Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Womens health exam 2 > Complications of Pregnancy > Flashcards

Complications of Pregnancy Flashcards

1
Q

1st Trimester Screen

A
  • Screening test for genetic defects and fetal abnormalities
  • Includes lab test and nuchal translucency ultrasound
  • Timing 11w0d to 13w6d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Timing of 1st Trimester Screen

A

11w0d to 13w6d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Benefit of early US

A
  • Detection of spontaneous abortions
  • Anatomic defects
  • Enlarged nuchal fold can also be found in cardiac defects (37% detection)
  • Cystic Hygroma- defect of lymphatics- build up fluid in nuchal fold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Quad Marker Screen

A
  • Screening test for genetic defects and some anatomic defects
  • Strictly lab testing
  • Labs- hCG, inhibin, Estriol, alpha fetoprotein (AFP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Quad Marker Screen timing

A

15w0d to 22w6d ideally 15-18wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anatomy Ultrasound

A
  • Standard 20 week ultrasound evaluating most fetal anatomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anatomy that can be visualized during an anatomy US

A
  • Head
  • Face/Neck
  • Chest/Heart
  • Abdomen
  • Spine
  • Extremities
  • Genitalia
  • Umbilical Cord
  • Placenta
  • Maternal Anatomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Spontaneous Abortion (pregnancy loss or miscarriage) definition

A

Defined as nonviable intrauterine pregnancy prior to 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

15% of women experience one in their life

A

Spontaneous Abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of Spontaneous Abortions

A
  • Complete Ab- Urine pregnancy test in 2 weeks
  • Incomplete Ab- Evaluate bleeding, urgency to complete abortion
  • May require D&C or medication, blood transfusion
  • Inevitable Ab- Expectant, medical, surgical management
  • Threatened Ab- 15-20% of pregnancies- 90% of pregnancies in this situation are not lost if fetal heart rate seen between 7-11 wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Typically occurs due to incomplete abortion

A

Hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications of Spontaneous Abortions: infection

A
  • Will require D&C
  • IV antibiotics
  • Called Septic abortion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Recurrent Pregnancy Loss

A

Defined as 2 or more consecutive ultrasound-confirmed pregnancies lost.
3 consecutive pregnancy losses (do not need to be intrauterine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Miscarriage risks per number of pregnancies

A

First pregnancy- miscarriage risk 11-13%
After 1 miscarriage- miscarriage risk 14-21%
After 2 miscarriages- 24-29%
After 3 miscarriages- 31-33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of recurrent Pregnancy Loss

A
  • Advanced maternal age
  • Uterine anomalies
  • Fibroids, uterine septum, polyps, adenomyosis,
    intrauterine adhesions,
  • Clotting issues
  • Antiphospholipid antibody syndrome,
    thrombophilias
  • Endocrine disorders
  • Diabetes, Thyroid, PCOS, Luteal phase defect
  • Autoimmune disorders
  • Genetic defects
  • Aneuploidy, chromosomal rearrangements
  • External factors
  • Environmental, chemicals
  • 50% of the time, no cause is found
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Workup for suspicion of recurrent pregnancy loss

A

Low hanging fruit first
A1C, TSH,
Antiphospholipid antibody testing
- B2 microglobulin, Anticardiolipin antibody, lupus anticoagulant
Uterine evaluation
- Hysteroscopy, saline infusion ultrasound, hysterosalpingogram, MRI
Genetic evaluation
Fertility specialist referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ectopic Pregnancy

A
  • Definition- Extrauterine pregnancy
  • Most in the fallopian tube, but also ovary, c-section scar, abdomen, etc.
  • Rarely heterotopic ectopic includes intrauterine and ectopic pregnancy (IVF more common)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clinical presentation of ectopic pregnancy

A

Most commonly vaginal bleeding and abdominal pain
- Some are found when the patient is asymptomatic
- Positive hCG, Ultrasound shows no intrauterine pregnancy
- Sometimes shows a pseudo-sac, but no yolk sac or fetal pole
- hCG over 3500 should be able to see an intrauterine pregnancy with fetal pole (not with twins)
- Presents either ruptured or unruptured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Risk factors for ectopic pregnancy

A
  • Previous adnexal surgery, IUD in place, IVF, hx of PID, endometriosis, fibroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diagnosis of ectopic pregnancy

A
  • Ultrasound (note- ovarian cyst is not diagnostic)
  • hCG
  • Clinical evaluation
  • US with adnexal pregnancy with FHR
  • Visualization during surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ectopic Pregnancy- Management

