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Womens health final > abnormal pregnancy I > Flashcards

abnormal pregnancy I Flashcards

1
Q

most common site of ectopic pregnancy

A
  • ampullary portion of fallopian tube
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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
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3
Q

clinical presentation

  • pelvic/abdominal pain and vaginal bleeding
A
  • ectopic pregnancy until otherwise proven!
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4
Q

sign associated with Hemoperitoneum: presence of blood in the peritoneal cavity

A
  • shoulder pain
  • subdiaphragmatic pain
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5
Q

what labs should you order when assessing for ectopic pregnancy

A
  • CBC: hemodynamic status
  • serum quantitative hcg
  • serum progesterone
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6
Q

serum quantitative hcg (QhCG) should rise a minimum of over 48 hours in a normal pregnancy

A
  • 50%
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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
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8
Q

imaging to evaulate for ectopic pregnancy

A
  • transvaginal ultrasound
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9
Q

treatment of ectopic pregnancy

A
  • methotrexate
    • may need 2 doses
  • surgical
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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
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11
Q

what is gestational trophoblastic disease

A
  • tumors that develop from an aberrant fertilization event and derive from abnormal placental (trophoblastic) proliferation
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12
Q

characteristic tumor marker of gestational trophoblastic disease

A

hCG

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13
Q

List the four types of gestational trophoblastic diseases

A
  • hydatidiform mole
  • gestational trophoblastic neoplasia
  • choriocarcinomas
  • placental-site trophoblastic tumors
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14
Q

most common form of gestational trophoblastic disease

A
  • hydatidiform mole
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15
Q

risk for hydatidiform mole increases with

A
  • <20 yo
  • >35 yo
  • previous GTD
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16
Q

describe a complete hydatidiform mole

A
  • chorionic villi are a mass of clear vesicles resembling grapes
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17
Q

medical complications associated with complete hydatidiform mole

A
  • gestational HTN
  • hyperthyroidism
  • hyperemesis gravidarum
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18
Q

fetus is present or absent in complete and partial hydatidiform mole

A
  • complete: absent
  • partial: often present
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19
Q

karyotype of parial hydatidiform mole

A
  • 69 XXX
  • 69 XXY
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20
Q

karyotype of complete hydatidiform mole

A
  • 46 XX
  • 46XY
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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
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22
Q

how does a partial hydatidiform mole arise

A
  • simultaneous fertilization of a normal ovum by two sperm
    • results in triploid karotype
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23
Q

US apperance of a “snow storm” is associated with

A
  • hydatidiform mole
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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
Q

describe Choriocarcinoma

A
  • highly malignant epithelial tumor arising from any type of trophoblastic tissue
    • metastasis common
    • follows pregnancy 25% of time
26
Q

most common finding associated with Choriocarcinoma

A
  • irregular vaginal bleeding
27
Q

PE of pt with Choriocarcinoma reveals

A
  • enlarge uterus
28
Q

how is Choriocarcinoma diagnosed

A
  • high QhCG levels and a “snowstorm” on US
  • CT scan of abd, pelvis, and head
29
Q

define Hyperemesis Gravidarum

A
  • unexplained intractable N/V beginning in 1st trimester resulting in
    • dehydration
    • ketonuria
    • weight loss
30
Q

how does Rh incompatibility arise

A
  • Rh negative woman with Rh positive fetus
31
Q

problem with Rh incompatibility

A
  • maternal IgG detroy fetal erythrocytes -> fetal hemolytic anemia
  • hemolytic disease of newborn when occurs in neonate
32
Q

typically 1st affected pregnancy of Rh incompatibility is characterized by

A
  • mild anemia and elevated biliruben
  • no signs/symptoms in mother
33
Q

how is Rh alloimmunization checked for

A
  • 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
Q

tx of Rh alloimmunization

A
  • fetal transfusion
35
Q

how is Rh alloimmunization prevented

A
  • if mother is Rh (-), inject with (anti-D immune globulin) RhoGAM at 28 weeks and within 72 hours of delivery
36
Q

define gestational HTN

A
  • HTN detected for 1st time after 20 weeks
  • absence of proteinuria
  • working dx only during pregnancy
37
Q

define Preeclampsia

A
  • HTN that occurs after 20 weeks with previously normal BP
  • + proteinuria
38
Q

define eclampsia

A
  • preeclampsia with new-onset convulsions
39
Q

define superimposed preeclampsia/eclampsia

A
  • preeclampsia/eclampsia in a woman with preexisting chronic HTN
40
Q

what is HELLP syndrome

A
  • represents a severe form of preeclampsia
  • Hemolysis
  • Elevated Liver enzymes
  • Low Platelets
41
Q

define mild preeclampsia

A
  • 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
Q

define severe preeclampsia

A
  • 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
Q

definitive treatment of preeclampsia

A
  • delivery
44
Q

managment of preeclampsia

A
  • glucocorticoids if < 34 weeks
  • magnesium sulfate - prevent sx
45
Q

define intrauterine growth restriction (AKA fetal growth restriction)

A
  • birth weight or estimated fetal weight at or below the 10th precentile for gestational age
    • complications and neonatal death significantly inc when < 3rd %
46
Q

what infections are associated with intrauterine growth restriction

A
  • TORCH
    • ​T = toxoplasmosis
    • O = other (syphillism varicella)
    • R = rubella
    • C = CMV
    • H = herpes simplex
47
Q

management of intrauterine growth restriction

A
  1. non-stress test: neg. predictive value for acidosis is 99.8%
  2. Biophysical Profile (BPP) with Umbical Artery doppler
48
Q

when is delivery best option for intrauterine growth restriction

A
  • risk of fetal death exceeds that of neonatal death
49
Q

hallmark of gestational diabetes is

A
  • insulin resistance
50
Q

complications with gestational diabetes

A
  • shoulder dystocia
51
Q

screening for gestational diabetes

A
  • 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
Q

if any one value is > on ​100g 3 hr oral GTT, then patient has GM

A
  • > 200
53
Q

goal glucose levels in ​gestational DM

A
  • fasting 70-95
  • 2 hr post-prandial < 120
    • **not met? consider insulin
54
Q

define preterm labor

A
  • regular contractions that occur after 20 weeks but before 37 weeks resulting in changes in cervix
55
Q

what test is available for diagnose preterm labor

A
  • 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
Q

management of preterm labor

A
  • corticosteroids (24-34 weeks)
    • will accelerate fetal pulmonary maturation
57
Q

prevention strategies for preterm labor

A
  • smoking cessation
  • progesterone supplementation
    • hx of preterm birth
58
Q

identification of intrauterine growth restriction can be done via what easy test

A
  • fundal height measurement
    • = 26 cm
59
Q

biggest concern for intrauterine growth restriction

A
  • inc risk for stillbirth

Womens health final (3 decks)

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