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pregnancy complications Flashcards

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1
Q

what percentage of ectopics occur in the ampulla of the fallopian tube

A

55%

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2
Q

common cause of the ectopic pg

A

secondary to adhesions

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3
Q

unilateral adnexal pain, amenorrhea or spotting, tenderness to the mass(mass felt 20%)

A

classic symptoms of ectopic

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4
Q

severe abdominal or shoulder pain associated with peritonitis, tachycardia, syncope, orthostatic hypotension

A

ruptured ectopic pg

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5
Q

what test is diagnostic in ectopic gestation

A

transvaginal u/s

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6
Q

hCG is what to show evidence of a developing intrauterine gestation on transvaginal ultrasound

A

1500

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7
Q

how to treat ectopic early

A

methotrexate (folic acid analog)

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8
Q

4 tests for ectopic

A

pelvic exam, pg test, serum progesterone, u/s

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9
Q

threatened abortion

A

cramping(often painless), bloody discharge, closed cervical os. small percentage will go into spontaneous abortion

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10
Q

inevitable abortion

A

obvious rupture of membranes and leaking of amniotic fluid in the first 12 wks.

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11
Q

what if a inevitable abortion occurs with cervical dilation,

A

it will likely progress to a miscarriage

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12
Q

complete abortion

A

complete detachment of the placenta from the uterus and expulsion of the products of conception. The os will be closed once complete

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13
Q

incomplete abortion

A

cervical os is open with some portion of the fetus and/or placenta remaining in the uterus

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14
Q

missed abortion

A

the cervical os is closed and the terminated fetus remains in the uterus.

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15
Q

recurrent abortion and prognosis

A

3 or more consecutive spontaneous abortions

-prognosis good

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16
Q

what abortions can be treated with bed rest, routine exam, u/s
- Rh negative

A
  • threatened and inevitable

- give immunoglobulin

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17
Q

which 2 abortions have an open os

A

incomplete and inevitable

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18
Q

which 2 abortions have no POC expulsion

A

threatened and inevitable

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19
Q

which abortion has no bleeding

A

missed

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20
Q

definition of spontaneous abortion

A

abortion is the termination of pregnancy before 20 wks of gestation

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21
Q

incidence of spontaneous abortions

  • when
  • 50% have what
A

15-20%; 80% first trimester; 50% have chromosomal abnormalities

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22
Q

what 3 tests to confirm a viable pregnancy

A

serial hCG, serum progesterone, or serial ultrasounds

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23
Q

inappropriate development/interval growth, poorly formed or unformed fetal pole, fetal demise