A
  • Takes more time, not a guarantee it will work
  • Minimally invasive
  • Methotrexate- folic acid antagonist- Give in ED
    and follow hCG levels to 0
  • Only specific candidates apply (Size of mass,
    hCG level, kidney/liver function)
  • Surgical management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Ectopic Pregnancy- Surgical Management

A
  • Quick and definitive
  • Laparoscopy, can consider evacuating uterus
    as well
  • Will likely loose tube
  • Complications of surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Molar Pregnancy

A

Definition- “Hydatidiform Mole” abnormal pregnancy caused by aberrant
fertilization. Characterized by abnormal chorionic villi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Complete vs. partial mole

A

Complete mole- 2 sperm in an empty egg. Higher hCG (300,000), 80% this type, cancer risk, increased theca lutein cysts, hyperemesis

Partial mole- 2 sperm + normal egg. Lower hCG, can have a fetus with heartbeat. Become hydropic. Misdiagnosed as abortion at times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

This can turn into neoplasia

A

“Hydatidiform Mole” / molar pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Molar Pregnancy- Clinical presentation

A

Missed period, positive pregnancy test, nausea and vomiting, bleeding, hyperemesis
Normally found on first ultrasound in pregnancy (Snow storm appearance). Look
for ovarian cysts, hyperthyroidism (beta subunit of hCG)
Heavy bleeding
Only incidence where someone can get Preeclampsia prior to 20 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Molar Pregnancy eval and diagnosis

A

Evaluation- History and physical, ultrasound, hCG, type and screen, CBC, manage
clinical symptoms.
Diagnosis- Ultrasound diagnosis taking in clinical situation with hCG is suggestive,
but diagnosis is histologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment of a molar pregnancy

A

Treatment- Uterine evacuation, need to follow hCG quants to 0 (need contraception
during monitoring) Wise to put blood on hold
Complete mole- GTN 15-20% get to 0, then monthly for 3 months
Partial mole- GTN 1-5%. Get to 0, then one more hCG in 1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Gestational Trophoblastic Disease

A

Includes a heterogenous group of related
lesions arising from abnormal proliferation of
trophoblasts of the placenta
Gestational trophoblastic disease- benign non-neoplastic lesions including moles with potential to become cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Gestational trophoblastic neoplasia- Gestational neoplasms

A
  • Choriocarcinoma, Placental site trophoblastic
    tumor, invasive mole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Gestational Trophoblastic Disease clinical presentation

A

After pregnancy (molar) with persistently elevated hCG
- AUB, Pulmonary, Pelvic Pain,
- Metastases- Pulmonary, vaginal, CNS, Hepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Gestational Trophoblastic Disease eval and diagnosis

A

Evaluation- Confirm hCG, evaluate for metastases (vagina, lungs), chest x-ray, pelvic
ultrasound,
Diagnosis- Clinical diagnosis, do not need biopsy of lesions, persistently elevated
hCG after molar pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Gestational Trophoblastic Disease treatment

A

Methotrexate vs EMA-CO (5 different chemotherapies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Causes of UTIs in Pregnancy

A

Dilation of urethra, pressure from uterus slows flow in ureters causing dilation and stasis of urine increasing susceptibility to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Elevated TSH in pregnancy

A

Diagnosed by elevated TSH (TSH range changes through pregnancy normally
upper limit of 4, but ideal number in pregnancy is 2.5 and below and low free T4
Between TSH 2.5-4, check TPO antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Treating hypothyroidism in pregnancy

A

Treat with levothyroxine, recheck every 4 weeks, then every trimester once stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Hypothyroidism consequences

A

Some increased risk in cognitive
impairment, preeclampsia, abruption,
fetal distress, preterm delivery, low birth
weight, hemorrhage, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Major Depressive Disorder treatment in pregnancy

A

SSRI best- particularly Zoloft (Sertraline) least crossing of placenta, particularly low
amount of it gets in the breast milk.
Avoid Paroxetine (Paxil)- possible association with VSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Cervical Insufficiency

A

The inability of the uterine cervix to retain a pregnancy in the 2nd trimester in the absence of clinical contractions, labor, or both.” ACOG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Cervical Insufficiency presentation

A

Normally presents with vaginal bleeding between 14-24 wks with
vaginal bleeding, pelvic pressure, low back pain, and advanced cervical dilation

39
Q

Diagnosis of Cervical Insufficiency

A

History (previous preterm birth), ultrasound (cervical length), physical
exam (Cervical dilation)

40
Q

Risk factors of Cervical Insufficiency

A

History of insufficiency, cervical trauma or surgery (LEEP, cervical trauma in birth), congenital abnormalities (Ehlers Danlos)

