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EOR Women's Health > pregnancy complications > Flashcards

pregnancy complications Flashcards

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1
Q

dystocia definition

A

failure to progress labor, prolonged labor

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2
Q

3 P’s of labor

A

Power (cervical dilation/contractions/descent, 25 mmHg pressure, min 3 contractions/10min)

Passenger (excess fetal wt, presentation, lie)

Passage (pelvis)

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3
Q

1st stage disorders

A 
latent phase (onset-4cm dilation)
>20 hrs null, >14 hrs multi

active phase (4-10cm dilation)
dilation <1.2-1.5 cm/hr multi
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4
Q

augmentation in 1st stage prolongation

A

oxytocin (incr contractions)

amniotomy (rupture membranes)

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5
Q

2nd stage disorders

A

> 3 hrs if anesthesia

>2 hrs if no anesthesia

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6
Q

Tx of prolonged 2nd stage labor

A

C section
forceps
vacuum extraction

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7
Q

shoulder dystocia maneuvers

A

McRoberts maneuver
mom’s thighs hyperflexed against abdomen
pressure over lower abdomen
episiotomy

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8
Q

shoulder dystocia injuries

A
  • brachial plexus injury
  • Erb Duchenne palsy: tear C5, C6; arm paralysis, motor movement hand intact
  • Klumpke paralysis: C8-T1 tear; hand paralysis
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9
Q

acceleration fetal HR means?

A
  • NORMAL

- normal with fetal scalp stim/vibroacoustic stim test

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10
Q

early deceleration fetal HR means?

A

-physiologic, occurs with uterine contractions (decr blood flow to fetus, hypoxia)

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11
Q

late deceleration fetal HR means?

A
  • FETAL HYPOXIA

- uteroplacental insufficiency

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12
Q

meconium aspiration: risk of developing what?

A

pneumonitis, pneumothorax

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13
Q

meconium aspiration Tx

A

immediate suction, intubation

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14
Q

MCC maternal death

A

postpartum hemorrhage

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15
Q

when does postpartum hemorrhage occur?

A

1st 24 hrs

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16
Q

causes of postpartum hemorrhage

A 
MCC: uterine atony
retained placenta
coag disorders
ruptured uterus
inverted uterus
genital tract trauma
hematomas
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17
Q

uterine atony

A

no constriction of arteries at site of placental separation to stop bleeding

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18
Q

RF for uterine atony

A

stretched uterus

polyhydramnios, twins, abnorm labor

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19
Q

uterine atony Sx

A

boggy uterus (normally firm)

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20
Q

Tx uterine atony

A

contractions!

  • manual massage (short term)
  • immediate breastfeeding
  • methylergonovine maleate
  • prostaglandins: misoprostol
  • surgery: compression sutures, selective artery embolization
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21
Q

retained placental tissue definition

A

sheared/torn cotyledons

placenta: missing cotyledons

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22
Q

cause of retained placental tissue

A

abnorm adherence, incomplete placenta separation

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23
Q

abnormal adherence causing retained placental tissue: placenta accreta / increta / percreta

A

superficial lining of uterus
uterine muscle
entire thickness of muscle, no separation at all