A

non viable pregnancy

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24
Q

% of developing diabetes in 5 years with gestational diabetes

A

50%

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25
recurrence rate of gestational diabetes
60-90%
26
hyperacceleration of general diabetic complications, traumatic birth, shoulder dystoccia, preeclampsia
fetal complications of gestational diabetes
27
when should you screen postpartum gestational diabetes pts
at 6 weeks and yearly intervals thereafter
28
office visits of gestational diabetes pts when necessary
2 hr postprandial blood glucose; if greater than 105 (fasting) or 120(2 hr), may require insulin
29
when to deliver pts with gestational diabetes
if well controlled and no signs of macrosomia: 40 wks. | if glucose is poorly controlled or if signs of macrosomia: 38 wks
30
tight maternal glucose control
fasting is less than 95 1 hr postprandial is less than 140 2 hr postprandial is less than 120
31
NST for gestational diabetes
begin at 34 wks
32
pre-eclampsia like sx before 20 wks, hCG over 100,000(complete), hyperemesis gravidum, abn uterine size, vag bleeding
molar pregnancy
33
snowstorm or grape clusters on u/s
molar pregnancy
34
is a complete or incomplete molar pg more common
complete
35
% of partial hydatidiform moles progress to malignancy
less than 5%
36
tx of benign and low risk metastatic tumors (hydatidiform moles)
chemo
37
high risk tx (hydatidiform moles)
combo of chemo w/ or w/out radiation and surgery
38
surgical tx of hydatidiform moles and cure rates
suction curretage and hysterectomy. | cure rates 80-100%
39
hydatidiform moles post tx and contraception
monitor serial hCG. | contraception recommended 6-12 months after remission
40
choriocarcinoma definition and treatment
malignant cancer found in the placenta following a hydatidiform mole tx: chemo and hysterectomy
41
preeclampsia/eclampsia triad
HTN, edema, and proteinuria | edema no longer necessary for dx
42
HELLP
severe preeclampsia Hemolysis Elevated liver enzymes Low Platelets
43
what is eclampsia
preeclampsia with seizures
44
most common risk factor for preeclampsia
nulliparity
45
extreme pg age(under 20 or over 35), multiple gestation, DM, pre-existing renal disease, chronic HTN
other risk factors for preeclampsia
46
cerebral hemorrhage, pulm edema, DIC, HELLP, abruption placenta
maternal complications of preeclampsia
47
hypoxia, low birth wt, preterm delivery, perinatal death
fetal complications of preeclampsia
48
HYPERreflexia, HTN, proteinuria
signs of preeclampsia
49
RUQ pain, edema face/hands, visual disturbances, HA, N/V, decreased urine output, sudden wt gain
symptoms of severe preeclampsia
50
5 labs for preeclampsia/eclampsia
sterile urine protein, 24 hr urine protein, CBC, fibrinogen, PT/PTT
51
chem panel for preeclampsia/eclampsia (3)
liver enzymes, creatinine, uric acid
52
what is pregnancy induced HTN
HTN after 20 wks with no other symptoms
53
BP in mild and severe preeclampsia/eclampsia
- taken 2 times at least 6 hrs apart mild: over 140/90 but under under 160/110 - or increase of 30 systolic or 15 diastolic from prepregnancy BP severe: over 160/180
54
proteinuria for mild and severe preeclampsia
mild: over 300mg/24 hr but <5 g/24 hr severe: 5 g/24 hr
55
uric acid for mild and severe preeclampsia
mild is > 4.5 | severe is much more then 4.5
56
creatinine for mild and severe preeclampsia
mild is normal | severe is elevated
57
liver enzymes for mild and severe preeclampsia
mild is normal | severe is elevated AST, ALT, LDH
58
first line med for inpt mgmt to decrease chance of seizures
MgSO4 IV drip, continue for 24 hrs after delivery
59
monitor what what MgSO4
urine output b/c it is cleared through kidney leading to an increased risk of mag toxicity when urine output is low
60
meds for acute tx of HTN
hydralazine or labetolol
61
what med to enhance fetal lung maturity
bethmethasone
62
% of gestation HTN progress to preeclampsia
25%
63
what meds to avoid in HTN PG
``` ace inh (uterine ischemia) diuretics (aggrevate low plasma volume to the point of uterine ischemia) ```
64
mag toxicity signs
loss of DTRs, respiratory paralysis, coma
65
common organism in pg UTI
e coli 70-90%
66
UTI tx pg
3-7 days nitrofurantoin, cephalexin, or augmentin
67
pyelo tx pg
admit to hosp. IV fluids and IV 3rd gen cephalosporin
68
administer in hyperemesis gravidarum - initial - antihistamine - 2 nausea drugs
vitamin B6 doxylamine dimenhydrinate or promethazine
69
doxylamine
antihistamine for hyperemesis gravidarum
70
severe hyperemesis gravidarum
prochlorperazine, reglan, zofran, promethazine
71
dimenhydrate IV, fluids, nutritional supplementation
dehydration in hyperemesis gravidarum
72
high incidence of what with multiple gestations
placenta previa
73
what occurs 1 out of 80 births
twins
74
what is 3% of births
multiple gestation
75
fraternal twins incidence
2/3.
76
blacks, moms with above wt & ht, FH, fertility drugs
increased chance of dizygotic twins
77
4 common complications of multiple gestation
spontaneous abortion and preterm birth | preeclampsia and anemia
78
HIV - placenta - labs - tx - transmission rate
- placenta: cannot cross; but can be transmitted through breast milk - labs: ELISA - tx: antiretroviral therapy throughout pregnancy for mom and 6 wks for the newborn - transmission rate is 25-45%, 1-8% with proper tx
79
neonatal herpes - sx - tx
fatal! very serious! - active herpes chancre - acyclovir 36 wks
80
syphillis - occur when - dx - tx
- can occur anytime during pregnancy - u/s, blood work - PCN. 50-100% transmission rate when untreated 1-2% transmission rate when treated
81
still birth, late term abortions, transplacental infection, congenital syphillis, intrauterine growth restriction
-complications of syphillis
82
group B strep - % of active carriers - active infection - labs and when - tx
group B strep - % of active carriers is 30% - active infection can be bad for mom and baby no matter vag or c section - labs: vag cultures at 35-37 wks - tx: PCN given during labor.
83
group B strep - mom can develop what (2) - newborn can develop what (3)
- mom: UTI, endometritis | - newborn: pneumonia, sepsis, meningitis
84
Group B strep tx if allergic to PCN
ampicillin, clinda, vanco
85
RUQ vs RLQ pain
RUQ: cholecystitis, supportive tx RLQ: appendicitis, do surgery
86
what level is low platelets
100,000
87
which placenta abruption is more severe and common
external is more common and less severe | concealed is less common and more severe
88
incidence of placenta abruption and previa
abruption is 1 in 100 | previa is 1 in 200
89
painful and dark vaginal bleeding
abruption
90
painless and bright red vaginal bleeding
previa
91
fetal distress with abruption and previa
usually abruption
92
uterus hypertonic
abruption
93
diagnostic test for abruption and previa
abruption is clinical | previa is ultrasound
94
also order what 3 studies for abruption and previa
CBC, coag studies, type/cross
95
tx for abruption
delivery. usually c section
96
tx for previa`
c section later. bethamethasone 28-32 weeks
97
DIC with what placenta disorder
abruption
98
risk factors for what? | abdominal trauma, HTN, alcohol/cocaine/tobacco use, preeclampsia, decreased folic acid levels
abruption
99
first step in diagnosis hyperemesis gravidarum
rule out molar pregnancy with u/s +/- B hCG

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