Abnormal Pregnancy Flashcards
MC location of ectopic pregnancy…
fallopian tube
pt. p/w:
1st trimester vaginal bleeding
abd. pain
hypotension/tachy
uterine enlargement/tenderness
what should you be concerned for?
ectopic pregnancy
progesterone < ____ = abnormal pregnancy
< 5
once discriminatory zone of beta hCG is reached, imaging can be performed.
5 weeks gestation the _____ sign is present
double ring sign
once discriminatory zone of beta hCG is reached, imaging can be performed.
5.5-6 weeks gestation the _____ can be detected
fetal pole w. cardiac activity
if pregnant but unable to locate on imaging, what classification?
pregnancy of unknown location
Expectant, medical and surgical mgmt of ectopic pregnancy…
expectant: serial beta hCGs q 48-72 hours
medical: MTX
surg: salpingectomy/salpingostomy
what patients w. ectopic pregnancy can be expectantly managed
asx
reliable
MTX targets ______ tissue
actively replicating tissue
major SE of MTX
abd. pain
the below are candidates for…
hemodynamic stability
unruptured mass
reliable for f/u
MTX
With medical mgmt and surgical mgmt of ectopic pregnancy, serial hCG should be completed until…
non-pregnancy level reached
overall effectiveness of medical mgmt of ectopic pregnancy
70-95%
which ectopic pregnancy procedure?
severe tubal damage
significant bleeding
salpingectomy
what condition?
abnormal proliferation of trophoblast/placental tissue
gestational trophoblastic disease
MC gestational trophoblastic disease
hydatidiform mole
This gestational trophoblastic disease is paternally derived and has the absence of a fetus
complete hydatidiform mole
Pt. p/w:
vaginal bleeding
enlarged uterus
+/- hyperthyroid, pre-eclampsia, hyperemesis, theca lutein cysts
complete hydatidiform mole
Snow storm appearance on US
complete hydatidiform mole
definitive dx of complete hydatidiform mole requires…
tissue bx
tx of complete hydatidiform mole
removal of uterine products
monitoring for future pregnancies if complete hydatidiform mole
early US and hCG
This gestational trophoblastic disease is maternally and paternally derived with the presence of a fetus
partial hydatidiform mole
this occurs when a normal ovum is fertilized by two sperm simultaneously
partial hydatidiform mole
swiss cheese appearance on intrauterine US
partial hydatidiform mole
Tx of partial hydatidiform mole
immediate removal of uterine contents
US shows intrauterine mass and increased vascularity of myometrium
invasive molar pregnancy
Tx of invasive molar pregnancy
single agent chemo (MTX or actinomycin D)
1st line anti-emetics for hyperemesis gravidarum
vitamin b6, doxylamine
2nd line for hyperemesis gravidarum
H1 antagonists
this occurs when women is Rh negative and fetus is Rh positive
Rh incompatibility and alloimmunization
Tx for Rh incompatibility and alloimmunization
RhoGAM (prevent sensitization)
leading cause of maternal morbidity/mortality…
HTN
time cutoff for chronic vs gestational HTN
20 weeks
HTN after 20 weeks gestation + proteinuria or severe features…
pre-eclampsia
when does pre-eclampsia become eclapsia?
seizure onset
what causes pre-eclampsia’s failure to establish adequate uteroplacental blood flow?
