abnormal pregnancy I Flashcards
1
Q
most common site of ectopic pregnancy
A
- ampullary portion of fallopian tube
2
Q
List high risk factors for ectopic pregnancy
A
- tubal surgery
- tubal ligation
- tubal pathology
- previous ectopic pregnancy
- in utero exposure to DES
- use of IUD
- assisted reproduction
3
Q
clinical presentation
- pelvic/abdominal pain and vaginal bleeding
A
- ectopic pregnancy until otherwise proven!
4
Q
sign associated with Hemoperitoneum: presence of blood in the peritoneal cavity
A
- shoulder pain
- subdiaphragmatic pain
5
Q
what labs should you order when assessing for ectopic pregnancy
A
- CBC: hemodynamic status
- serum quantitative hcg
- serum progesterone
6
Q
serum quantitative hcg (QhCG) should rise a minimum of over 48 hours in a normal pregnancy
A
- 50%
7
Q
what values for serum progesterone identify an abnormal pregnancy? normal pregnancy
A
- < 5 ng/ml has a 100% specificity for identifying an abnormal pregnancy
- > 20 ng/ml normal IUP
8
Q
imaging to evaulate for ectopic pregnancy
A
- transvaginal ultrasound
9
Q
treatment of ectopic pregnancy
A
-
methotrexate
- may need 2 doses
- surgical
10
Q
what factors come into play when determining surgical or medical tx of ectopic pregnancy
A
- size <3.5 cm
- QhCG levels < 5000
- cardiac activity
- ruptured vs unruptured
- reliable for f/u
11
Q
what is gestational trophoblastic disease
A
- tumors that develop from an aberrant fertilization event and derive from abnormal placental (trophoblastic) proliferation
12
Q
characteristic tumor marker of gestational trophoblastic disease
A
hCG
13
Q
List the four types of gestational trophoblastic diseases
A
- hydatidiform mole
- gestational trophoblastic neoplasia
- choriocarcinomas
- placental-site trophoblastic tumors
14
Q
most common form of gestational trophoblastic disease
A
- hydatidiform mole
15
Q
risk for hydatidiform mole increases with
A
- <20 yo
- >35 yo
- previous GTD
16
Q
describe a complete hydatidiform mole
A
- chorionic villi are a mass of clear vesicles resembling grapes
17
Q
medical complications associated with complete hydatidiform mole
A
- gestational HTN
- hyperthyroidism
- hyperemesis gravidarum
18
Q
fetus is present or absent in complete and partial hydatidiform mole
A
- complete: absent
- partial: often present
19
Q
karyotype of parial hydatidiform mole
A
- 69 XXX
- 69 XXY
20
Q
karyotype of complete hydatidiform mole
A
- 46 XX
- 46XY
21
Q
how does a complete hydatidiform mole arise
A
- fertilization of an empty enucleate egg by normal sperm.