41
Q

Cervical Insufficiency treatment

A

Pre-treatment- Rule out infection (consider amniocentesis), labor, abruption/previa
Treatment- Vaginal progesterone, cervical cerclage, (Pessary controversial)

42
Q

Diamniotic/Dichorionic pregnancy

A

Each twin has a separate sac and separate placenta- 38wks

43
Q

Diamniotic/Monochorionic pregnancy

A

Each twin has a separate sac, but share a placenta- 36 wk

44
Q

Monoamniotic/Monochorionic pregnancy

A

Each twin shares a sac and placenta- 32-34 wks

45
Q

Etiologies for having twins

A

ART (Assisted reproductive
technology), Ovulation induction
IVF, Clomiphene Citrate, Femara, IUI
(Intrauterine insemination)

46
Q

Delivery- Twins

A

Vaginal- Only for Mono/Di or Di/Di, Baby A head down, possible breech extraction
of 2nd twin- baby B must be concordant growth. Risk of head entrapment

C-section- Every other situation

47
Q

Fetal Growth Restriction

A

Estimated fetal weight (EFW) or abdominal circumference (AC) by ultrasound
<10% for gestational age
Severe- <3%ile, or with abnormal dopplers

Concern is placental resistance causing poor blood flow leading to the baby not growing
appropriately. The first area to be affected is typically the abdominal circumference.

48
Q

Fetal Growth Restriction risk factors

A

Hypertension, type I DM, chronic kidney disease, preeclampsia, aneuploidy,
smoking, drug use, thrombophilia, placental abnormalities, cord abnormalities

49
Q

Fetal Growth Restriction clinical presentation

A

Size less than dates on measurements,
otherwise by ultrasound due to some risk facto

50
Q

Fetal Growth Restriction eval and diagnosis

A

Evaluation- Growth ultrasound, evaluation of risk for aneuploidy,
Doppler velocimetry, NST
Diagnosis- Ultrasound-based diagnosis

51
Q

Fetal Growth Restriction treatment

A

depending on elevated dopplers, severity of growth restriction

52
Q

Gestational Diabetes

A

New onset diabetes after 20 weeks of pregnancy - pancreas is unable to
overcome insulin resistance caused by pregnancy

53
Q

Pregnancy and insulin

A

Pregnancy causes insulin resistance through hormones like HPL (Human placental
lactogen) which causes insulin resistance for the sake of the fetus
If there is baseline risk for preexisting insulin resistance, it compounds to Diabetes
Different from preexisting type I or II diabetes

54
Q

Gestational Diabetes clinical presentation

A

Normally no
symptoms- test is screening prior
to symptoms

55
Q

Diagnosis of gestational diabetes

A

Screening test- 1 hour
Glucose Challenge Test (GCT)
Confirmatory test- 3 hour Glucose
Tolerance Test (GTT)

56
Q

Risk factors for GDM

A
  • Age >35
  • Preexisting insulin resistance (PCOS)
  • Obesity
  • History of GDM
  • Previous large baby
  • Certain high risk groups- Native american etc
57
Q

Short-term increased risks of GDM

A
  • Preeclampsia
  • LGA baby (Large for gest. age)
  • Operative delivery
  • Cesarean section
  • Perinatal mortality
  • Fetal hypertrophic cardiomyopathy
  • Neonatal problems
  • Hypoglycemia, jaundice, etc
  • Polyhydramnios
58
Q

Long-term increased risks of GDM

A

Maternal increased risk of
- Outright diabetes
- Cardiac disease
- Metabolic syndrome

Fetal risk as an adolescent or adult
- Obesity
- Hypertension
- Metabolic syndrome
- Diabetes

59
Q

Does insulin cross the placenta?

A

No

60
Q

Gold standard treatment of GDM

A

Insulin

61
Q

Gestational hypertension

A

New onset systolic bp >140 mmHg and/or diastolic bp >90 mmHg on at least 2 occasions 4 hours apart after 20 weeks of gestation in a previously normotensive individual
And
- no proteinuria
- no s/s preeclampsia

62
Q

Risk factors of gestational hypertension

A

Nulliparous, multifetal pregnancy, obesity, pregestational diabetes, Lupus,
antiphospholipid antibody syndrome, chronic kidney disease, advanced maternal age, IVF

63
Q

Clinical Presentation of gestational hypertension

A

Incidentally found elevated pressure in clinic, need to rule out white coat
hypertension, normally no PreE symptoms.

