Abnormal pregnancy Flashcards
Implantation to site other than endometrial cavity
Ectopic pregnancy
Implantation to site other than endometrial cavity
Ectopic pregnancy
Most common site of ectopic pregnancy
Ampulla of fallopian tube
When ampullary pregnancy raptures
8-12wks
When isthmic pregnancy raptures
6-8wks
Why is the incidence of ectopic pregnancy decreasing
Early detection and tx
Pathophys of ectopic pregnancy
Impaired ability of tube to transport gametes/embryo
pt presentation of ectopic pregnancy
Pelvic/abd pain
Bleeding
Unitlat. adnexal pain w/ spotting or amenorrhea
Diagnostic test of choice for ectopic pregnancy
Trans vaginal U/S
QhCG pattern in normal pregnancy
rise min of 58% over 48hrs
Serum progesterone that signifies abn pregnancy
Unequivocal progesterone range (non conclusive)
5-20
Unequivocal progesterone range (non conclusive)
5-20
Most common site of ectopic pregnancy
Ampulla of fallopian tube
When ampullary pregnancy raptures
8-12wks
When isthmic pregnancy raptures
6-8wks
Why is the incidence of ectopic pregnancy decreasing
Early detection and tx
Pathophys of ectopic pregnancy
Impaired ability of tube to transport gametes/embryo
pt presentation of ectopic pregnancy
Pelvic/abd pain
Bleeding
Unitlat. adnexal pain w/ spotting or amenorrhea
Diagnostic test of choice for ectopic pregnancy
Trans vaginal U/S
Tumor development from aberrant fertilization event derived from abnormal placental proliferation
Gestational trophoblastic disease
Serum progesterone that signifies abn pregnancy
Is an abn serum progesterone indicative of location
No
Unequivocal progesterone range (non conclusive)
5-20
What does pregnancy of unknown location signify
Ectopic pregnancy. find it
QhCG for normal intrauterine pregnancy (IUP)
1500-2000
Complete mole
Grape like vessicles/snow storm appearance
higher QhCG levels
Larger uterus than expected
45XX (46XX) or 46XY
How do you follow a pregnancy of unknown location
TV U/S
Serial QhCG levels q 48h
+/- laparoscopy/MRI
Partial mole
Less advanced milder focal changes and complications but fetal /embryonic structures present
69XXX or 69XXY
Surgical tx for ectopic pregnancy
Laparotomy vs laparoscopy
Salpingectomy vs salpingostomy (incr chance of ectopic pregnancy)
What do maternal genes influence
fetal growth
What is the biggest consideration in the decision for medical vs surgical mgt for ectopic pregnancy
Reliable follow up (if unreliable = surgical)
Tumor development from aberrant fertilization event derived from abnormal placental proliferation
Gestational trophoblastic disease
Tumor marker for GTD
hCG
Classifications of GTD
Hydatidiform mole (benign)
Choriocarcinoma
Gestational trophoblastic neoplasia
Placental site trophoblastic tumor
Most common form of GTD
Hydatidiform mole
Risk factors for hydatidiform mole
age 35
Prev GTD
xtics of hydatidiform mole
abnormalities of chorionic villi and prolif and edema of villous stroma
Complete mole
Grape like vessicles/snow storm appearance
higher QhCG levels
Larger uterus than expected
Complications of complete mole
Gestational HTN (
Partial mole
Less advanced milder focal changes and complications but fetal /embryonic structures present
What do paternal genes influence
Placental growth
What do maternal genes influence
fetal growth
Definitive tx for hydatidiform mole
Evacuation of uterine contents/hysterectomy
for how long QhCG be monitored
6-12mos; if persistent, treat for choriocarcinoma
Chronic HTN in pregnancy
HTN present before pregnancy or before 20 wks
Gestational HTN
HTN after 20 wks w/out proteinuria
Pre-eclampsia
HTN after 20wks w/out prev hx of HTN + Proteinuria
Eclampsia
Pre-eclampsia w/ new onset of convulsions
