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Women's health > pregnancy complications (15%) > Flashcards

pregnancy complications (15%) Flashcards

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1
Q

what is the MC cause of placental abruption + others

A

maternal HTN is MC

smoking, ETOH, cocaine, folate deficiency, high parity, inc age, trauma, chorioamnionitis

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2
Q

what is the presentation of placental abruption

A

3rd trimester painful bleeding, continuous + dark red
severe abd pain, painful uterine ctxs, rigid uterus
fetal bradycardia/distress

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3
Q

how do you dx placental abruption

A

pelvic US

DO NOT DO PELVIC EXAM

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4
Q

what is the tx for placental abruption

A

hospitalize if HD unstable

immediate delivery- C/S preferred

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5
Q

grades of placental abruption (I, II, III)

A

I- mild, slight bleeding
II- moderate/partial
III- complete

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6
Q

what is the major complication of placental abruption

A

DIC

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7
Q

where are ectopic pregnancies most common

A

fallopian tube- ampulla

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8
Q

what is the classic triad of ectopic pregnancy

A

unilateral pelvic/abd pain
vaginal bleeding
amenorrhea

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9
Q

what other dx has a similar presentation to ectopic pregnancy

A

threatened abortion

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10
Q

what is found on PE of ectopic pregnancy

A

CMT

adnexal mass +/- mild uterine enlargement

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11
Q

what should you check to dx ectopic pregnancy

A

serial hcg

TVUS

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12
Q

what does serial hcg show in ectopic pregnancy

A

normal pregnancy- doubles q24-48h

ectopic- doesn’t

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13
Q

what do you see on TVUS in ectopic pregnancy

A

absence of gestational sac

if hcg >2,000, highly suggests ectopic

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14
Q

what is the tx for unruptured, stable ectopic pregnancy

A

methotrexate OR laparoscopic salpingostomy/salpingectomy
rhogam if Rh negative mom
contraception x2mo

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15
Q

what is the tx for ruptured, unstable ectopic pregnancy

A

laparoscopic salpingostomy 1st choice

rhogam if mom is Rh neg

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16
Q

RFs for ectopic

A 
previous abd/tubal surgery/ligation --> adhesions
PID
previous ectopic
endometriosis
IUD use
assisted reproduction
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17
Q

what are the requirements for methotrexate tx of ectopic pregnancy

A

stable
early gestation <4cm
hcg <5000
no fetal tones

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18
Q

CIs for methotrexate tx of ectopic

A

ruptured/unstable
hcg >5000
fetal heart tones
noncompliant pt

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19
Q

dosing options for methotrexate

A

multiple dose- MTX + leucovorin x4 doses; monitor day 0 then odd days; hcg should drop 15% btw2 successive draws

single dose- monitor hcg on days 0, 4, 7; should drop by day 4-7

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20
Q

what causes incompetent cervix

A

premature cervical dilation

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21
Q

RFs for incompetent cervix

A

previous cervical trauma
uterus defects
DES exposure in utero
multiple gestations

