Quiz 7

Question 1

Gestational diabetes

Answer 1

develops during pregnancy and screened at 24-28 weeks by a FBS and 1-hr glucose challenge test—if abnormal, then 3-hr glucose tolerance test (GTT); affects about 18% of pregnant women

Question 2

Pregestational diabetes

Answer 2

detected during the first prenatal visit by a FBS or random BS

Question 3

Prevalence order for gestational diabetes

Answer 3

African American
Hispanic
Native American
Asian cultures/ethnic groups

Question 4

Insulin in normal pregnancy

Answer 4

As the placenta grows, the hPL and somototropin (placental) hormones increase in production causing insulin resistance, causing increases in insulin secretion to overcome the action of these hormones. Normally the pancreas can respond and control glucose levels

Question 5

Insulin in diabetes pregnancy

Answer 5

insufficient insulin to meet the metabolic needs and changes

Question 6

Spontaneous Abortion

Answer 6

Bleeding disorder
Loss of a pregnancy before 20 weeks gestation
Cause unknown/highly variable
1st trimester commonly due to fetal genetic abnormalities (80%)
2nd trimester more likely related to maternal conditions (20%)
This is usually managed as an outpatient

Question 7

Spontaneous Abortion symptoms

Answer 7

Vaginal bleeding (starts as spotting, can increase)
Cramping or contractions

Question 8

Spontaneous Abortion: threatened

Answer 8

Slight bleeding, no cervical changes

reduce activity, ensure adequate hydration

Question 9

Spontaneous Abortion: Inevitable

Answer 9

Increased vaginal bleeding, ROM, cervical dilation, strong cramping, possible passage of “POC”

U/S & hCG levels to confirm pregnancy loss, vacuum curettage if POC are not passed to prevent infection & reduce risk of excessive bleeding

Question 10

Spontaneous Abortion: Incomplete

Answer 10

heavy bleeding, intense cramping, cervical dilation

U/S to confirm, stabilize patient, u/s confirms that “POC” are still in uterus, D&C or Misopostol (prostaglandin analog)

Question 11

Spontaneous Abortion: Complete

Answer 11

ID & treat underlying cause, genetic/chromosomal abnormalities, reproductive tract abnormalities, incompetent cervix; possible cervical cerclage in 2nd trimester of future pregnancies

U/S to confirm, no med/surg intervention necessary, f/u appt for family planning discussion

Question 12

Spontaneous Abortion: Missed

Answer 12

irregular spotting, absent contractions, U/S to confirm presence of “POC”

U/S to confirm presence of “POC”, vac.curettage-1st Tri, D&C-2nd Tri, (Induction of Labor-post 20 weeks gestation= stillbirth).

Question 13

Spontaneous Abortion: Habitual

Answer 13

hx of 3 or more consecutive spontaneous abortions

ID & treat underlying cause, genetic/chromosomal abnormalities, reproductive tract abnormalities, incompetent cervix; possible cervical cerclage in 2nd trimester of future pregnancies

Question 14

Cervical insufficiency

Answer 14

Premature spontaneous dilatation of cervix

Spontaneous dilation occurs without contractions in the second trimester. It is typically rapid, relatively painless, and accompanied by minimal bleeding, and it results in the loss of the pregnancy

Cervical cerclage can be put in to prevent this- snip at 36 weeks

Question 15

Ectopic Pregnancy

Answer 15

Emergency***
Fertilized ovum implants outside the uterine cavity
Most common place is Fallopian tube
Pain on side and bleeding- common symptoms

Question 16

Ectopic Pregnancy symptoms

Answer 16

Abdominal pain
Spotting
6-8 weeks after a missed period

Question 17

Ectopic preg rupture symtpoms

Answer 17

severe sharp, sudden pain, hypotension, abdominal tenderness with distention, hypovolemic shock

Question 18

Gestational Trophoblastic Disease (GTD)

Answer 18

Fertilized egg by sperm but doesn’t have mothers DNA so it’s not viable
Hydatidiform Mole
Choriocarcinoma

Question 19

Complete Hydatidiform Mole

Answer 19

empty egg fertilized by one normal sperm

Question 20

Partial Hydatidiform Mole

Answer 20

normal egg fertilized by two normal sperm

Question 21

Choriocarcinoma

Answer 21

Aggressive, virulent cancer that rises from the trophoblastic tissue and
often metastasizes to lungs, lower GI tract, brain, liver, kidneys

