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Women's Health > Abnormal Pregnancy > Flashcards

Abnormal Pregnancy Flashcards

1
Q

MC location of ectopic pregnancy…

A

fallopian tube

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2
Q

pt. p/w:

1st trimester vaginal bleeding

abd. pain

hypotension/tachy

uterine enlargement/tenderness

what should you be concerned for?

A

ectopic pregnancy

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3
Q

progesterone < ____ = abnormal pregnancy

A

< 5

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4
Q

once discriminatory zone of beta hCG is reached, imaging can be performed.

5 weeks gestation the _____ sign is present

A

double ring sign

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5
Q

once discriminatory zone of beta hCG is reached, imaging can be performed.

5.5-6 weeks gestation the _____ can be detected

A

fetal pole w. cardiac activity

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6
Q

if pregnant but unable to locate on imaging, what classification?

A

pregnancy of unknown location

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7
Q

Expectant, medical and surgical mgmt of ectopic pregnancy…

A

expectant: serial beta hCGs q 48-72 hours
medical: MTX
surg: salpingectomy/salpingostomy

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8
Q

what patients w. ectopic pregnancy can be expectantly managed

A

asx

reliable

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9
Q

MTX targets ______ tissue

A

actively replicating tissue

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10
Q

major SE of MTX

A

abd. pain

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11
Q

the below are candidates for…

hemodynamic stability
unruptured mass
reliable for f/u

A

MTX

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12
Q

With medical mgmt and surgical mgmt of ectopic pregnancy, serial hCG should be completed until…

A

non-pregnancy level reached

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13
Q

overall effectiveness of medical mgmt of ectopic pregnancy

A

70-95%

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14
Q

which ectopic pregnancy procedure?

severe tubal damage

significant bleeding

A

salpingectomy

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15
Q

what condition?

abnormal proliferation of trophoblast/placental tissue

A

gestational trophoblastic disease

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16
Q

MC gestational trophoblastic disease

A

hydatidiform mole

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17
Q

This gestational trophoblastic disease is paternally derived and has the absence of a fetus

A

complete hydatidiform mole

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18
Q

Pt. p/w:

vaginal bleeding
enlarged uterus

+/- hyperthyroid, pre-eclampsia, hyperemesis, theca lutein cysts

A

complete hydatidiform mole

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19
Q

Snow storm appearance on US

A

complete hydatidiform mole

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20
Q

definitive dx of complete hydatidiform mole requires…

A

tissue bx

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21
Q

tx of complete hydatidiform mole

A

removal of uterine products

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22
Q

monitoring for future pregnancies if complete hydatidiform mole

A

early US and hCG

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23
Q

This gestational trophoblastic disease is maternally and paternally derived with the presence of a fetus

A

partial hydatidiform mole

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24
Q

this occurs when a normal ovum is fertilized by two sperm simultaneously

A

partial hydatidiform mole

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25
Q

swiss cheese appearance on intrauterine US

A

partial hydatidiform mole

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26
Q

Tx of partial hydatidiform mole

A

immediate removal of uterine contents

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27
Q

US shows intrauterine mass and increased vascularity of myometrium

A

invasive molar pregnancy

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28
Q

Tx of invasive molar pregnancy

A

single agent chemo (MTX or actinomycin D)

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29
Q

1st line anti-emetics for hyperemesis gravidarum

A

vitamin b6, doxylamine

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30
Q

2nd line for hyperemesis gravidarum

A

H1 antagonists

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31
Q

this occurs when women is Rh negative and fetus is Rh positive

A

Rh incompatibility and alloimmunization

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32
Q

Tx for Rh incompatibility and alloimmunization

A

RhoGAM (prevent sensitization)

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33
Q

leading cause of maternal morbidity/mortality…

A

HTN

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34
Q

time cutoff for chronic vs gestational HTN

A

20 weeks

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35
Q

HTN after 20 weeks gestation + proteinuria or severe features…

A

pre-eclampsia

36
Q

when does pre-eclampsia become eclapsia?

A

seizure onset

37
Q

what causes pre-eclampsia’s failure to establish adequate uteroplacental blood flow?