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22
Q

when does incompetent cervix usu occur

A

2nd trimester

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23
Q

presentation of incompetent cervix

A

bleeding, vaginal discharge

painless dilation + effacement of cervix

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24
Q

tx of incompetent cervix

A

cerclage + bed rest esp if prior hx

+/- weekly 17-alpha-hydroxyprogesterone injxn if preterm birth hx

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25
when should cerclage be done
h/o incompetent cervix | develop short cervix (25mm or less) before 24wks
26
types of placenta previa
partial- covers part of cervix complete- total coverage marginal w.i 2-3cm of the os
27
presentation of placenta previa
3rd trimester painless bleeding, bright red resolves w.i 1-2hrs no and pain, uterus soft + contender normal fetal HR/no distress
28
dx of placenta previa
pelvic US DON'T DO PELVIC EXAM
29
tx of placenta previa
hospitalize to stabilize + bed rest tocolytics (mag sulf), betamethasone if 24-24wks to inc lung maturity C/S
30
RFs for placenta previa
multiparity inc age smoking
31
what is vasa previa
fetal vesels traverse fetal membranes over cervical os
32
what is the presentation of vasa previa
ROM --> painless vaginal bleeding + fetal bradycardia/distress
33
dx of vasa previa
pelvic US
34
tx of vasa previa
immediate C/S
35
what causes gestational diabetes
placental release of growth hormone, corticotropin releasing hormone + human placental lactogen --> antagonizes insulin
36
RFs for GDM
``` fhx or personal h/o GDM spontaneous abortion infant >4000g at irth multiple gestations obesity 25yo+ AA, hispanic, asian/pacific islander, native american ```
37
what are fetal complications of GDM
``` fetal demise congenital malformation premature labor neonatal hypoglycemia shoulder dystocia macrosomia birth trauma neonatal hypocalcemia hyperbili ```
38
what are maternal complications of GDM
preeclampsia placental abruption >50% chance of DM after pregnancy + recurrence in future pregnancies
39
when should moms be screened for diabetes after giving birth
6wks PP + yearly afterword
40
dx of GDM
``` 50g oral glucose challenge at 24-28wks >95 fasting >180 1hr >155 2hr >140 3hr ```
41
tx of GDM
glucose monitoring diet + exercise +/-insuline (DOC), glyburide
42
insulin indications
Fasting >105, PPG >120
43
insulin vs glyburide
insulin- doesn't cross placenta | glyburide- doesn't cross placenta but higher risk of eclampsia
44
when should mom w GDM be induced
38wks if uncontrolled/macrosomia | 40wks if controlled/no macrosomia
45
what is the definition of transitional (gestational) HTN
HTN w/o proteinuria s/p 20wks GA that resolves 12wks PP
46
tx of transitional HTN
may withhold meds | +/- hydralazine or labetalol
47
definition of mild preeclampsia
140/90+ on 2 separate occasions, at least 6hr but not >1wk apart proteinuria (300mg/24h or >1 on dipstick) s/p 20wks GA
48
definition of severe preeclampsia
``` 160/1100+ on 2 separate occasions, at least 6hr but not >1wk apart proteinuria (5000mg/24h) oliguria (<500ml/24h) thrombocytopenia s/p 20wks GA ```
49
complications of preeclampsia
``` DIC HELLP syndrome (hemolytic anemia, elevated liver, low plts) ```
50
tx of mild preeclampsia
deliver @ 37wks | <34wks = daily wits, BP + dipstick weekly, bedrest, steroids to mature fetal lungs if elective delivery planned
51
tx of severe preeclampsia
``` prompt delivery + hospitalization mag sulf to prevent eclampsia BP meds (hydralazine, labetalol, nifedipine) ```
52
what is eclampsia
preeclamspia + seizure or coma
53
what are sx of eclampsia
abrupt tonic-clonic seizures 1-2min --> post-ictal | hyperreflexia
54
tx of eclampsia
ABCDs! mag sulf for seizures (lorazepam 2nd line) hydralazine, labetalol for HTN deliver once mom is stable
55
what is chronic/preexisting HTN
HTN before 20wks GA | persists >6wks PP
56
definition of mild chronic/preexisting HTN
140/90+ on 2 separate occasions at least 6hr but not >1wk apart
57
definition of moderate chronic/preexisting HTN
150/100+ on 2 separate occasions at least 6hr but not >1wk apart
58
definition of severe chronic/preexisting HTN
160/110+ on 2 separate occasions at least 6hr but not >1wk apart
59
what should be avoided in tx of chronic/preexisting HTN
ACEi | Diuretics
60
tx of mild chronic/preexisting HTN
