 hr OGTT <
140
45
when should FHR be monitored in pt w. GDM
weekly
46
what complications are you worried about for baby in mom w. GDM (5)
hypoglycemia
shoulder dystocia
cardiac abnormalities
respiratory distress syndrome
IUGR (intrauterine growth restriction)
47
gestational trophoblastic dz includes (2)
molar pregnancy
choriocarcinoma
48
31 yo f, LMP 6 weeks ago - bHCG 100,000 - US has a snowstorm pattern
gestational trophoblastic dz
49
gestational trophoblastic dz includes both benign and malignant
proliferation of placental cells
50
3 signs of gestational trophoblastic dz
bHCG higher than expected
size/date discrepancy
hyperemesis
51
2 rf for molar pregnancy
maternal age extremes (<20, >35)
previous molar pregnancy
52
benign gestational trophoblastic dz
molar
aka hydatidiform moles
53
two types of molar pregnancy
complete
incomplete
54
6 signs of complete molar pregnancy
huge amounts of hCG
missed periods
positive pregnancy test
vaginal bleeding
hyperthyroidism sx
uterus larger than expected for GA
55
3 US findings of molar pregnancy
grape-like mass
snow storm
swiss cheese pattern
56
2 signs of incomplete molar pregnancy
-elevated hCG but not as much as complete
-uterus NOT larger than expected
57
most incomplete molar pregnancies result in
spontaneous abortion
58
t/f:both complete and incomplete molar pregnancies are premalignant conditions that can develop into invasive moles
t!
59
malignant trophoblastic pregnancy can develop from (2)
benign moles (complete and incomplete)
choriocarcinoma
60
malignant trophoblastic gestation is same-same
invasive moles
61
placental ca that mc occurs in absence of molar pregnancy
choriocarcinoma
62
invasive moles ALWAYS develop after _
choriocarcinoma may develop after _
invasive moles: molar pregnancy
choriocarcinoma: molar pregnancy OR regular pregnancy
63
hCG > _ are diagnostic of molar pregnancy
100,000
64
with complete molar pregnancies, _ may be seen on one or both ovaries
lutein cysts
65
with incomplete moles, fetal parts may be visible and there is often
oligohydraminos
66
dx of invasive moles and choriocarcinoma is made when (3)
-hCG levels plateau (remain w.in 10% of previous result x 3 weeks)
OR
-hCG levels increase > 10% across 3 values x 2 weeks
OR
-there is detectable serum hCG up to 6 months after evacuation of molar pregnancy
67
2 US findings of invasive mole
anechoic areas
high vascular flow
68
US findings of choriocarcinoma
-heterogeneous single mass distending from uterus
-areas of necrosis and hemorrhage
69
work up for persistent mole and choriocarcinoma
-CXR
-head/abd/pelvis CT
70
stages I-IV invasive moles/choriocarcinoma
I: tumors confined to uterus
II: tumors extend to fallopian tubes, ovaries, or vagina
III: tumors have lung metastases, regardless of genital structure metastases
IV: tumors have metastases in any organ other than lungs or genital structures
71
tx for complete and incomplete mole
1. uterine evacuation via suction curretage
2. histological analysis of contents
3. hCG weekly until no longer detectable for 3 weeks; then monthly x 5 months
4. if bHCG rises: consider persistent invasive mole vs choriocarcinoma
72
tx for choriocarcinoma
0-6: low risk -> MTX
> 6: high risk -> combo chemo
73
remission of choriocarcinoma is defined as
3 consecutive undetectable hCB levels during weekly monitoring
74
32 yo F, G7P0A3 in 13th week of pregnancy - hx of 3 consecutive fetuses before 20 weeks gestation and 3 spontaneous first trimester abortions
incompetent cervix
75
premature, dilation, or shortening of the cervix during the second or early third trimester of pregnancy
incompetent cervix
76
incompetent cervix mc presents with _ trimester miscarriages
second trimester
77
5 rf for incompetent cervix
prev hx
hx of injury/surgery
colonization
DES exposure in utero
anatomic abnormalities
78
PE findings of incompetent cervix
cervical dilation > 2 cm
minimal contractions until 4 cm
bleeding/d.c mc in 2nd trimester
79
dx for incompetent cervix
transvaginal US
80
US finding of incompetent cervix
funneling of the cervix
81
btw 18-22 weeks, the US focuses on
detecting fetal abnormalities
82
normal length cervix:
incompetent cervix length:
normal: 30 mm
incompetent: < 25 mm before 24 weeks
83
tx for incompetent cervix
-cervical cerclage placed at 12-16 weeks
-removed at 36-38 weeks for delivery
84
2 things that need to be done before placement of a cervical cerclage
-culture G/C and GBS
-comfirm viable intrauterine pregnancy
85
29 yo F, 36 weeks gestation w. sudden onset of back pain w. uterine contractions that are very close together - c/o painful bright red vaginal bleeding - pelvis is ttp - cervix is closed, no e/o rupture of membranes
placental abruption
86
premature separation of all/section of otherwise normally implanced placenta from the uterine wall after 20 weeks gestation resulting in hemorrhage
placental abruption
87
mc cause of third trimester bleeding
placental abruption
88
5 rf for placental abruption
prev hx
trauma
smoking
HTN
preeclampsia
cocaine
89