- sperm duplicates its own chromosome -> all chromosomes are paternal
22
Q
how does a partial hydatidiform mole arise
A
- simultaneous fertilization of a normal ovum by two sperm
- results in triploid karotype
23
Q
US apperance of a “snow storm” is associated with
A
- hydatidiform mole
24
Q
treatment of hydatidiform mole
A
- evacuation of uterine contents
- close monitorof QhCG levels for 6-12 months after
- avoid pregnancy during this time
25
describe Choriocarcinoma
* highly malignant epithelial tumor arising from any type of trophoblastic tissue
* metastasis common
* follows pregnancy 25% of time
26
most common finding associated with Choriocarcinoma
* irregular vaginal bleeding
27
PE of pt with Choriocarcinoma reveals
* enlarge uterus
28
how is Choriocarcinoma diagnosed
* high QhCG levels and a "snowstorm" on US
* CT scan of abd, pelvis, and head
29
define Hyperemesis Gravidarum
* unexplained intractable N/V beginning in 1st trimester resulting in
* **dehydration**
* **ketonuria**
* **weight loss**
30
how does Rh incompatibility arise
* Rh negative woman with Rh positive fetus
31
problem with Rh incompatibility
* maternal IgG detroy fetal erythrocytes -\> **fetal hemolytic anemia**
* **hemolytic disease of newborn** when occurs in neonate
32
typically 1st affected pregnancy of Rh incompatibility is characterized by
* mild anemia and elevated biliruben
* no signs/symptoms in mother
33
how is Rh alloimmunization checked for
* draw antibody titers at **first prenatal visit** and at week **26-28**
* ****high titers suggests sensitization
* doppler **US**: measures peak velocity of fetal **middle cerebral artery**
* velocity increases with fetal anemia due to few cells (less viscous)
34
tx of Rh alloimmunization
* fetal transfusion
35
how is Rh alloimmunization prevented
* if mother is Rh (-), inject with (anti-D immune globulin) **RhoGAM** at 28 weeks and within 72 hours of delivery
36
define gestational HTN
* HTN detected for 1st time **after 20 weeks**
* **absence of proteinuria**
* working dx only during pregnancy
37
define Preeclampsia
* HTN that occurs **after 20 weeks** with previously normal BP
* **+ proteinuria**
38
define eclampsia
* preeclampsia with new-onset convulsions
39
define superimposed preeclampsia/eclampsia
* preeclampsia/eclampsia in a woman with preexisting chronic HTN
40
what is HELLP syndrome
* represents a severe form of preeclampsia
* **H**emolysis
* **E**levated **L**iver enzymes
* **L**ow **P**latelets
41
define mild preeclampsia
* BP of \> /= **140** systolic or \>/= **90** diastolic (BP elevated on two readings \> 6 hrs apart)
* **AND**
* **\>/= 300** mg protein in a 24 hour urine
42
define severe preeclampsia
* if any of following are present
* BP \>/= 160 systolic OR \>/= 110 diastolic (2 occasions \> 6 hrs apart)
* severe proteinuria
* end organ damage
* fetal growth restriction
43
definitive treatment of preeclampsia
* delivery
44
managment of preeclampsia
* glucocorticoids if \< 34 weeks
* magnesium sulfate - prevent sx
45
define intrauterine growth restriction (AKA fetal growth restriction)
* birth weight or estimated fetal weight at or below the 10th precentile for gestational age
* complications and neonatal death significantly inc when \< 3rd %
46
what infections are associated with intrauterine growth restriction
* **TORCH**
* T = toxoplasmosis
* O = other (syphillism varicella)
* R = rubella
* C = CMV
* H = herpes simplex
47
management of intrauterine growth restriction
1. **non-stress test**: neg. predictive value for acidosis is 99.8%
2. Biophysical Profile (BPP) with Umbical Artery doppler
48
when is delivery best option for intrauterine growth restriction
* risk of fetal death exceeds that of neonatal death
49
hallmark of gestational diabetes is
* insulin resistance
50
complications with gestational diabetes
* shoulder dystocia
51
screening for gestational diabetes
* non-fasting women at **24-28 weeks** ingest **50 g glucose** load
* plasma glucose measured 1 hr later
* if **\>130-140**, then do **100g 3 hr oral GTT**
52
if any one value is \> on 100g 3 hr oral GTT, then patient has GM
* \> 200
53
goal glucose levels in gestational DM
* fasting 70-95
* 2 hr post-prandial \< 120
* \*\*not met? consider insulin
54
define preterm labor
* regular contractions that occur after 20 weeks but before 37 weeks resulting in changes in cervix
55
what test is available for diagnose preterm labor
* **fetal fibronectin (fFN)**
* ****glycoprotein in high levels in maternal blood and amniotic fluid
* if none, 99% predictive of no preterm labor for 2 weeks
* if (+), pt is at risk for preterm labor
56
management of preterm labor
* corticosteroids (24-34 weeks)
* will accelerate fetal pulmonary maturation
57
prevention strategies for preterm labor
* smoking cessation
* progesterone supplementation
* hx of preterm birth
58
identification of intrauterine growth restriction can be done via what easy test
* fundal height measurement
* = 26 cm
59
biggest concern for intrauterine growth restriction
* inc risk for stillbirth
