Complication Of Pregnancy Flashcards
What is the failure to conceive after 12 months of frequent unprotected intercourse
Infertility
About how long after an LH surge is ovulation
24 hours
what testing can you do for infertility
Hysterosalpingogram
Saline infusion sonography
Hysteroscopy
Exploratory laparoscopy
What is a radiopaque dye injected through the cervix into the uterus with fluoroscopy images to assess for flow of dye into the uterus through the fallopian tube’s and into the peritoneal cavity
Hysterosalpingogram
Saline infused into the uterine cavity while viewing by ultrasound is known as what
Saline infusion sonography
What is a Camera device to look inside the uterus
Hysteroscopy
What drug can be given to induce ovulation
Clomiphene
What drug inhibits estrogen from binding in the hypothalamus in the pituitary
Clomiphene
When is clomiphene given at
Given for five days in the follicular phase then monitor for ovulation
What is interuterine insemination
Washed sperm injected into the uterine cavity
What is the pregnancy which implant somewhere other than the uterus
Ectopic pregnancy
A rupture of an Ectopic pregnancy can lead to what
Hemorrhaging into the peritoneal space
What is the most common cause of maternal death in the first trimester
Ectopic pregnancy
Name the diagnosis.
The patient comes to you after two months of amenorrhea followed by abnormal vaginal bleeding. She’s been experiencing this lower quadrant pain that is slowly becoming more and more severe. On exam she has a tender adnexa and cervical motion tenderness.
Ectopic pregnancy
What labs do you want to run if you suspect in Ectopic pregnancy
Beta hCG – will not be rising as expected
Blood type and antibody screen
What will you see on ultrasound if your diagnosing an ectopic pregnancy
Empty uterine cavity
Adnexal mass or extrauterine pregnancy may be found
If patient is stable when you suspect an ectopic pregnancy how do you monitor them?
Monitor and follow serial b-hcg every 48 hours
At what level of beta – Hcg should in interuterine pregnancy be visible at
1500 to 2000 about 45 weeks from last menstrual period
Fetal heart rate should be detected when the Beto – ECG is at what level
> 4000
How do you treat Ectopic pregnancy
If patient stable methotrexate
What both definitively diagnoses and treats an ectopic pregnancy
Laparoscopy
What is a fetus lost before 20 weeks
Abort us
What is a complete expulsion of all products of conception
Complete abortion
What is a partial expulsion of some but not all products of conception
Incomplete abortion
What is no expulsion of products of conception, but bleeding and dilation of cervix such that passage of products of conception seems inevitable
Inevitable abortion
What is any uterine bleeding before 20 weeks without dilation of the cervix or expulsion of any products of conception
Threatened abortion
What is death of an embryo/fetus before 20 weeks with complete retention of the products of conception
Missed abortion
When do most spontaneous abortions occur
In the first trimester, especially before eight weeks
What are most spontaneous abortions due to
Chromosomal abnormality’s
When should fetal heart tones be present by?
Week 10 to 12
How do you treat a threatened abortion
Limit activity, monitor with a weekly ultrasound to confirm viable pregnancy
How do you treat an incomplete/inevitable/missed abortion
Requires removal of remaining products of conception to prevent further bleeding
Medical management – prostaglandin misoprostal causes cervical dilation and uterine treatment
How do you treat a complete abortion
Generally symptoms resolve monitor for heavy bleeding if needed d/c
What is painless dilation of the cervix often leading to second trimester spontaneous abortion or preterm birth
Incompetent cervix
Name the diagnosis.