monitor q2-4wks --> weekly @34wks --> deliver at 37wks weekly NST during 3rd tri serial BP + urine protein
61
tx of moderate/severe chronic/preexisting HTN
meds (methyldopa DOC, labetalol, hydralazine, nifedipine)
62
what are the 4 types of gestational trophoblastic disease
molar (benign) invasive molar choriocarcinoma placental site trophoblastic tumor
63
what is the presentation of gestational trophoblastic disease
painless vaginal bleeding 6wks-5mo GA larger uterine size than date indicates preeclampsia before 20wks hyperemesis gravidarum, earlier than usu
64
what should you check to dx gestational trophoblastic disease
hcg (>100k) very low maternal AFP US (snowstorm or cluster of grapes = enlarged cystic chorionic villi, absence of fetal parts + heart sounds)
65
what is the tx of gestational trophoblastic disease
surgical uterine evacuation ASAP + follow weekly until hcg undetectable rhogam if Rh negative mom avoid pregnancy for 1yr
66
where are the MC mets in choriocarcinoma
lung, lower genital tract (purple, black nodules), pelvis (mass)
67
tx of mets caused by choriocarcinoma
methotrexate or hysterectomy
68
when should choriocarcinoma mets be suspected
if hcg rises or plateaus s/p tx continued hemorrhage s/p tx vaginal tumor or pelvic mass
69
what is the MC type of gestational trophoblastic disease
hydatiform mole (80% benign)
70
2 types of molar pregnancies and their description
complete molar- egg w no DNA fertilized by 1 or 2 sperm (46XX)- all paternal chromosomes, higher risk of choriocarcinoma partial molar- egg fertilized by 2 sperm or 1 that duplicates chromosomes --> +/-fetal development but always malformed + never viable
71
MC RFs for molar pregnancy
prior molar pregnancy mom <20 or >35yo asian
72
Rh incompatibility cause
Rh- mom + Rh+ dad --> Rh+ baby | mom's antibodies develop after 1st Rh+ baby + attack RBCs of 2nd Rh+ baby --> blue baby/hemolytic anemia of newborn
73
neonatal sx of hemolytic anemia of the newborn
``` jaundice kernicterus hepatosplenomegaly fetal hydrops CHF ```
74
what is fetal hydrops
fluid accumulation in 2 places- pericardial effusion, ascites, pleural effusion, subQ edema
75
when should rhogam be given to mom
Rh- mom, antibody negative when: 28wks GA w.i 72h of delivery after any potential blood mixing
76
what result of antibody screen suggests fetal hemolysis in Rh incompatibility
1:8-1:32
77
what is the definition of morning sickness
N/V up to 16wks GA
78
what is hyperemesis gravidarum
severe, excessive N.V associated w wt loss, electrolyte imbalance, acidosis (d/t starvation), alkalosis (d/t vomiting) develops in 1st or 2nd trimester + persists >16wks
79
antiemetics for morning sickness/HEG
1st = pyridoxine (vit B6) +/- doxylamine | promethazine, dimenhydrinate
80
what is a spontaneous abortion
termination before 20wks GA
81
when is spontaneous abortion MC
1st 7wks
82
MC etiology of spontaneous abortion
fetal chromosomal abnormalities
83
what is a threatened abortion
pregnancy MAY BE VIABLE | no POC expelled, cervix closed
84
tx of threatened abortion
bed rest @ home return if sx persist or POC pass serial hcg to see if doubling rhogam if indicated
85
what is an inevitable abortion
pregnancy not salvageable | no POC expelled, cervix dilated
86
tx of inevitable abortion
D&E/D&C | rhogam if indicated
87
what is an incomplete abortion
pregnancy not salvageable some POC expelled, cervix dilated boggy uterus
88
what is the tx for incomplete abortion
may allow to finish OR D&E/D&C OR pitocin | rhogam if indicated
89
what is a complete abortion
pregnancy not salvageable all POC expelled, cervix closed pre-pregnancy uterus size
90
tx of complete abortion
rhogam if indicated
91
what is a missed abortion
fetal demise but still retained in uterus | no POC expelled, cervix closed
92
tx of missed abortion
D&E/D&C or misoprostol
93
what is a septic abortion
retained POC becomes infected --> infxn of uterus + organs | closed cervix w CMT
94
tx of septic abortion
D&E + broad spectrum abx
95
medical options for elective abortion
mifepristone --> misoprostol 24-72h later (Safe up to 9wks) methotrexate --> misoprostol 3-7d later (safe up to 7wks)
96
what is mifepristone
anti-progestin
97
what is methotrexate
folic acid antagonist
98
what is misoprostol
prostaglandin that causes ctx
99
surgical options for elective abortion
up to 24wks from LMP D&C (4-12wks) D&E (12wks+)

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