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PoM II - Final Exam > 12. Preg Complications > Flashcards

12. Preg Complications Flashcards

1
Q

Spontaneous abortion/Miscarriage

A

Ends before 20 weeks; 80% occur within 1st 12 wks; 1 in 5 pregnancies end in miscarriage

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2
Q

Preterm Birth

A

Delivery of live infant prior to 37 wks; Incidence = 5-10%

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3
Q

IUFD

A

Intrauterine Fetal Demise - Fetal death in utero after 20 weeks or > 500 grams

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4
Q

General categories of IUFD Causes

A

Maternal, Fetal, Placental

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5
Q

Stillbirth

A

Delivery of fetus after 20 wks without evidence of life; Most stillbirths are actually IUFDs because most don’t die during delivery

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6
Q

Single most important test for a reproductive aged female with abdominal pain

A

Pregnancy test

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7
Q

Induced abortion

A

Planned procedure

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8
Q

Spontaneous abortion

A

Passage of fetus

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9
Q

Complete abortion

A

Spontaneous abortion of all products of conception

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10
Q

Incomplete abortion

A

Spontaneous abortion where some tissue is retained

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11
Q

MC reason for ER visit d/t abortion

A

Incomplete abortion resulting in hemorrhaging

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12
Q

Threatened abortion

A

Less than 20 weeks with viable pregnancy, vaginal bleeding & CLOSED CERVIX

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13
Q

Inevitable abortion

A

Less than 20 weeks, vaginal bleeding & DILATED CERVIX; preg loss unavoidable

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14
Q

Missed abortion

A

Retention of a failed IUP

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15
Q

Septic abortion

A

Any type of abortion complicated by a pelvic infection

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16
Q

Recurrent abortion

A

2 or more consecutive or a total of 3 spontaneous abortions

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17
Q

MCC of abortion in 1st 10 weeks

A

Genetic abnormality; 70% trisomies (Trisomy 16 MC)

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18
Q

MCC of abortion in weeks 14-18

A

Less likely genetic; More likely = maternal illness, uterine abnormality; placental factor; incompetent cervix

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19
Q

S/Sx of Abortion

A

HCG not properly increasing (should double every 48 hr in 1st trimester)

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20
Q

Blighted Ovum

A

AKA Anembryonic pregnancy = Failed development of the embryo so that only a gestational sac, with or without a yolk sac, is present

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21
Q

Complications of Abortion

A

Hemorrhage (MC); Sepsis; Emotional/Psychological

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22
Q

Threatened abortion tx

A

Bed rest (no data to support); Pelvic rest (NO INTERCOURSE!)

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23
Q

Incomplete abortion tx

A

Type & Screen; Rhogam; OB consult; Prep for OR or D&C

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24
Q

What should happen if patient with incomplete abortion passes a lot of tissue & cervix is open?

A

Avoid surgery if tissue is passed.

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25
Q

Complete abortion tx

A

Cervix is closed; pain and bleeding decrease. U/S shows no IUP and no ectopic. Re-exam shows closed os. Eval need for transfusion; Cytotec & RTC in 1 wk

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26
Q

Missed abortion tx

A

Watchful waiting. Most terminate spontaneously after 2 wks. Intervention necessary if no change after 4 wks.

Tx: uterine curettage or D & C

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27
Q

Complication of Missed Abortion

A

Prolonged retention can result in DIC

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28
Q

Septic abortion pathogens

A

E. coli; Strep fecalis, and Clostridia perfringes

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29
Q

Septic abortion tx

A

Resuscitation, broad spectrum ABX; tetanus toxoid; Early evacuation of uterus

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30
Q

Leading cause of Pregnancy Related Maternal Death in First Trimester

A

Ruptured ectopic pregnancy leading to hemorrhage

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31
Q

High risk factors for Ectopic Pregnancy

A

Previous ectopic pregnancy; Tubal pathology & surgery; IUD

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32
Q

Why do IUDs increase risk of pregnancy?

