CF: 11-15 Flashcards
22 yo G2P1 cocaine user at 35 wk gestation c/o abd pain and moderate vaginal bleeding/ Her BP in 150/90, HR 110. Fundal tenderness. Normal US. FHR 160s-170s.
Most likely Dx?
4 major Cpx?
Best management for this condition?
Placental abruption Cpx: -Hemorrhage -Fetal-to-maternal bleeding -Coagulopathy -Preterm delivery Deliver since she's >34 wk
35 yo G5P4 woman at term w/ PMH myomectomy and C/S is undergoing vaginal delivery. Retained placenta is firmly adherent to the uterus when there’s an attempt at manual extraction.
Most likely Dx?
Next step in management?
Placenta accreta
Hysterectomy
23 yo G2P1 woman at 16 wk gestation w/ an 8 cm ovarian cyst c/o 12 hr Hx of colicky RLQ pain w/ n/v. Tenderness in RLQ w/ significant involuntary guarding.
Most likely Dx?
Best treatment?
Ovarian torsion
Surgery (Laparotomy vs laparoscopy)
24 yo G1P0 at 28 wk gestation c/o 2 wk duration of generalized pruritis. She’s anicteric and normotensive. No rashes. FHR in 140s.
Most likely Dx?
Intrahepatic cholestasis of pregnancy
19 yo G1P0 woman at 20 wk gestation c/o acute onset pleuritic chest pain and severe dyspnea. HR 120 and RR 40. CTAB. Low O2 sat.
Test most likely to lead to Dx (name 2)?
Major concerning Dx?
Spiral CT, MRA
PE
What is the best treatment for ovarian torsion (if it’s possible)?
Ovarian cystectomy, which removes only the cyst and leaves the remainder of normal ovarian tissue
Which 2 major times in/around pregnancy are women at highest risk of ovarian torsion?
At 14 wk (when uterus rises above the pelvic brim) Immediately postpartum (when uterus rapidly involutes)
Name 6 common, but serious, causes of abdominal pain in pregnancy
- Appendicitis
- Torsion
- Cholecystitis
- Placental abruption
- Ectopic pregnancy
- Ruptured corpus luteum
What hormonal change in pregnancy leads to red/carneous degeneration of a uterine fibroid?
High estrogen–> rapid growth of fibroid–> outgrowth of blood supply–> ischemia–> pain
What’s the CC of patients with carneous degeneration of a fibroid, and how can you confirm the Dx?
Point tenderness at the fibroid
US
Pregnant woman with n/v/a, fever, and RUQ/flank abdominal pain?
Acute appendicitis
Why is abdominal pain superior and lateral to McBurney’s point in pregnancy?
Enlarged uterus pushes on appendix, moving it upward and outward toward the flank
How do you diagnose acute appendicitis in pregnancy?
Clinically
Treatment of acute appendicitis in pregnancy?
Surgery + IV Abx
Why does pregnancy predispose to gallstones?
Increase in GB volume + biliary sludge
Dx of cholelithiasis?
US
Treatment of biliary colic in pregnancy?
Low-fat diet + obs until postpartum
Tx of cholecystitis, biliary obstruction, or gallstone pancreatitis in pregnancy?
Surgery (typically after cooling off period)
Most freq and serious Cpx of a benign ovarian cyst?
Torsion
While doing surgery for ovarian torsion, what determines if you can do cystectomy vs oophorectomy?
If untwisting the adnexa–> reperfusion: cystectomy
If can’t restore perfusion: oophorectomy
Leading cause of maternal mortality in 1st and 2nd trimesters?
Ectopic pregnancy
Young woman w/ amenorrhea, vaginal spotting, n/v, and sharp/tearing lower abdominal/pelvic pain. PE: slightly enlarged uterus +/- palpable adnexal mass. Dx?
Ectopic pregnancy
What 2 major s/s would make you think rupture of ectopic vs just presence of ectopic?
Syncope, hypovolemia
2 major aspects of Dx of ectopic?
bhCG and TVUS
2 major tx options for ectopic?
MTX vs surgery
From what do corpus luteum cysts develop?
Mature Graafian follicles
Why can there be hemorrhage in CL cysts?
Thin-walled capillaries invade the granulosa cells from the theca interna–> intrafollicular bleeding
What’s the major thing leading to increased risk of rupture of a CL cyst?
Excessive hemorrhage
Name 2 RFs for CL cyst rupture
Pregnancy
Anti-coagulants
During what times of the menstrual cycle is cyst rupture most common?
Days 20-26
Describe typical presentation of hemorrhagic CL cyst
Sudden onset severe lower abdominal pain w/ 1-2 wk Hx of unilateral cramping and lower abdominal pain.
US findings for hemorrhagic CL cyst?
Free intraperitoneal fluid +/- fluid around the ovary
How do you confirm diagnosis of hemorrhagic CL cyst?
Laparoscopy
1st step in tx of ruptured CL cyst? What do you do after this?
Secure hemostasis
- If bleeding stops: you’re done
- If bleeding continues: perform cystectomy
Supply of progesterone in pregnancy:
0-7 wk?
7-10 wk?
>10 wk?
0-7 wk: corpus luteum
7-10 wk: corpus luteum + placenta
>10 wk: placena
What do you have to give patient if remove CL before 10-12 wk of gest?
Exogenous progesterone
Which is an earlier indicator of hypovolemia: positive tilt table test or tachycardia?
Positive tilt table test
MCC of hemoperitoneum in early pregnancy?
Ectopic pregnancy
Next best step after diagnosis of acute pancreatitis in pregnancy?
US to look for gallstones (MCC of acute pancreatitis in preg)