failure of spinal a. remodeling
Pt. p/w:
new onset htn
proteinuria
non-tx responsive HA
scotomata
pre-eclampsia
2 dx for pre-eclamsia
2+ elevated BPs 4 hours apart
presistent BP > 160/110 requiring IV tx
pre-eclamspia = ____mg of total prot and total Cr clearance during 24 hour uring collection…
300 mg
urine prot/Cr x 1000/greater than ____mg for pre-eclampsia
300mg
pre-eclampsia w/out severe features, delivery occurs at _____ and lab frequency of…
37 0/7 gestation
weekly outpatient labs
pre-eclampsia with severe features requires delivery at ____ and lab frequency of…
34 weeks
twice weekly inpatient labs
severe pre-eclampsia tx:
IV labetalol, hydralazine, PO nifedipine
Mg sulfate for seizure prophylaxis
GCs for fetal lung maturity
This is a syndrome a/w hemolysis, elevated LFTs and low platelet count
it is a severe form of preeclampsia
HELLP syndrome
in addition to preeclampsia tx, what is added…
platelet transfusion if < 50 for c-section
< 20 for vaginal delivery
intrauterine growth restriction occurs if estimated fetal weight is below _____ percentile for gestational age
10th percentile
TORCH infx cause intrauterine growth restriction… what are TORCH infx?
toxoplasmosis other (syphilis, varicella) rubella cmv hsv
what imaging is used to evaluate EFW?
US
IUGR management
US q 3 weeks
twice weekly biophysical profile and nonstress test
fetal kick counts
OGTT for gestational diabetes is completed at _____. (+) result is ____
24-28 weeks
(+) if > 199 on 2 or more dx
1st line in gestational DM
insulin
preterm labor is regular contractions after…
20 weeks
Evaluation of pretern labor (6)
r/o ROM digital cervical exam US (cervical length) UA + cx GBS cx fetal fibronectin
if no ____ is present in cervicovaginal secretions during preterm contractions, then it is 99% predictive of no preterm labor for 2 weeks
fetal fibronectin
Uterine contractions + what 3 factors = preterm labor
cervical dilation (3+)
cervical length < 20mm
cervical length < 30 + (+) Ffn
inpatient Tx for preterm labor (4)
betamethasone
tocolytics x 48 hours
Mg sulfate
abx
The below are what class of drugs for preterm labor?
beta-mimetics (terbutaline)
CCBs (nifedipine)
NSAIDs (indomethacin)
Mg Sulfate
tocolytics
placental location close to or over internal cervical os…
placenta previa
4 degrees of previa
complete
partial
marginal
low lying
Pt. p/w
moderate to severe painless AUB in 2nd/3rd trimester
placenta previa
Dx procedure for placenta previa
transabd. US then confirm with transvaginal US
what must always be avoided in placenta previa pt?
bimanual exam
placenta previa deliver occurs via…
c section
premature separation of normally implanted placenta during 2nd/3rd trimester
abruptio placentae
3 types of abruptio placenta
marginal
partial
complete
major RF for abruptio placenta
abd. trauma
pt p/w:
vaginal hemorrhage abd. pain fetal distress irritable uterus DIC
abruptio placetae
what should be administered if abruptio placentae in < 37 week gestation?
CS
fetal blood vessels running unsupported thru membranes over cervix and under presenting fetal part…
can lead to rupture
vasa previa
Pt. p/w:
vaginal bleeding upon rupture of membrane (ROM)
changes in fetal HR tracing
vasa previa
Dx of vasa previa…
doppler US
Mgmt of vasa previa (4)
inpatient if 3rd trimester
CS between 28-32 wks
pelvic rest
c section at 35 wks
This condition can cause preterm labor, prolapse of cord, placental abruption, uterine infx
premature rupture of membranes
_____ doubles the risk fo PROM
smoking
in PROM, ____ confirms leaking of fluid
nitrazine paper
cause of postterm pregnancy
inaccurate gestational age
induction of postterm pregnancy should occur…
at 41 weeks
mgmt of breech position…
external cephalic version at 36 weeks
Tx of cord prolapse…
trendelenburg
immediate c section
Adverse response of fetus to the stress of
labor contractions usually reflected in the
interpretation of the fetal heart rate
pattern.
fetal intolerance to labor
is vaginal birth after cesarean safe?
yes
major risk of vaginal birth after cesarean
uterine rupture
fetal risk of Trial of labor after cesarean
neonatal/perinatal mortality
MC cause of PPH
uterine atony