A patient comes to you and on exam they present with the cervix dilated more than 2 cm without any other symptoms
Incompetent cervix
How do you treat an incompetent cervix
Cerclage – until 36 to 37 weeks
What is considered recurrent pregnancy loss
Two or more consecutive spontaneous abortions
What do you want to look into if someone has recurrent pregnancy loss
Karotypes of both parents
Maternal anatomy assessed by hysterosalpingogram
Test for thyroid disease, diabetes, lupus, and hypercoagulable states
What is the spectrum of neoplasms from abnormal proliferation of trophoblastic tissue
Gestational trophoblastic disease
What is the most common gestational trophoblastic disease
Molar pregnancy
What are the four major types of gestational trophoblastic disease
Molar pregnancy
Invasive mole
Choriocarcinoma
Placental site trophoblastic tumor
What is thought to be due to fertilization of an empty a lacking a nucleus
Hydatidiform complete moles
Are partial or complete hydatidiform moles More common
Complete
What is a normal over fertilized by two sperm simultaneously
Partial mole
Need to diagnosis.
A patient come see you with symptoms of being pregnant. When checking their hCG levels they are much higher than what they should be. On exam the uterus is larger than expected and there’s no fetal heart tones
Hydatidiform mole
What will show on ultrasound of a hydatidiform mole
Grape like clusters, snowstorm appearance
What is the treatment of hydatidiform mole
Removal of all uterine contents by D&C with suction
How often do you need to follow hCG levels after treating a molar pregnancy
Every 1 to 2 weeks until three consecutive negatives, then every 1 to 2 months for 6 to 12 months
If you have a molar pregnancy with an hCG level greater than 100,000 what are they at risk for
Malignant gestational trophoblastic disease
Name the mole.
What is a local invasion into the myometrium that may reach the peritoneal cavity but rarely metastasizes
Invasive mole
Name the mall.
Malignant necrotizing tumor invading uterine wall and blood vessels
Choriocarcinoma
How do you treat an invasive more choriocarcinoma
Methotrexate
What is an extremely rare tumor arising from the placental site infiltrates the Miami trip and blood vessels and produces a chronic low level of hCG
Placental site trophoblastic tumor
How do you treat placental site trophoblastic tumor
Hysterectomy
What can happen if a mother is Rh negative
She can develop antibodies to the fetus if they are Rh positive
What happens if the antibodies that a mother developed cross the placenta
Hemolysis of the fetal red blood cells and this can lead to hydrops fetalis
Hydrops fetalis
What is a syndrome of hyperdynamic state, heart failure, diffuse edema and pericardial effusion resulting from severe anemia
If a mother is Rh negative what do you have to do to keep her from becoming sensitized
Anytime she may have exposure to fetal blood she should receive RhoGAM
What attacks fetal red blood cells before the maternal immune system can react to them
Rhogam
When is RhoGAM given routinely if a mother is Rh negative
28 weeks in postpartum if the neonate is Rh positive
What do you do if the mother is our age negative and a B positive
Check the tighter – associated with fetal hydrops if greater than 1:16
How often do you follow the titers if a patient is Rh negative a B positive as long as they are less than 1:16
Every four weeks
What is an abnormal implantation of placenta over the internal cervical os
Placenta previa
What is considered a complete placenta previa
Completely covers os
What is considered a partial placenta previa
Covers portion of the os
What is considered a marginal placenta previa
Edge of the placenta reaches margin of os
What is a frequent cause of antepartum hemorrhage
Placenta previa
Name the diagnosis.
A patient presents you with sudden profuse painless bleeding. She’s 32 weeks pregnant.
Placenta previa
What do you do in order to diagnose placenta previa
Ultrasound
Vaginal exam is contraindicated it could cause further bleeding and separation
How do you treat placenta previa if found on US with no bleeding
Most resolve by third trimester repeat ultrasound at 32 weeks
How do you treat placenta previa if a patient comes to you bleeding
Treat any acute blood loss
If <34 weeks give betamethasone
If a patient presents to you with placenta previa but they are stable in the bleeding is controlled how do you treat them
Considered outpatient management with pelvic rest in bed rest plan a C-section at 36 to 37 weeks after confirming to fetal lung maturity
What are the indications for an immediate C-section of placenta Previa
Unstoppable labor, fetal distress, life-threatening hemorrhage
What is an abnormal insertion of placenta into the uterine wall
Placenta Accreta
How do you diagnose placenta Accreta
Ultrasound
How do you treat placenta Accreta
Preplan delivery
What is the premature separation of placenta from the uterine wall
Placental abruption
Name the diagnosis.
