TBI Complications of Pregnancy

Question 1

threatened abortion

Answer 1

vaginal bleed before 20 wk gestation

Question 2

spontaneous abortion

Answer 2

loss of pregnancy before 20 wk gestation

Question 3

misoprostol

Answer 3

PGE1 analog

induces smc contraction in uterus

Question 4

missed abortion

Answer 4

non-viable early pregnancy

prod of conception remain in uterus

lil/no bleed

empty sac, no cardiac sounds

Question 5

inevitable abortion

Answer 5

significant volume of bleeding

cervical os is OPEN

Question 6

septic abortion

Answer 6

more assoc w/ induced abortion

fever, chills, malaise, abd pain, vaginal bleed/discharge

Question 7

most common location of ectopic pregnancy is

Answer 7

ampulla of fallopian tube

Question 8

hCG rises until

Answer 8

10 wk gestation

Question 9

hCG levels indicating intrauterine pregnancy

Answer 9

1500-2000 mIU/ml

discriminatory zone

Question 10

medical therapy for ectopic pregnancy

Answer 10

methotrexate
(folic acid antagonist)

inhibits growth of rapidly dividing cells (growing embryo)

Question 11

contraindications of methotrexate for ectopic preg

Answer 11

• embryo bigger than 4cm
• ruptured ectopic
• abd bleed signs
• hepatic/renal/pulm/peptic ulcer/immunosuppressed

Question 12

risk fx of ectopic preg

Answer 12

adhesions (PID, endometriosis, prev abd surg)

past ectopic

Question 13

Placentia previa

Answer 13

placental tissue overlying or proximate to internal cervical os

beyond 24 wk gestation

PAINLESS BLEEDING in 3rd trimester

ABSENCE of abd pain/uterine contractions

Question 14

how to distinguish Placentia previa from placental abruption

Answer 14

placenta abruption –> abd pain, uterine contractions

Question 15

hCG levels higher than 2000 are more reliable in

Answer 15

ruling out a viable pregnancy

Question 16

dx of Placentia previa

Answer 16

US

echogenic placental tissue overlying the internal cervical os

*BEFORE digital vaginal exam (may cause hemorrhage)

Question 17

probs assoc w/ placenta previa

Answer 17

• placenta accreta
• malpresentation of fetus
• preterm premature rupture of the membranes
• intrauterine growth restriction
• vasaprevia and velamentous umbilical cord
• congenital anomalies

Question 18

Placenta accreta

Answer 18

abnormal adherence to uterine wall

Question 19

placenta increta

Answer 19

abnormal adherence of placenta through myometrium

Question 20

placenta percreta

Answer 20

abnormal adherence in which placenta invades through myometrium to uterine serosa and even to adjacent organs

Question 21

vasa previa

Answer 21

velamentous cord insertion causes fetal vessels to cross over os

Question 22

velamentous placenta

Answer 22

umbilical vessels course through amnionic sac before reaching placenta, which leaves vessels unprotected/vulnerable to rupture or compression

Question 23

succenturiate lobe

Answer 23

extra placental lobe that implants at some distance from the rest of the placenta

Question 24

• vaginal bleeding
• uterine tenderness/abd or back pain
• uterine contractions
• fetal distress/demise

Answer 24

placental abruption

Question 25

risk fx for placental abruption

Answer 25

``` HTN/preeclampsia Previous placental abruption Premature rupture of membranes Multiple gestations/overdistension Polyhydramnios Cigarette smoking Trauma Cocaine abuse Advanced maternal age Abnormalities of placentation and cord Intrauterine infection ```

Question 26

uterine rupture tx

Answer 26

IMMEDIATE laparotomy with delivery of fetus and repair of uterus or hysterectomy

Question 27

vasa previa

Answer 27

rupture of fetal vessel --> perinatal mortality exceeds 50% present. .. - vag bleed - non-reassuring fetal HR pattern (sinusoidal) - need to deliver immediately by C. section

Question 28

pathogenesis of preeclampsia

Answer 28

- faulty trophoblastic vascular remodeling of uterine a.s --> placental hypoxia --> release of placental fx into maternal circulation --> dysfunction of vascular endothelium --> vasospasm, coagulation - vasoconstriction --> inc resistance and HTN - damage to endothelium --> edema and microangiopathic hemolysis from platelet adherence and fibrin deposition (thrombocytopenia) - diminished blood flow --> end-organ damage (proteinuria, hepatocellular necrosis)

Question 29

gestational HTN dx criteria

Answer 29

systolic BP greater or equal to 140 mmHg or diastolic BP greater or equal to 90 mmHg developing AFTER wk 20 in previously normotensive pt and NO proteinuria

Question 30

preeclampsia dx criteria

Answer 30

systolic BP greater or equal to 140 mmHg or diastolic BP greater or equal to 90 ^on 2 occasions at least 4 hr apart AFTER wk 20 in a previously normotensive pt AND proteinuria or inc protein/creatinine ratio

Question 31

pt with new onset HTN without proteinuria, new onset of which findings is dx of preeclampsia?

Answer 31

``` thrombocytopenia inc serum creatinine 2x normal liver transaminases pulm edema cerebral visual sx ```

Question 32

severe preeclampsia dx criteria

Answer 32

systolic greater or equal to 160 mmHg or diastolic greater or equal to 110 mmHg on 2 occasions at rest ``` also CNS dysfunction (HA) hepatic abnormality thrombocytopenia renal abnormality pulm edema ```

Question 33

hemolysis elevated LFTs low platelets

Answer 33

HELLP syndrome

Question 34

risk fx for preeclampsia

Answer 34

``` PHx of preeclampsia first preg black race Fix of preeclampsia DM chronic HTN obesity chronic kidney disease antiphospholipid Abs twin preg advanced maternal age (>40) ```

Question 35

sx of preeclampsia become apparent in most women after how many weeks gestation?

Answer 35

34

Question 36

eclampsia

Answer 36

one or more generalized convulsions and/or coma in a woman with preeclampsia in absence of other neuro conditions before, during delivery, or postpartum

Question 37

anti seizure meds for eclampsia

Answer 37

Mg sulfate

Question 38

tx of preeclampsia/eclampsia

Answer 38

DELIVERY

Question 39

HTN medical tx used dur preg

Answer 39

- methyldopa - labetalol - nifedipine (CCB) - oral hydralazine

Question 40

HTN medical tx CONTRAINDICATED dur preg

Answer 40

nitroprusside | ACEi/ARBs

Question 41

Rh antigen

Answer 41

AD inheritance | most commonly D antigen

Question 42

Ig_ readily crosses placenta

Answer 42

IgG

Question 43

anti-D Ig

Answer 43

RhoGam

Question 44

Kleihauer-Betke

Answer 44

estimate of amount of fetal cells crossed into mother | smear of mothers blood, stain for fetal red cells

Question 45

Does prior spontaneous abortion put woman at inc risk of ectopic?

Answer 45

No

Question 46

painless bleeding during preg is ____ UPO

Answer 46

placenta previa

Question 47

Is advanced maternal age a risk fx of placental abruption?

Answer 47

No

Question 48

Is HTN a risk fx of placental abruption?

Answer 48

Yes

Question 49

Is advanced maternal age a risk fx of placental previa?

Answer 49

Yes

Question 50

Is HTN a risk fx of placental previa?

Answer 50

No