A

IUD slows rate of egg travel, so ectopic common if IUD fails

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33
Q

Signs/Symptoms of Ectopic Pregnancy

A

Tenderness; Adnexal mass; Uterine changes; “The Triad” = Pain, Vag bleeding; Amenorrhea

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34
Q

Pitfalls in Dx Ectopic Pregnancy

A

Atypical/absent pain; Failure to recognize factors; Passage of uterine tissue

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35
Q

MCC of Death in Young, Healthy Pregnant Woman

A

Unrecognized ectopic pregnancy

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36
Q

MC location of ectopic pregnancy

A

Ampulla

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37
Q

Worst Ectopic Pregnancy Outcomes Location

A

Cornual

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38
Q

Dx of Ectopic Pregnancy

A

Quantitative hCG levels greater than 6000 and absence of gestational sac; OR transvaginal U/S

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39
Q

TVUS findings of Ectopic Pregnancy

A

Shows fluid in the cul de sac; No IUP visualized

40
Q

Management of Stable Pt following Ectopic Pregnancy

A

Rh- women should be given Rhogam (50 mcg IM)

41
Q

Medical tx of Ectopic Pregnancy

A

Methotrexate

42
Q

Methotrexate in Ectopic Pregnancy

A

Inhibits rapidly growing cells; Peak serum concentrations occur 2 hr after IM dose; half-life = 2-4 hr; remains in breast milk up to 6 mo

43
Q

Methotrexate indications in pregnancy

A

No sonographic evidence of rupture; No fetal cardiac activity; Tubal mass

44
Q

Contraindications of Methotrexate

A

Liver/renal dz; Bleeding diathesis

45
Q

Complications of Methotrexate

A

DIC; Pelvic pain (even with effective tx); Ruptured ectopics can still have falling hCG

46
Q

Signs of Methotrexate failure

A

Rising hCG; Decreasing hematocrit; Significant pelvic fluid; Unstable vitals

47
Q

Surgical Tx of Ectopic Preg

A

Salpingostomy; Salpingectomy; Segmental resection; Fimrial resection

48
Q

MC surgical tx of ectopic preg

A

Segmental resection

49
Q

Salpingostomy

A

Making an incision on tube and removing pregnancy

50
Q

Salpingectomy

A

Cutting tube out

51
Q

Segmental resection

A

Cutting out affected portion of tube

52
Q

Fibrial resection

A

“milking” the pregnancy out the end of the tube

53
Q

Which treatment method reduces infertility after an ectopic pregnancy?

A

Medical tx (Methotrexate)

54
Q

MCC of IUFD

A

Placental abruption

55
Q

Placental abruption

A

Premature separation of placenta from uterus

56
Q

What is the most common time for a placental abruption?

A

Third trimester; 80% just before onset of labor

57
Q

Placental abruption grades

A

Grade 1 = Mild (40-48%); Grade 2 = Partial (27-45%); Grade 3 = Complete (15-24%)

58
Q

External bleeding & Placental abruption grades

A

External grading does not necessarily correlate with grade of disruption

59
Q

Grade 1 Placental Abruption: Mom’s Vitals/Baby’s Well-Being

A

Mom = WNL; Baby = FHR WNL

60
Q

Grade 2 Placental Abruption: Mom’s Vitals/Baby’s Well-Being

A 
Mom = BP nl; HR elev;  
Baby = FHR suggests distress
61
Q

Grade 3 Placental Abruption: Mom’s Vitals/Baby’s Well-Being

A 
Mom = BP low; HR elev;  
Baby = Fetal demise
62
Q

Uterine Irritability

A

Grade 1 = Some irritability; Grade 2 = Irritability or tetany; Grade 3 = Tetany or pain

63
Q

Placental Abruption Risk Factors

A

Maternal HTN associated with Grade 3; COCAINE; Predisposed to vascular dz.; Tobacco; Trauma; Chorio; Age > 35; PROM; Elevated AFP in 2nd trimester

64
Q

Leading cause of Placental Abruption

A

Spousal abuse

65
Q

Management of Placental Abruption

A

Fluids; Correction of coagulopathy; RhoGAM; Manage fetus (viable? C-section?)

