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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
Complete abortion tx
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
26
Missed abortion tx
Watchful waiting. Most terminate spontaneously after 2 wks. Intervention necessary if no change after 4 wks. Tx: uterine curettage or D & C
27
Complication of Missed Abortion
Prolonged retention can result in DIC
28
Septic abortion pathogens
E. coli; Strep fecalis, and Clostridia perfringes
29
Septic abortion tx
Resuscitation, broad spectrum ABX; tetanus toxoid; Early evacuation of uterus
30
Leading cause of Pregnancy Related Maternal Death in First Trimester
Ruptured ectopic pregnancy leading to hemorrhage
31
High risk factors for Ectopic Pregnancy
Previous ectopic pregnancy; Tubal pathology & surgery; IUD
32
Why do IUDs increase risk of pregnancy?
IUD slows rate of egg travel, so ectopic common if IUD fails
33
Signs/Symptoms of Ectopic Pregnancy
Tenderness; Adnexal mass; Uterine changes; "The Triad" = Pain, Vag bleeding; Amenorrhea
34
Pitfalls in Dx Ectopic Pregnancy
Atypical/absent pain; Failure to recognize factors; Passage of uterine tissue
35
MCC of Death in Young, Healthy Pregnant Woman
Unrecognized ectopic pregnancy
36
MC location of ectopic pregnancy
Ampulla
37
Worst Ectopic Pregnancy Outcomes Location
Cornual
38
Dx of Ectopic Pregnancy
Quantitative hCG levels greater than 6000 and absence of gestational sac; OR transvaginal U/S
39
TVUS findings of Ectopic Pregnancy
Shows fluid in the cul de sac; No IUP visualized
40
Management of Stable Pt following Ectopic Pregnancy
Rh- women should be given Rhogam (50 mcg IM)
41
Medical tx of Ectopic Pregnancy
Methotrexate
42
Methotrexate in Ectopic Pregnancy
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
Methotrexate indications in pregnancy
No sonographic evidence of rupture; No fetal cardiac activity; Tubal mass
44
Contraindications of Methotrexate
Liver/renal dz; Bleeding diathesis
45
Complications of Methotrexate
DIC; Pelvic pain (even with effective tx); Ruptured ectopics can still have falling hCG
46
Signs of Methotrexate failure
Rising hCG; Decreasing hematocrit; Significant pelvic fluid; Unstable vitals
47
Surgical Tx of Ectopic Preg
Salpingostomy; Salpingectomy; Segmental resection; Fimrial resection
48
MC surgical tx of ectopic preg
Segmental resection
49
Salpingostomy
Making an incision on tube and removing pregnancy
50
Salpingectomy
Cutting tube out
51
Segmental resection
Cutting out affected portion of tube
52
Fibrial resection
"milking" the pregnancy out the end of the tube
53
Which treatment method reduces infertility after an ectopic pregnancy?
Medical tx (Methotrexate)
54
MCC of IUFD
Placental abruption
55
Placental abruption
Premature separation of placenta from uterus
56
What is the most common time for a placental abruption?
Third trimester; 80% just before onset of labor
57
Placental abruption grades
Grade 1 = Mild (40-48%); Grade 2 = Partial (27-45%); Grade 3 = Complete (15-24%)
58
External bleeding & Placental abruption grades
External grading does not necessarily correlate with grade of disruption
59
Grade 1 Placental Abruption: Mom's Vitals/Baby's Well-Being
Mom = WNL; Baby = FHR WNL
60
Grade 2 Placental Abruption: Mom's Vitals/Baby's Well-Being
``` Mom = BP nl; HR elev; Baby = FHR suggests distress ```
61
Grade 3 Placental Abruption: Mom's Vitals/Baby's Well-Being
``` Mom = BP low; HR elev; Baby = Fetal demise ```
62
Uterine Irritability
Grade 1 = Some irritability; Grade 2 = Irritability or tetany; Grade 3 = Tetany or pain
63
Placental Abruption Risk Factors
Maternal HTN associated with Grade 3; COCAINE; Predisposed to vascular dz.; Tobacco; Trauma; Chorio; Age > 35; PROM; Elevated AFP in 2nd trimester
64
Leading cause of Placental Abruption
Spousal abuse
65
Management of Placental Abruption
Fluids; Correction of coagulopathy; RhoGAM; Manage fetus (viable? C-section?)
66
Placenta Previa
PAINLESS!!! Sudden, profuse bleeding in 3rd trimester. Improper implantation of the placenta over the cervix.
67
3 types of Placenta Previa
Marginal; Partial; Complete
68
DX of Placenta Previa
U/S
69
#1 cause of neonatal morbidity and mortality
Preterm Labor
70
Preterm Labor Dx
Reg, painful contractions (4@20 min or 8@60 min) AND Cervical dilation/effacement
71
Tx of Preterm Labor
Mag Sulfate or Nifedipine
72
Maternal contraindications to tocolysis
Severe maternal HTN; Pulm or cardiac dz; Advanced cervical dilation (>4cm); MATERNAL HEMORRHAGE!!!
73
Fetal contraindications to tocolysis
Fetal death or lethal anomaly; Fetal distress; Chorio; Hydrops; Severe intrauterine growth restriction
74
Cerclage
Tx for cervical incompetence
75
Cervical Incompetence
Painless cervical changes in 2nd trimester with recurrent preg loss
76
Pre-eclampsia dx
SBP >140; DBP > 90; Proteinuria >0.3 g in 24 hr urine; BP should be sustained; Repeat BP measurement
77
S/Sx of Pre-eclampsia
Edema of hands/face; Hyperreflexic DTR; Visual disturbances
78
Mild Pre-eclampsia tx
Bed rest; U/S for growth & fluid; Kick count;
79
Severe Pre-eclampsia tx
Bed rest & decreased stimuli; MgSO4; Steroids for FLM; Delivery
80
S/Sx of Eclampsia
Same as pre-eclampsi AND facial twitching, tonic-clonic seizure
81
HELLP Syndrome S/Sx
RUQ pain; N/V; Edema; Decreased H&H, Decreased plts; Increased LFTs; Jaundice; Visual changes
82
HELLP Syndrome Dx
Plt 600 IU/L; | AST >70 IU/L (nl = 40)
83
Tx of Eclampsia & HELLP
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
Eclampsia & HELLP outcomes
DIC!
85
GBS in Preg
Frequent cause of asymptomatic bacteriuria, UTI, Chorio
86
2nd most common cause of bacteremia
GBS
87
Risk factor of GBS
Intrapartum fever >100.4F; PROM >18 hr; Prev delivery of affected infant; GBS bacteriuria during preg
88
When to screen for GBS
35-37 wks, unless GBS on urine culture or previously affected infant
89
GBS tx
ABX prophylaxis at least 4 hr before delivery; PCN G Amp PCN Allergy? - Clinda or Vanc
90
Early Onset (
Septicemia; shock; pneumonia; and/or meningitis
91
Late Onset (7-89 d) Neonatal complicationso of GBS
Meningitis
92
PROM Risk Factors
Maternal infxn (any); Intrauterine infxn; CERVICAL INCOMPENCY; Multiple prev preg; Polyhydramnios; FH of PROM
93
PROM DX
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
Primary complication of PROM
Chorio
95
Management of Chorio d/t PROM
Deliver & start ABX
96
Management of Pre-PROM
ABX; Steroids; Tocolytics for transport to large hospital

PoM II - Final Exam (12 decks)

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