Superimposed pre-eclamsia/eclampsia
Pre-eclampsia/eclampsia in woman w/ pre-existing chronic HTN
HELLP syndrome
Hemolysis
Elevated Liver enzymes
Low plateletes
How do you follow HELLP syndrome
CBC/CMP
Signs and sys of Pre-eclampsia
HTN Proteinuria Edema H/A N/V, hyper-reflexia, Oliguria, Blurred vision, scotoma, epigastric pain
Mild pre-eclampsia
BP >140/90 on 2 occasions at least 6hrs apart
300mg proteinuria on 24hr urine (2+ on dipstick)
Severe pre-eclampsia
BP > 160/110 on 2 occasions at least 6hrs apart
5g proteinuria on 24hr urine
Signs/sxs of end organ damage
Fetal growth restriction
Definitive tx for pre-eclampsia
Delivery
Pre-eclampsia mgt
Reduced activity
Labs (CBC/CMP/Uric acid)
Glucocorticoids if
Intrauterine growth restriction (Fetal growth restriction)
Birth weight or estimated fetal weight
At what percentile is neonatal death significantly decreased
≤3rd percentile
Maternal etiology for IUGR
Extremes of age (35) smoking, substance abuse, HTN , anemia, DM, SLE, malnutrition, renal dz
Placental etiology for IUGR
1˚ placental disease, uterine abnormalities
Fetal etiology for IUGR
Multiple gestation, genetic disorders, teratogens, infection: TORCH (toxoplasmosis, Other-Varicella, Syphillis,Rubella, CMV, HSV
Diagnostics for IUGR
Fundal height measurements
U/S (confirmatory)
*doppler velocimetry of umbilical artery: helpful after
*mean cerebellar artery doppler: most diagnostic
IUGR mgt
Fetal surveillance
*NST: -ve predictive value for acidosis
*Biophysical profile w/ UA doppler: fetal tone, movt, breathing, NST, amniotic fluid vol (2 pts. each) 1-2x/wk
Glucocorticoids if
Normal BPP values
≥8
how do you decide when to deliver in the mgt of IUGR
Risk of fetal death > risk of neonatal death
Hallmark of GDM
Insulin resistance
Risk factors for GDM
FH of DM, BMI>30 ,age >25, Hx of macrosomia, PCOS, Hx of unexplained still birth, Prior hx of GDM, HTN
Maternal and fetal complications of GDM
Pre-eclampsia, still birth, macrosomia, shoulder dystocia, C-section
Infant complications of GDM
Hypoglycemia, Hyperbilirubinemia, Hypocalcemia, RDS, obesity, glucose intolerance
When do you do the GDM screen
24-28 wks; screen earlier of +ve risk factors
GDM screen
50g 1hr OGTT (+ve if >130-140)
GDM Dx
100g 3hr OGTT (+ve if >130-140): 2 or more elevated values
When do you not need to do a 3hr OGTT to dx GDM
if 1hr OGTT is >200
GDM glucose goal
70-95 fasting glucose
GDM nutrition goal
1800-2400 calorie diet
Initial mgt of GDM
Tight glycemic control
Nutrition control
Exercise
Pharmacologic mgt of GDM
Insulin +/- Glyburide
When should pts. w/ GDM hv a 2hr 75g OGTT
6wks post partam
What considerations need to be made for Class A2 GDM or higher
if est. weight >4500g consider C/S to avoid shoulder dystocia
Preterm labor
Regular contractions after 20wks but before 37 wks resulting in cervical changes
etiology for preterm labor
- Following PPROM
- Deliberate intervention (eclampsia)
Diagnostics for pre-term labor
R/O ROM
Digital cervical exam
U/S for cervical length
UA w/ C&S
GBS culture +/- vaginal culture for CT, GC, BV
+/- NST
Fetal fibronectin (High glycoprotein levels in maternal blood and amniotic fluid before term - measured at 24 wks
Absent fibronectin at 24 wks
no pre-term labor for 2wks (-ve predictive value)
Positive fibronectin at 24 wks
Risk for pre-term labor, give Betamethasone (corticosteroids)
Mgt pre-term labor
Hospitalization
Corticosteroids (24-34wks)
Tocolytics (Beta-mimetic: terbutaline, CCB, Indomethacin, Mag sulfate: neuroprotective against cerebral palsy)
How to prevent pre-term labor
Smoking cessation
Progesterone supplementation in pts. w/ prev preterm birth starting at 16-20 wks to 36wks