Blood trapped between the uterine wall and placenta – enlarging collection of blood leads to further separation and bleeding
Concealed hemorrhage a placental abruption
Name the diagnosis.
A 33 week pregnant lady comes to you with bleeding and severe abdominal pain. She feel she is in labor because she’s having very strong contractions. On exam the patient is bleeding and has a firm tender uterus
Placental abruption
How do you diagnose placenta abruption
Confirmed by inspection of placenta at delivery.
Presence of clot overlaying placental destruction
How do you treat placental abruption
Stabilize patient give RhoGAM if Rh-
If preterm give betamethasone
Deliver if bleeding is life-threatening or fetal distress
What is considered preterm labor
Labor occurring before 37 weeks
What two things do you need in order to be diagnosed with preterm labor
You need both contractions and cervical changes
How do you treat preterm labor
Tocolysis
MgSO4
Terbutaline
What drug is given for preterm labor in attempt to prevent or stop contractions
Tocolysis
What drug is given in preterm labor to decrease uterine tone and contractility
MgSO4
If a patient is in preterm labor and they are between 24 to 34 weeks what do you need to do
Give corticosteroids to promote fetal lung maturity
What are some signs of chorioamnionitis
Fever
Maternal and fetal tachycardia
Uterine tenderness
If PROM happened more than 18 hours before delivery what do you need to do
Give antibiotics during labor
What can you do for a large just stational age baby for treatment
Control blood sugar and just stational diabetes, less weekend if there are obese
Consider induction of labor at term before macrosomic
What is amnionic fluid index less than five
Olgiohydraminos
What is the umbilical cord more susceptible to with less amniotic fluid
Compression
How can you measure amniotic fluid
By ultrasound
What is the most common cause of olgiohydraminos
rupture of membranes
What is an amniotic fluid index greater than 24
Polyhydramnios
What is associated with structural and chromosomal abnormality’s, neural tube defect’s, fetal hydrops, obstruction in fetal G.I. tract
Polyhydramnios
When is a pregnancy considered post term
More than 42 weeks
What is the most common reason for post term diagnosis
In accurate dating
With ultrasound when are you more likely to establish correct dates early in pregnancy
First trimester
What do you need to monitor after 41 weeks
Nonstress test and/or biophysical profile
If you have a patient who is greater than 20 weeks along and has absence of fetal movement in lack of uterine growth by ultrasound what do they have
Intrauterine fetal demise
How do you treat interuterine fetal demise
Induction of labor
Extensive testing usually done to figure out cause
For a multiple gestation delivery how must the babies be on order to attempt a vaginal delivery
Vertex/vertex or vertex/breach
How often do you monitor ultrasounds for a twin/twin transfusion syndrome
Every two weeks to assess amniotic fluid volume and fetal growth
What is the treatment for twin – twin transfusion syndrome
Fetoscope laser ablation
Amnio reduction
What type of twins are at risk for cord entanglement
Mono/mono twins
What is chronic HTN
HTN prior to pregnancy
When can a diagnosis of chronic HTN be made
If elevated HTN prior to 20 weeks gestation OR
Increased BP persist 12 weeks post-partum
What is gestational HTN
Elevated BP detected after 20 weeks gestation
What is preclamsia
New onset HTN AND protenuria or end-organ dysfunction
What is elclampsia
New onset HTN AND proteinuria or end-organ dysfunction with seizures
Is BP normally increased or decreased in pregnancy
Decreased due to vascular resistance
When is BP the lowest during pregnancy normally
2nd trimester
When is someone considered to have gestational HTN number wise
> 140/90 when >20 weeks gestation
