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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
swiss cheese appearance on intrauterine US
partial hydatidiform mole
26
Tx of partial hydatidiform mole
immediate removal of uterine contents
27
US shows intrauterine mass and increased vascularity of myometrium
invasive molar pregnancy
28
Tx of invasive molar pregnancy
single agent chemo (MTX or actinomycin D)
29
1st line anti-emetics for hyperemesis gravidarum
vitamin b6, doxylamine
30
2nd line for hyperemesis gravidarum
H1 antagonists
31
this occurs when women is Rh negative and fetus is Rh positive
Rh incompatibility and alloimmunization
32
Tx for Rh incompatibility and alloimmunization
RhoGAM (prevent sensitization)
33
leading cause of maternal morbidity/mortality...
HTN
34
time cutoff for chronic vs gestational HTN
20 weeks
35
HTN after 20 weeks gestation + proteinuria or severe features...
pre-eclampsia
36
when does pre-eclampsia become eclapsia?
seizure onset
37
what causes pre-eclampsia's failure to establish adequate uteroplacental blood flow?
failure of spinal a. remodeling
38
Pt. p/w: new onset htn proteinuria non-tx responsive HA scotomata
pre-eclampsia
39
2 dx for pre-eclamsia
2+ elevated BPs 4 hours apart presistent BP > 160/110 requiring IV tx
40
pre-eclamspia = ____mg of total prot and total Cr clearance during 24 hour uring collection...
300 mg
41
urine prot/Cr x 1000/greater than ____mg for pre-eclampsia
300mg
42
pre-eclampsia w/out severe features, delivery occurs at _____ and lab frequency of...
37 0/7 gestation weekly outpatient labs
43
pre-eclampsia with severe features requires delivery at ____ and lab frequency of...
34 weeks twice weekly inpatient labs
44
severe pre-eclampsia tx:
IV labetalol, hydralazine, PO nifedipine Mg sulfate for seizure prophylaxis GCs for fetal lung maturity
45
This is a syndrome a/w hemolysis, elevated LFTs and low platelet count it is a severe form of preeclampsia
HELLP syndrome
46
in addition to preeclampsia tx, what is added...
platelet transfusion if < 50 for c-section < 20 for vaginal delivery
47
intrauterine growth restriction occurs if estimated fetal weight is below _____ percentile for gestational age
10th percentile
48
TORCH infx cause intrauterine growth restriction... what are TORCH infx?
``` toxoplasmosis other (syphilis, varicella) rubella cmv hsv ```
49
what imaging is used to evaluate EFW?
US
50
IUGR management
US q 3 weeks twice weekly biophysical profile and nonstress test fetal kick counts
51
OGTT for gestational diabetes is completed at _____. (+) result is ____
24-28 weeks (+) if > 199 on 2 or more dx
52
1st line in gestational DM
insulin
53
preterm labor is regular contractions after...
20 weeks
54
Evaluation of pretern labor (6)
``` r/o ROM digital cervical exam US (cervical length) UA + cx GBS cx fetal fibronectin ```
55
if no ____ is present in cervicovaginal secretions during preterm contractions, then it is 99% predictive of no preterm labor for 2 weeks
fetal fibronectin
56
Uterine contractions + what 3 factors = preterm labor
cervical dilation (3+) cervical length < 20mm cervical length < 30 + (+) Ffn
57
inpatient Tx for preterm labor (4)
betamethasone tocolytics x 48 hours Mg sulfate abx
58
The below are what class of drugs for preterm labor? beta-mimetics (terbutaline) CCBs (nifedipine) NSAIDs (indomethacin) Mg Sulfate
tocolytics
59
placental location close to or over internal cervical os...
placenta previa
60
4 degrees of previa
complete partial marginal low lying
61
Pt. p/w moderate to severe painless AUB in 2nd/3rd trimester
placenta previa
62
Dx procedure for placenta previa
transabd. US then confirm with transvaginal US
63
what must always be avoided in placenta previa pt?
bimanual exam
64
placenta previa deliver occurs via...
c section
65
premature separation of normally implanted placenta during 2nd/3rd trimester
abruptio placentae
66
3 types of abruptio placenta
marginal partial complete
67
major RF for abruptio placenta
abd. trauma
68
pt p/w: ``` vaginal hemorrhage abd. pain fetal distress irritable uterus DIC ```
abruptio placetae
69
what should be administered if abruptio placentae in < 37 week gestation?
CS
70
fetal blood vessels running unsupported thru membranes over cervix and under presenting fetal part... can lead to rupture
vasa previa
71
Pt. p/w: vaginal bleeding upon rupture of membrane (ROM) changes in fetal HR tracing
vasa previa
72
Dx of vasa previa...
doppler US
73
Mgmt of vasa previa (4)
inpatient if 3rd trimester CS between 28-32 wks pelvic rest c section at 35 wks
74
This condition can cause preterm labor, prolapse of cord, placental abruption, uterine infx
premature rupture of membranes
75
_____ doubles the risk fo PROM
smoking
76
in PROM, ____ confirms leaking of fluid
nitrazine paper
77
cause of postterm pregnancy
inaccurate gestational age
78
induction of postterm pregnancy should occur...
at 41 weeks
79
mgmt of breech position...
external cephalic version at 36 weeks
80
Tx of cord prolapse...
trendelenburg immediate c section
81
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
82
is vaginal birth after cesarean safe?
yes
83
major risk of vaginal birth after cesarean
uterine rupture
84
fetal risk of Trial of labor after cesarean
neonatal/perinatal mortality
85
MC cause of PPH
uterine atony

Women's Health (10 decks)

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