Question 22

GTD symtpoms

Answer 22

Early is normal signs of pregnancy
Late: similar to spontaneous abortion at 12 weeks
severe, morning sickness
brownish vaginal spotting/bleeding,
uterine size larger than expected for dates,
extremely high hCG levels
U/S shows no fetal activity/heart rate at 6-10 weeks,
U/S shows typical transparent vesicular molar pattern in uterus

Question 23

GTD management

Answer 23

Emphasize the importance of serial hCG monitoring & birth control for 1 year
Avoid pregnancy for 1 year

Question 24

Placenta Previa

Answer 24

Usually happens last 2 trimesters
Occurs when embryo implants in the lower uterine segment
Placenta covers some to all of the cervical os

Question 25

Placenta previa symptoms

Answer 25

Bright red bleeding Usually painless Start and stop bleeding Baby's HR is normal

Question 26

Placenta previa | Accreta, Increta, or Perceta

Answer 26

Accerta- sticks to wall of uterus Increta- penetrates wall Perceta- whole way through

Question 27

Abruptio Placentae

Answer 27

Emergengy*** Separation of a normally located placenta leading to hemorrhage & compromised fetal blood supply Pregnant woman can lose up to 40% of her blood volume before showing signs Immediate C-section

Question 28

Abruptio Placentae symptoms

Answer 28

``` Bleeding (dark red clot) Decrease fetal movement/HR Fundal height changes could indicated a concealed hemorrhage Painful (knife-like) uterine tenderness ```

Question 29

Disseminated Vascular Coagulation (DIC)

Answer 29

Patient starts to bleed (due to increase of circulating plasmin) yet has too much thrombin therefore develops small clots throughout the body

Question 30

DIC symptoms

Answer 30

bleeding from other places such as gums and IV site, petechiae, tachycardia

Question 31

Hyperemesis Gravidarum

Answer 31

Severe form of persistent, uncontrollable n/v

Question 32

Chronic HTN

Answer 32

HTN that exists prior to pregnancy or that develops before 20 weeks’ gestation. Classified as mild or severe based on systolic & diastolic values.

Question 33

Gestational HTN

Answer 33

BP elevation (140/90) identified after 20 weeks’ gestation without proteinuria. BP returns to normal by 12 weeks postpartum Diagnosis = BP >140/90 mm Hg, 2x, at least 6h apart, after 20 weeks of gestation

Question 34

Preeclampsia

Answer 34

st common HTN disorder of pregnancy, which develops with proteinurea after 20 weeks’ gestation. It is a multisystem disease process, classified as mild or severe, depending on the severity of the organ dysfunction

Question 35

Eclampsia

Answer 35

Onset of seizure activity in a woman with preeclampsia

Question 36

Chronic HTN & Superimposed Preeclampsia

Answer 36

Occurs in ~20% of pregnant women, with increased maternal & fetal morbidity rates

Question 37

Preeclampsia symptoms

Answer 37

Vasospasm & hypoperfusion are the underlying mechanisms epigastric pain and increased liver enzymes headaches, visual disturbances, blurred vision and hyperactive DTR's Edema (pulmonary and generalized) IUGR, abruptio placentae, persistent fetal hypoxia, acidosis

Question 38

Eclampsia management

Answer 38

seizures prevention- bedrest, position on side, low stimulation Diuresis is a positive sign that, along with a decrease in proteinuria, signals resolution of the disease.

Question 39

Severe preeclampsia symptoms

Answer 39

BP >160/110 & symptomatic

Question 40

HELLP syndrome

Answer 40

complication of severe preeclampsia | hemolysis, elevated liver enzymes, low platelets

Question 41

Hydramnios

Answer 41

Too much amniotic fluid in third trimester

Question 42

Oligohydramnios

Answer 42

Decreased amount of amniotic fluid

Question 43

Multiple gestation

Answer 43

More than one fetus being born to a pregnant woman

Question 44

Premature rupture of membranes

Answer 44

Water breaks after 37 weeks but before onset of labor Risk for infection if rupture is greater than 24 hours PPROM rupture before 37 weeks Amniotic fluid looks like a fern leaf under microscope Nitrazine paper --> blue=amniotic fluid