Cholestasis Of Pregnancy Flashcards
Pruritic urticarial papules and plaques of pregnancy - etiology? Sx? Findings?
Skin condition of unknown etiology
Intensive pruritus and erythematous papules on abdomen and extremities
Cholestasis in pregnancy? Symptoms? Symptoms usually occur when? Confirm Diagnosis with?
Intrahepatic cholestasis (unknown etiology)
pruritus +/- jaundice, with NO skin rash
Night
Increased circulating bile acid levels
Herpes gestationis?
Skin condition only seen pregnancy – intense itching and vesicles/tense bullae on abdomen and extremities
Intrahepatic cholestasis of pregnancy – can recur with?
Subsequent pregnancies and ingestion of OCP
Intrahepatic cholestasis pregnancy – LFTs? Tx?
Not necessarily elevated but may be over 1000
Ursodeoxycholic acid (less effective: hydroxyzine, cholestyramine)
Intrahepatic cholestasis – Effects on the mother? fetus?
No hepatic sequelae, but increased incidence of
- Gallstones
- recurrence in subsequent pregnancies
- prematurity
- fetal distress/Meconium aspiration
- fetal loss
Intrahepatic cholestasis of pregnancy – treatment? Previously used?
Antihistamines and cornstarch baths, ursodeoxycholic acid
Bile salt binder, cholestyramine has been associated with vitamin K deficiency
Herpes gestationis – Relationship to HSV? Begins when? Etiology?
None; second trimester
Possibly autoimmune – IgG antibodies directed at basement membrane
Herpes gestationis – areas most affected? Definitive diagnosis by? Tx?
Arms;
Immunofluorescent examination biopsy specimens
Oral corticosteroids
Herpes gestationis – effects on fetus? On neonates?
IUGR, stillbirth
Transient neonatal herpes gestationis
Progression of PUPPP? Description of lesions?
Begins on abdomen, spreads to thighs, butt, arms
Erythematous urticarial plaques surrounded by narrow pale halo
PUPPP – immunofluroescent studies show? Immunologic findings? Effects on fetus? Treatment?
Negative for IgG and complement
Normal epidermis with superficial perivascular infiltrate of lymphocytes and histiocytes of papillary dermis
No adverse effect on fetal/maternal outcome
Steroids and antihistamines
Cause of intrafollicular bleeding?
Thin-walled capillaries invade granulosa cells from theca interna
Status and Drug therapy that predisposes to cyst rupture? Prevent by?
Pregnancy and Anticoagulation; more drugs to prevent ovulation
Symptoms of hemorrhagic corpus lutea? Prior to rupture?
Severe onset of severe lower abdominal pain (especially with hemoperitoneum)
Unilateral cramping and lower abdominal pain for 1 to 2 weeks before rupture
Most common times for corpus luteum cyst rupture?
The 20-26 of menstrual cycle
Differential diagnosis for suspected hemorrhagic corpus luteum?
Ectopic pregnancy, ruptured endometrioma, adnexal torsion, appendicitis, splenic injury/rupture
Ultrasound findings of hemorrhagic corpus luteum? Confirm diagnosis by?
Free intraperitoneal fluid and fluid around ovary
Laparoscopy
Treatment of ruptured luteal cyst?
Secure homeostasis
If bleeding stops, no further therapy
If bleeding continues, cystectomy
Corpus luteum produces? Until? Corpus luteum maintained by? What takes over?
It progesterone, 10 weeks,
Beta hCG; placental steroidogenesis
If corpus luteum removed prior to 12 weeks gestation, patient needs?
Exogenous progesterone to sustain pregnancy
Patient with localized tenderness over fibroid in pregnancy? Mechanism?
Degenerating leiomyoma;
Estrogen causes rapid growth of fibroid, fibroid out-grows blood supply leading to ischemia and pain
Pain in ovarian torsion?
Colicky abdominal pain
Movement of appendix in pregnancy? Movement of gallbladder?
Superiorly and laterally; does not move