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24
Q

Tx retained placental tissue

A

currettage

hysterectomy

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25
uterine inversion cause, Tx
- tug umbilical cord during placental delivery | - manually replace
26
uterine rupture RF, Tx
RF: uterine surgery/procedure, C section Tx: hysterectomy
27
amniotic fluid embolism cause, Sx
amniotic fluid into maternal circulation | -resp distress--> cyanosis--> CV collapse--> hemorrhage/coag DIC--> coma
28
ectopic MC site
fallopian tube
29
RF for ectopic
- tubal ligation/tubal surgery - Hx ectopic - IUD - DES exposure (diethylstillbestrol) - PID - infertility Tx - endometriosis (scar, adhesions) - tobacco
30
DES assoc with
vaginal clear cell carcinoma, ectopic, miscarriage, breast CA
31
Sx ectopic
amenorrhea, vaginal bleeding, abdom pain on affected side | adnexal tenderness
32
DDx ectopic
abortion, ovarian cyst rupture, renal calculi, appendicitis
33
differentiate DDx ectopic
amenorrhea not in appendicitis/renal calculi | appendicitis- RLQ pain
34
Dx ectopic
- serum HCG: lower than expected - transvaginal US: no gestational sac, free fluid pouch of Douglas, echogenic adnexal mass (decr progesterone = nonviable preg; blood in cul-de-sac) gestational sac visualized 1000-2000 IU/L
35
Tx ectopic
methotrexate (abort, folic antagonist, stops rapidly dividing cells) surgery if needed (salpingostomy)
36
spontaneous abortion / miscarriage definition
expulsion before 20 wks gestation
37
early miscarriage cause
chromosomal abnorm (trisomy)
38
2nd trimester miscarriage cause
maternal systemic dz, placental abnorm
39
RF for miscarriage
infection (chlamydia, syphilis, HIV, GBS), thryoid autoAb/hypothyroidism, DM 1, smoking, radiation, coag disorders, uterine leiomyomata, Hx DES
40
threatened abortion
BLEED WITHOUT TISSUE LOSS, bleeding then cramping days later | risk of preterm delivery, low birth wt
41
inevitable abortion
gross rupture membranes, cervical dilation
42
classifications of spontaneous abortion
complete, incomplete, missed
43
complete spontaneous abortion
<10 wks, everything expelled
44
incomplete spontaneous abortion
later in preg, not everything expelled, tissue partially protrude through cervix, remove with forceps/suction
45
missed spontaneous abortion
retained failed intrauterine preg for months, no uterine growth, loss of early preg Sx, resolve spontaneously
46
medical induced abortion when?
< 49 days
47
induced abortion how for <49 days?
antiprogestin (mefepristone), methotrexate, prostaglandin (misopristol)
48
induced abortion how for >49 days?
surgical- suction currettage
49
concerning finding in fetal HR monitoring?
late decelerations
50
hydatidiform mole (partial? complete?)
partial: 1 egg, 2 sperm non viable, recognize fetal material 69 XXX, XXY complete: egg without DNA, 2 sperm NO recognize fetal material 46 XX, XY
51
gestational trophoblastic neoplasia aka
hydatidiform mole | range of neoplasms from trophoblastic tissue
52
gestational trophoblastic neoplasia / hydatidiform mole Sx
neoplasia = grows out of control - vaginal bleeding, pain, hyperemesis gravidarum - uterine enlargement, ovarian enlargement (TLC), no fetal HR - HTN!! (if <20 wks), EXCESSIVE HCG
53
gestational trophoblastic neoplasia / hydatidiform mole Dx
US: hydatidiform mole = snowstorm, clusters of grapes | excessive HCG
54
gestational trophoblastic neoplasia / hydatidiform mole Tx
``` evacuation- D&C dilation & curettage monitor HCG until zero -weekly until zero x 4 wks -monthly x 1 yr OCP (prevent preg b/c recurrence x 1 yr) ```
55
gestational trophoblastic neoplasia / hydatidiform mole complications & Tx
invasive mole: HCG doesn't drop -Tx methotrexate choriocarcinoma -Tx methotrexate (chemo), XRT, monitor HCG
56
RF for choriocarcinoma
molar preg!! | abortion, ectopic
57
chronic vs. gestational HTN
20 wks
58
RF for hydatidiform mole
chronic HTN <20 wks/before preg
59
chronic HTN BP mild, severe