66
Q

Placenta Previa

A

PAINLESS!!! Sudden, profuse bleeding in 3rd trimester. Improper implantation of the placenta over the cervix.

67
Q

3 types of Placenta Previa

A

Marginal; Partial; Complete

68
Q

DX of Placenta Previa

69
Q

1 cause of neonatal morbidity and mortality

A

Preterm Labor

70
Q

Preterm Labor Dx

A

Reg, painful contractions (4@20 min or 8@60 min) AND Cervical dilation/effacement

71
Q

Tx of Preterm Labor

A

Mag Sulfate or Nifedipine

72
Q

Maternal contraindications to tocolysis

A

Severe maternal HTN; Pulm or cardiac dz; Advanced cervical dilation (>4cm); MATERNAL HEMORRHAGE!!!

73
Q

Fetal contraindications to tocolysis

A

Fetal death or lethal anomaly; Fetal distress; Chorio; Hydrops; Severe intrauterine growth restriction

74
Q

Cerclage

A

Tx for cervical incompetence

75
Q

Cervical Incompetence

A

Painless cervical changes in 2nd trimester with recurrent preg loss

76
Q

Pre-eclampsia dx

A

SBP >140; DBP > 90; Proteinuria >0.3 g in 24 hr urine; BP should be sustained; Repeat BP measurement

77
Q

S/Sx of Pre-eclampsia

A

Edema of hands/face; Hyperreflexic DTR; Visual disturbances

78
Q

Mild Pre-eclampsia tx

A

Bed rest; U/S for growth & fluid; Kick count;

79
Q

Severe Pre-eclampsia tx

A

Bed rest & decreased stimuli; MgSO4; Steroids for FLM; Delivery

80
Q

S/Sx of Eclampsia

A

Same as pre-eclampsi AND facial twitching, tonic-clonic seizure

81
Q

HELLP Syndrome S/Sx

A

RUQ pain; N/V; Edema; Decreased H&H, Decreased plts; Increased LFTs; Jaundice; Visual changes

82
Q

HELLP Syndrome Dx

A

Plt 600 IU/L;

AST >70 IU/L (nl = 40)

83
Q

Tx of Eclampsia & HELLP

A

DELIVERY if fetus >34 wk, or nonreassuring tests of fetal status; Presence of severe maternal dz

Medical tx:
MgSO4
Hydralazine
Steroids to improve fetal lung maturity

84
Q

Eclampsia & HELLP outcomes

85
Q

GBS in Preg

A

Frequent cause of asymptomatic bacteriuria, UTI, Chorio

86
Q

2nd most common cause of bacteremia

87
Q

Risk factor of GBS

A

Intrapartum fever >100.4F; PROM >18 hr; Prev delivery of affected infant; GBS bacteriuria during preg

88
Q

When to screen for GBS

A

35-37 wks, unless GBS on urine culture or previously affected infant

89
Q

GBS tx

A

ABX prophylaxis at least 4 hr before delivery;

PCN G
Amp
PCN Allergy? - Clinda or Vanc

90
Q

Early Onset (

A

Septicemia; shock; pneumonia; and/or meningitis

91
Q

Late Onset (7-89 d) Neonatal complicationso of GBS

A

Meningitis

92
Q

PROM Risk Factors

A

Maternal infxn (any); Intrauterine infxn; CERVICAL INCOMPENCY; Multiple prev preg; Polyhydramnios; FH of PROM

93
Q

PROM DX

A

Sterile speculum exam:
Pooling in posterior fornix
Nitrazine (litmus pape) - Blue = alkaline (pH 7-7.25)
Ferning - Fluid dried on slides looks like ferns

94
Q

Primary complication of PROM

95
Q

Management of Chorio d/t PROM

A

Deliver & start ABX

96
Q

Management of Pre-PROM

A

ABX; Steroids; Tocolytics for transport to large hospital

PoM II - Final Exam (12 decks)

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