When diagnosing gestational HTN how many readings must you have
2 readings 4 hours apart
When is HTN considered severe
> 160/110
What must proteinuria be in order to diagnose preeclamsia
> 0.3 in 24 hour urine specimen or 1+ on urine dip
What is considered end-organ dysfunction
Thrombocytopenia, elevated Cr or LFT’s, pulmonary edema, or cerebral/visual symptoms
If a diagnosis of Gestational HTN is made how often do you monitor the fetus
Daily “kick counts”
Weekly or biweekly NST or BPP
US every 3-4 weeks to assess fetal growth and fluid status
What is HELLP syndrome
Hemolysis, Elevated liver enzymes, and Low platelets
How does a patient with hellp syndrome often presents
Abd/epigastric pain, N/V, malaise
What are the diagnosisitc findings of a patient with HELLP syndrome
- Evidence of hemolysis (schistocytes on blood smear) elevated bilirubin or LDH
- Platelet count <100,000
- AST >70
When do most cases of eclampsia occur
Within 24 hours of labor up to 2-10 days post partum
Cerebral hemorrhage, aspiration pna, hypoxic encephalopathy, thromboembolic events are all complications of what problem
Eclampsia
What is the treatment of eclampsia
Seizure management-
Mag sulfate, immediate delivery
C-section delivery if maternal instability or fetal distress
What medication is given if BP is in the severe range
Hydralazine or labetolol
What can be given as a reversal for Mg sulfate
Calcium gluconate
What meds are typically given for gestational HTN
Labetolol, Nifedipine, methyldopa
What HTN meds are contraindicated in gestational HTN
ACEI or ARBS they are associated with fetal malformations
When a pt is on Mg sulfate how often do you monitor their urine output and what else do you monitor
Every hour and monitor deep tendon reflexes, respiration rate, and mental status for possible toxicity
What is an extrernal fetal HR monitoring for 20 min
Non-stress test
When is a non-stress test considered reactive
Acceleration of HR increased by 15 bpm for at least 15 seconds twice in the 20 min
If a patient has a nonreactive non-stress test what is the next step
Biophysical profile
Do you want a higher or lower score on a patients BPP
Higher
How can you check a fetal lung maturity
Obtain amniotic fluid
What ratio of lecithin:sphingomylien is considered high likely that the lungs are mature
2:1
What hormone is considered to affect diabetes in pregnancy
Human placental lactogen (hPL)
What is a patient at risk for who has gestational diabetes
Macrosominia
When do you screen for gestational diabetes
24-28 weeks
How do you screen for gestational diabetes
1 hour glucose challenge test–50g glucose and check BS 1 hour later (>140 have to check GTT)
GTT-3 hour- 100g–check fasting BS and at hours 1,2,3. If BS >95, >180, >155, >140–> diagnosis is 2 or more abnormal
What is the diagnosis criteria for the GCT
If >140 then you have to check a GTT
What is the diagnostic criteria for the GTT
BS fasting, hour 1, hour 2, hour 3
>95, >180, >155, >140
If 2 or more abnormal diagnosis is made
What is the treatment for gestational diabetes
Diabetic diet, monitoring BS 4 times a day
What is the goal fasting blood sugar? What about 2 hour post-prandial?
<95. And <120
What med is used to control gestational dm if lifestyle not working
Glyburide or Metformin
When monitoring a pt with gestational dm when do you start doing weekly or biweekly NST or BPP
32-36 weeks
With a patient with gestational dm at what fetal weight are you more at risk for shoulder dystocia? What about a weight that you want to do an elective C-section?
Shoulder dystocia: >4,000 (8lb 13oz)
C-section: >4500 (9lb 15oz)
If a patient with gestational dm is on medication to control it when do you want the patient to give birth
Induce them at 39-40 weeks
If poorly controlled at 37-39 weeks
What should be given to reduce the risk of neural tube defects
Folic acid