mild >140/90 | severe >180/100
60
mild preeclampsia
HTN + proteinuria >20 wks >140/90 proteinuria >0.3 g x 24hr urine
61
severe preeclampsia
``` >160 (180)/110 proteinuria >5 g x 24hr urine, 3+ protein dip x 2 oliguria <500 mL x 24 hrs cerebral visual disturbance (HA, scotomata) RUQ pain (hep hemorrhage) pulm edema hepatic dysfn thrombocytopenia IUGR ```
62
delivery guidelines in severe preeclampsia
delivery regardless of gest age
63
RF for (pre)eclampsia
**nulliparity | multi fetal gestation, >35 y/o, chronic HTN, nephropathy, obesity, AA, DM, Hx of preeclampsi
64
eclampsia
severe preeclampsia + grand mal seizure fetus can withstand 20 min seizure: fetal hypoxia
65
Sx preeclampsia
**puffy face, edema doesn't resolve with elevation, HTN RUQ tender, hyperreflexia, ankle clonus
66
labs preeclampsia
incr Hct, thrombocytopenia, incr PT/PTT, decr renal function, proteinuria, hepatic dysfn
67
BP goal pregnancy- in chronic HTN
150-160 / 110-110
68
Tx chronic HTN in pregnancy
methyldopa, labetalol, nifedipine, hydralazine | CAN continue diuretics if on them
69
Tx mild preeclampsia
MONITOR | non-stress test 2x/wk, US q 3 wks, fetal movement daily
70
Tx severe preeclampsia
*hydralazine (HTN) *Mg sulfate 4-6 mg/dL IV (seizure prophylaxis) labor induction- C section postdelivery- 24 hrs on Mg sulfate (not diazepam, phenytoin)
71
Mg sulfate reversal agent
10% Ca gluconate IV
72
HELLP syndr
hemolysis, elev liver enzymes, low plts | sometimes with severe preeclampsia/eclampsia
73
HELLP Sx
high BP, vague Sx malaise, RUQ pain
74
HELLP complications
fetal mortality, hepatic rupture, ARF, pulmonary edema, postpartum hemorrhage, DIC
75
Tx HELLP
plt transfusion (if <500) RBC FFP
76
when to Tx anemia in pregnancy
Hg < 10-11
77
folate supplemetation.
0.4 mg/day
78
Fe def anemia supplement
PNV + Fe 60-120 mg/day + vit C
79
gestational diabetes complications
spontaneous abortion, macrosomia (big), polyhydramnios
80
gestational diabetes testing when, what
24-28 wks glucose intolerance test: 1 hr glucose challenge (no fast) if >140 then GTT
81
Tx gestational diabetes
1st line: diet, nutrition - monitor - combo NPH/regular (immed, fast) - glyburide NOT metformin after 1st trimester
82
DM 1 in pregnancy complications
hypoglycemia, DKA, preeclampsia, ESRD (diabetic nephropathy), retinopathy
83
postpartum thyroiditis def
painless hyperthyroid--> hypothyroid in 1 yr postpartum
84
existing hypothyroidism in preg- mgmt
monitor levels once per trimester
85
Tx UTI in preg
macrobid (not after 38 wks) keflex ceftin NOT bactrim! (C)
86
Tx pyelonephritis in preg
ceftriaxone (rocephin) | unasyn, ampicillin, gentamicin
87
Tx asthma in preg
ICS (budesonide) + rescue (albuterol)
88
Tx appendicitis in preg
open or laparoscopic ectomy
89
Tx cholelithiasis in preg
asymptomatic: conservative symptomatic: open or laparoscopic ectomy
90
Tx trauma in preg
fetal monitor minor: 2-6 hrs major: min 24 hrs
91
TORCH
``` toxoplasmosis other: syphilis, parvovirus, varicella, mumps, HIV Rubella CMV Herpes ```
92
Toxoplasmosis mom Tx
spiramycin (prevent transmission)
93
fetal complications Toxoplasmosis
mental retardation, chorioretinitis | blind, epilepsy, hydrocephalus, intracranial calcifications
94
congenital syphilis syndr
MP rash, snuffles, hepatosplenomegaly, jaundice, chorioretinitis, LAN, Hutchinsons teeth
95
chorioretinitis assoc with
toxoplasmosis, syphilis, varicella | posterior uveitis
96
parvovirus complications
spontaneous abortion, hydrops fetalis (fluid overload)
97
treponema pallidum
syphilis
98
varicella complications
skin scar, limb hypoplasia, chorioretinitis, microcephaly
99
can you give varicella vaccine in preg?
no. live
100
HIV Tx
antiretroviral therapy C section at 38 wks no breastfeeding
101
breastfeeding if HIV?
no
102
rubella testing when?
1st prenatal visit
103
german measles
rubella
104
rubella complications
mental retardation, deaf, cataracts, congenital heart dz, PDA
105
can you give rubella vaccine in preg?
no. live
106
