Complicated Pregnancy Flashcards
Spontaneous abortion
MIscarriage of pregnancy less than 20 weeks.
20% of recognized pregnancies miscarry
80% in first trimester, usually do to chromosomal abnormality
Spontaneous abortion S/S
Bleeding, bright red MIdline cramping Low back pain Expulsion of products of conception os open OR closed
Threatened abortion
Slight bleeding abd vramping Cervical os CLOSED Uterine size compatible w/ dates No products of conception passed
Incomplete abortion
Usually the placenta stays in uterus
Complete abortion
All contents passed including placenta
Threatened abortion mgmt
Bed rest 24-48 hrs No work or responsibilities No intercourse Rest in horizontal position Hydration NO hormones
Ectopic pregnancy
Implantation of fertilized ovum outside uterine cavity.
Fallopian tube is most common
Rupture is inevitable
1 in 80 pregnancies
Major cause of maternal death in first tri
Ectopic preg s/s
1-2 months of amenorrhea DIarrhea, urge to defecate Mower abd pain, sudden and severe, adnexal Referred pain to shoulder Tender adnexal mass
B-hCG in ectopic
Will be lower than a normal pregnancy of same duration
Ectopic tx
Laproscopy
Methotrexate for stable pt’s
Hydatidiform Mole
Benign neoplasm of chorion where villi become transparent vessicles.
Occurs when a single sperm fertilizes egg w/o nucleus
Hydatidiform Mole S/S
Bleeding, enlarged uterus Pelvic pain, anemia Hyperemesis gravidarum Preeclampsia Passage of hydropic vesicles
B-hCG for Hydatidiform Mole would be
Very high for gestational age
Hydatidiform Mole US
Absence of gestational sac SNowy uterus (multiple echogenic regions)
Hydatidiform Mole pregnancy delay
Should not get pregnant until B-hCG levels are normal for a YEAR.
Choriocarcinoma
Rare, highly malignant
Causes ulcerating surfaces into endometrial cvity
Mets to lung, brain
Choriocarcinoma Tx
Highly sensitive to chemo (TOC)
Placenta Previa
Placenta implanted in lower segment of uterus and lies near cervical os
Placenta Previa presentation
Painless bleeding in 3rd tri (bright red)
fetal heart tones normal
Dx best made w/ US
Should a pelvic exam be done on suspected placenta previa?
No, do an US
Abruptio Placentae
Placental abruption
Partial or complete detachment or normally implanted placenta
Usually 3rd tri
Abruptio Placentae risks`
Abd trauma Cocaine SMoking Eclampsia HTN
Abruptio Placentae S/S
Vaginal bleeding
Abd, back pain
Uterine contractions
abnormal Fetal heart pattern
All pregnant women with abd pain, contractions and bleeding need to have what ruled out?
Abruptio Placentae
Abruptio Placentae complications
Hemorrhage and shock
Coagulopathy, DIC
Fetal harm or death
Classic imaging finding for Abruptio Placentae
Retroplacental hematoma
Placanta Accretas
The placenta attaches itself too deeply into the wall of the uterus.
1 in 2500
Placanta Accretas risks
Previous C-section
uterine surgery
Placenta previa
Placanta Accretas complications
Preterm delivery
Severe post-partum hemorrhage
Placanta Accretas Tx
Not much can be done
Try to spare uterus upon delivery … but may need historectomy
Hyperemesis Gravidarum
Persistent, severe intractable vomiting
peak incidence 8-12 wks
Should resolve by 20 wks
Hyperemesis Gravidarum Tx
Hosp. w/ bedrest
NPO x 48 hrs
IV Hydration
Meds for Hyperemesis Gravidarum
Pyridoxine (Vitamin B6)
Promethazine rectally
Zofran
Preeclampsia
Presence of HTN and proteinuria during pregnancy.
Caused by vasospasm and endothelial dysfxn
preeclampsia dx
HTN >140 systolic or 90 diastolic after 20 wks gest.
Proteinuria of >300 mg in 24 hrs
Edema
Preeclampsia range
After 20 wks gest to 6 wks postpartum
Who most frequently has preeclampsia?
Primiparas (first time pregnancy)
Extremes of maternal age
Multiple gestation
Preeclampsia Patho
Placenta produced far more thromboxane than prostacycline causing dysfunction
Preeclampsia of 36 wks gest or more tx?
Delivery
Mgmt of severe preeclampsia
Hospitalize
Delivery
Factors suggesting delivery is needed in preeclampsia
VIsual changes
Thrombocytopenia
Epigastric pain
Mild preeclampsia tx
bedrest
60-80 mg ASA daily
Hydralazine or methyldopa
If delivery is not possible in severe preeclampsia then what bed should be given to pervent seizures?
Magnesium Sulfate drip
HELLP
Variant of severe preeclampsia
Hemolysis
Elevated liver enzymes
Low platelets
HELLP S/S
Mildly elevated BP \+/- proteinuria Malaise (100%) GI sx RUQ tenderness
HELLP lab dx
Burr cells, schistocytes
Increased LDH, bili, SGOT
Low platelets
HELLP mgmt
delivery
WHen does preeclampsia become eclampsia
When seizures are present
prevent w/ mag sulfate drip
Eclampsia emergency care
Turn on side of seizing
Mag sulfate bolus followed by drip
What reverses magnesium toxicity?
Calcium gluconate
Most reliable indicator for resolution of eclampsia postpatrum?
Diuresis
Preterm labor (PTL)
Labor that begins before 37th week
Fetal fibronectin (fFN)
Trophoblast glue
Taken from cervix. if present in 2nd or 3rd trimester it is a serious warning sign of PTL
Amniotic fluid ferning pattern
Light and delicate