heavy painful vaginal bleeding in the 3rd trimester is _ until proven otherwise
placental abruption
90
dx for placental abruption
clinical...always
91
US finding of placental abruption even tho you don't need it for dx
retroplacental blood collection
92
what might you find in the vagina w. placental abruption
blood stained amniotic fluid
93
2 fetal signs of placental abruption
decelerations -> fetal hypoxia
bradycardia
94
tx for placental abruption (5)
delivery of fetus and placenta
corticosteroids
type and screen
coag studies
large bore IV
95
why give corticosteroids for placental abruption
enhance fetal lung maturity
96
management of small placental abruptions
expectant management
97
32 yo f, G2P1 at 35 weeks gestation - c/o painless vaginal bleeding x 2 hr w. substantial amt of blood clot d/c - no cramping, fetal HR nl - last pregnancy was via emergency c section at 37 weeks due to breech
placenta previa
98
condition in which placenta lies very low in the uterus and covers all parts of the cervix
placenta previa
99
5 types of placenta previa
complete
partial
marginal
low-lying
vasa previa
100
placenta completely covers internal os
complete placenta previa
101
placenta covers a portion of the intenal os
partial previa
102
edge of the placenta reaches the margin of the os
marginal previa
103
placenta implanted in lower uterine segment in close proximity but not extending to the internal os
low-lying previa
104
fetal vessel may overlie the cervix
low lying previa
105
painless vaginal bleeding after 28 weeks is always
placenta previa
106
bleeding from placenta in placenta previa results from (2)
-small disruptions in placenta
-thinning of lower uterin segment during third trimester
107
5 fetal complications of placenta previa
preterm delivery
preterm PROM
intrauterine growth restriction
vasa previa
congenital abnormalities
108
4 rf for placenta previa
prior c section
multiple gestations
multiple induced abortions
advanced maternal age
109
dx for placenta previa
transvaginal US
110
what exam is contraindicated w. placenta previa
digital vaginal exam
111
tx for placenta previa
strict rest
no intercourse
no vigorous exercise
+/- transfusion
c-section
Rhogam if Rh-
delivery 34-37 weeks
112
what differentiates eclampsia from preeclampsia
eclampsia: development of sz in a woman w. preeclampsia
113
time period in which pre-eclampsia may occur
20 weeks gestation to 6 weeks postpartum
114
preeclampsia triad
HTN
proteinuria
+/- edema
**after 20 weeks gestation**
115
mild preeclampsia parameters
-140/90 - 160/10
-proteinuria: > 300 mg/24 hr OR > +1 on dipstick
-edema of face, hands, feet
116
only cure for preeclampsia
delivery ->
at 34-36 weeks
117
t/f: preeclampsia requires c section
f!
only if complications
118
management of moderate preeclampsia
-steroids to mature lungs at 26-30 weeks
-daily weights and BP
-weekly dipstick
-bed rest
119
severe preeclampsia parameters
-BP > 160/110
-proteinuria: > 5 g x 24 hr OR no urine OR 3+ on dipstick
-pulmonary edema
120
complication of severe preeclampsia
HELLP syndrome:
hemolysis
elevated LFTs
low platelets
121
management of severe pre eclampsia
-hospitalization
-Mg sulfate
+/- BP meds
122
indication for BP meds w. severe eclampsia
BP med of choice
BP > 180/110
hydralazine
123
HTN + proteinuria should make you think
pre eclampsia
124
pt's w. preeclampsia w.o severe sx are generally induecd into labor after _ weeks
pt's w. severe preeclampsia are generally induced at _ weeks
preeclampsia: 37 weeks
severe preeclampsia: 34-36 weeks
125
what drug should a pt with preeclampsia receive if less than 34 weeks gestation
antenatal steroids
126
medication for sz prophylaxis for preeclampsia pt
Mg sulfate
127
gestational HTN (pregnancy induced HTN) is BP > _ after 20 _ weeks into the pregnancy that resolves _ weeks postpartum
> 150/90
> 20 weeks
> 12 weeks
128
what differentiates pregnancy indcued HTN from preeclampsia
proteinuria w. preeclampsia
129
HTN w.o proteinuria in pregnant pt should make you think
gestational HTN
130
management of pregnancy induced HTN
+/- meds
if meds: hyralazine, labetalol
131
when is gestational HTN considered chronic HTN
BP > 140/90 prior to 20 weeks gestation
that persists > 6 weeks postpartum
132
management of chronic HTN in pregnant pt
-BP q 2-4 weeks, then weekly at 34-36 weeks
-delivery 39-40 weeks
133
when should meds be initiated in pt w. chronic HTN
what meds are safe?
>150/100
labetalol
nifedipine
hydralazine
134
if the mother is Rh_
and the baby is Rh
then the mother may develop abs against the infant's blood
mother: Rh-
baby: Rh+
135
t/f: first pregnancy can never be affected by Rh incompatability
t!
136
dx for Rh incompatability (4)
-ABO blood group
-RhD type
-indirect erythrocyte abs screen
-indirect coombs
-fetal monitoring 2nd trimester
137
tx for Rh incompatability
rhogam given at:
-28 weeks
-72 hr of delivery
-during any uterine bleeding throughout pregnancy
138
Rhogam should be given if the mother is Rh_,
the father is Rh_,
or if unknown
mother: Rh-
father: Rh+
139
consequence of Rh incompatability
hydrops fetalis