CMV screening and Tx
none. no routine screening b/c rare
107
CMV complications
hydrops fetalis, IUGR
108
genital herpes Tx when, what
acyclovir, 36 wks
109
herpes delivery policy
no active infection: vaginal | active: C section
110
Hep B breastfeeding policy
transmitted through breastmilk | can breastfeed if chronic carrier + infant vaccinated/HBIG
111
Hep B Tx mom, infant
mom: HBIG + vaccine immediately infant: in 12 hrs birth
112
Hep B infectious
HBeAg
113
Hep B acute infection
HBsAg
114
Hep B transmission
high if contracted in 3rd trimester
115
Hep C transmission
lower | high if viral load high
116
GC ophtalmia infant Tx
emycin or tetracycline eye ointment
117
chlamydia presentation infants
conjunctivitis birth, 1-2 mo pneumonia
118
chlamydia Tx mom
ceftriaxone | 1 g azithromycin
119
hydrops fetalis assoc is
parvovirus, CMV
120
IUGR
< 10th %
121
SGA
lower extreme of normal
122
IUGR complications
death, asphyxia | acidemia, seizures, sepsis, resp distress, meconium aspiration, low apgar
123
RF for IUGR
mom medical dz, smoking, substance abuse, malnutrition, placental dz, multiple gestation, infection, genetic disorder, teratogen
124
IUGR Tx
fetal monitoring amniotic fluid vol (oligohydramnios) amniocentesis (FLM)
125
macrosomia
>90th % 8.8-9.9 lb 4000-4500 g
126
RF for macrosomia
DIABETES, Hx macrosomia, preg wt gain, male, genetics
127
placenta previa def, Sx
close/over os PAINLESS BLEEDING, spotting stops in 2 hrs >30 wks gestation
128
RF placenta previa
EXPERIENCED MOMS | Hx, C section, uterine surgery, multiparity, advanced age, cocaine, smoking
129
Tx placenta previa
bed rest, fluids | C section usually
130
complications placenta previa
placenta acreida (abnorm adherence) fetal anomalies preterm
131
placental abruption def, Sx
premature separation from uterine wall PAINFUL BLEEDING, continuous, increased
132
RF placental abruption
HTN, preeclampsia, infection, trauma | +same as placenta previa
133
Tx placental abruption
C section
134
uterine rupture Px
bad. 75% mom mortality. fetal mortality
135
preterm labor
<37 wks
136
complications of preterm delivery
RESP DISTRESS, intraventricular hemorrhage, enterocolitis, sepsis, neuro impairment, seizure, cerbral palsy
137
MCC preterm
mult gestations | PROM, Hx, cervical insuff, infection, uterine enlargement, smoking
138
how to predict preterm
``` fetal fibronectin (present if near delivery) transvag US (cervical length) cervix dilation/effacement bacterial vaginosis (predisposes to preterm) ```
139
Tx preterm labor
tocolytic agents- anti contraction (Mg sulfate!!!!), corticosteroids (for FLM)
140
MC complication of PROM
intrauterine infection
141
Dx PROM
gush/steady leakage nitrazine: alkaline 7.1-7.3 fern test US: vol amniotic fluid *sterile speculum exams! no digital exams!
142
Tx PROM >37 wks, 28-37 wks
>37 wks: delivery 32-33 wks: corticosteroids (FLM), abx 24-31 wks: corticosteroids, abx, tocolytics <24 wks: delivery (not enough amniotic fluid) 28-37 wks: labor in 24 hrs-1wk, amniocentesis (FLM), corticosteroids (FLM)
143
goal of preg length
33 wks
144
MCC postterm pregnancy
incorrect est of gestational age | obesity, nulliparity
145
postterm complications
birth trauma, labor dysfn | macrosomia, shoulder dystocia, meconium aspiration, oligohydramnios
146
result of isoimmunization (Rh D)
fetal anemia, jaundice, kernicterus
147
Tx isoimmunization
rhogam anti-D = at 28 wks, and within 72 hrs delivery, and if bleeding/trauma
148
1 Rhogam dose protects?
30 mL fetal blood
149
isoimmunization test
Kleihauer-Betke test
150
MC complication mult gestations
preterm L&D | polyhydramnios, preeclampsia!!!, spontaneous abortion
151
adding each baby = decr gest age by
3-4 wks
152
twin-twin transfusion syndr def, Tx
monochorionic | Tx: intrauterine laser Tx (helps both)
153
death of one fetus Tx
none. damage done by the time of discovery (HOTN). no benefit to early delivery

EOR Women's Health (4 decks)

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