A

failure of spinal a. remodeling

38
Q

Pt. p/w:

new onset htn
proteinuria
non-tx responsive HA
scotomata

A

pre-eclampsia

39
Q

2 dx for pre-eclamsia

A

2+ elevated BPs 4 hours apart

presistent BP > 160/110 requiring IV tx

40
Q

pre-eclamspia = ____mg of total prot and total Cr clearance during 24 hour uring collection…

A

300 mg

41
Q

urine prot/Cr x 1000/greater than ____mg for pre-eclampsia

A

300mg

42
Q

pre-eclampsia w/out severe features, delivery occurs at _____ and lab frequency of…

A

37 0/7 gestation

weekly outpatient labs

43
Q

pre-eclampsia with severe features requires delivery at ____ and lab frequency of…

A

34 weeks

twice weekly inpatient labs

44
Q

severe pre-eclampsia tx:

A

IV labetalol, hydralazine, PO nifedipine

Mg sulfate for seizure prophylaxis

GCs for fetal lung maturity

45
Q

This is a syndrome a/w hemolysis, elevated LFTs and low platelet count

it is a severe form of preeclampsia

A

HELLP syndrome

46
Q

in addition to preeclampsia tx, what is added…

A

platelet transfusion if < 50 for c-section

< 20 for vaginal delivery

47
Q

intrauterine growth restriction occurs if estimated fetal weight is below _____ percentile for gestational age

A

10th percentile

48
Q

TORCH infx cause intrauterine growth restriction… what are TORCH infx?

A 
toxoplasmosis
other (syphilis, varicella)
rubella
cmv
hsv
49
Q

what imaging is used to evaluate EFW?

A

US

50
Q

IUGR management

A

US q 3 weeks

twice weekly biophysical profile and nonstress test

fetal kick counts

51
Q

OGTT for gestational diabetes is completed at _____. (+) result is ____

A

24-28 weeks

(+) if > 199 on 2 or more dx

52
Q

1st line in gestational DM

A

insulin

53
Q

preterm labor is regular contractions after…

A

20 weeks

54
Q

Evaluation of pretern labor (6)

A 
r/o ROM
digital cervical exam
US (cervical length)
UA + cx
GBS cx
fetal fibronectin
55
Q

if no ____ is present in cervicovaginal secretions during preterm contractions, then it is 99% predictive of no preterm labor for 2 weeks

A

fetal fibronectin

56
Q

Uterine contractions + what 3 factors = preterm labor

A

cervical dilation (3+)

cervical length < 20mm

cervical length < 30 + (+) Ffn

57
Q

inpatient Tx for preterm labor (4)

A

betamethasone
tocolytics x 48 hours
Mg sulfate
abx

58
Q

The below are what class of drugs for preterm labor?

beta-mimetics (terbutaline)
CCBs (nifedipine)
NSAIDs (indomethacin)
Mg Sulfate

A

tocolytics

59
Q

placental location close to or over internal cervical os…

A

placenta previa

60
Q

4 degrees of previa

A

complete
partial
marginal
low lying

61
Q

Pt. p/w

moderate to severe painless AUB in 2nd/3rd trimester

A

placenta previa

62
Q

Dx procedure for placenta previa

A

transabd. US then confirm with transvaginal US

63
Q

what must always be avoided in placenta previa pt?

A

bimanual exam

64
Q

placenta previa deliver occurs via…

A

c section

65
Q

premature separation of normally implanted placenta during 2nd/3rd trimester

A

abruptio placentae

66
Q

3 types of abruptio placenta

A

marginal
partial
complete

67
Q

major RF for abruptio placenta

A

abd. trauma

68
Q

pt p/w:

vaginal hemorrhage
abd. pain
fetal distress
irritable uterus
DIC
A

abruptio placetae

69
Q

what should be administered if abruptio placentae in < 37 week gestation?

A

CS

70
Q

fetal blood vessels running unsupported thru membranes over cervix and under presenting fetal part…

can lead to rupture

A

vasa previa

71
Q

Pt. p/w:

vaginal bleeding upon rupture of membrane (ROM)

changes in fetal HR tracing

A

vasa previa

72
Q

Dx of vasa previa…

A

doppler US

73
Q

Mgmt of vasa previa (4)

A

inpatient if 3rd trimester

CS between 28-32 wks

pelvic rest

c section at 35 wks

74
Q

This condition can cause preterm labor, prolapse of cord, placental abruption, uterine infx

A

premature rupture of membranes

75
Q

_____ doubles the risk fo PROM

A

smoking

76
Q

in PROM, ____ confirms leaking of fluid

A

nitrazine paper

77
Q

cause of postterm pregnancy

A

inaccurate gestational age

78
Q

induction of postterm pregnancy should occur…

A

at 41 weeks

79
Q

mgmt of breech position…

A

external cephalic version at 36 weeks

80
Q

Tx of cord prolapse…

A

trendelenburg

immediate c section

81
Q

Adverse response of fetus to the stress of
labor contractions usually reflected in the
interpretation of the fetal heart rate
pattern.

A

fetal intolerance to labor

82
Q

is vaginal birth after cesarean safe?

A

yes

83
Q

major risk of vaginal birth after cesarean

A

uterine rupture

84
Q

fetal risk of Trial of labor after cesarean

A

neonatal/perinatal mortality

85
Q

MC cause of PPH

A

uterine atony

Women's Health (10 decks)

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