64
Q

Evaluation of gestational hypertension

A

See if it’s preeclampsia- CBC, CMP, Urine protein (Protein to Creatinine ratio), (24 hr
urine is gold standard) evaluate for severe disease, assess fetal wellbeing

65
Q

Treatment of gestational hypertension

A

treat the same way as PreE. Delivery at 37 weeks. Prior to 37 wks, weekly labs, fetal
surveillance (NSTs, BPP), blood pressure log at home, precautions for severe features. Steroids?

66
Q

Definition of Preeclampsia Without Severe Features

A

New onset systolic bp >140 mmHg and/or diastolic bp >90 mmHg on at least 2 occasions 4 hours apart after 20 weeks of gestation in a previously normotensive individual
AND
- proteinuria

67
Q

RFs for Preeclampsia

A

gHTN. Deliver at 37 wks
Comes from both placental and maternal factors- Failure of spiral artery remodeling
leading to underperfusion, oxidative stress leading to release of antiangiogenic factors to
maternal circulation lead to HTN

68
Q

Clinical features of Preeclampsia

A

watch for heavy swelling (Every mom has some swelling), high weight
gain in small amount of time, HA, vision changes, epigastric pain, oliguria

69
Q

Preeclampsia with Severe Features

A
  • New onset systolic bp >160 mmHg and/or diastolic bp >10 mmHg on at least 2 occasions 4 hours apart
  • thrombocytopenia
  • Impaired liver function
  • Progressive renal insufficiency
  • Pulmonary edema
  • Persistent Cerebral or visual disturbances
70
Q

Indication to deliver with severe preeeclampsia

A

Indication is to deliver at 34 weeks, or earlier if clinically needed. Inpatient management

71
Q

Treatment of preeclampsia

A

Once Severe preeclampsia diagnosed, oral antihypertensives (labetalol, nifedipine) can be used to control BPs. IV
Labetalol or hydralazine for acute pressures
Magnesium 4g bolus, 2g/hr infusion required to prevent progression to eclampsia

72
Q

Eclampsia

A

In a patient with preeclampsia, presence of a generalized seizure that cannot be attributed to other causes

73
Q

HELLP syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelets
Hypertension may be present
HELLP

74
Q

HELLP diagnosis

A

Hemolysis evaluated by LDH >600

75
Q

Placenta Previa

A

Growth of the placenta over the
cervical os

76
Q

Trophotropism

A

placenta grows towards more
blood flow, away from the cervix with time

77
Q

Presentation of placenta previa

A

painless bleeding in the 3rd trimester

78
Q

Eval and diagnosis of placenta previa

A

Evaluation- Bleeding without ultrasound showing no
previa requires ultrasound prior to digital exam.
Diagnosis- Diagnosis is strictly ultrasound-based

79
Q

Management of plalcenta previa

A

Management- US at 20 wks, 32 weeks, then 36ish
weeks. Avoid sexual activity, moderate exercise
Delivery at 36-37 weeks
Required cesarean delivery

80
Q

Low-lying placenta (Marginal)

A

When the placenta is <2cm away from the
cervical os
If placenta is <1 cm from the os, c-section best.
Risk of requiring section - 45%
If >1 cm and <2 cm from the os, vaginal delivery
could be attempted, but higher risk of cesarean
due to bleeding Risk of requiring section - 14%
>2cm risk of section 10%

81
Q

Premature separation of the placenta
after 20 weeks

A

Placental abruption

82
Q

Clinical Presentation of placental abruption

A

Painful vaginal bleeding
typically with contractions, uterine tenderness,
sometimes nonreassuring fetal status

83
Q

Where is the blood coming from in placental abruption?

A

Bleeding comes from maternal vessels in the
decidua, not baby’s blood

84
Q

Placental Abruption risk factors

A

Trauma, previous abruption, HTN,
structural anomalies, drus (Cocaine), COVID?

85
Q

Placental Abruption eval & diagnosis

A

Evaluation- Monitor baby, labs- CBC, Coags, Kleihauer-Betke, Ultrasound
Diagnosis- Clinical diagnosis (No US or lab value will diagnose, take in all info)

86
Q

Placental Abruption treatment

A

Monitor baby, IV access with fluid, quantify blood loss, steroids if
needed, Could stop, continue, or get worse, treat accordingly.
Delivery can be vaginal if stable, C-section if bleeding too heavy

87
Q

PPROM

A

preterm prelabor rupture of membranes
Rupture of fetal membranes prior to 37 wks

88
Q

PPROM clinical presentation

A

Typically experiences a gush of fluid, not always large gush

89
Q

PPROM eval and diagnosis

A

Evaluation- Sterile speculum exam- no digital exam if possible. Watch for pooling, ferning,
nitrazine, Ultrasound, ROM+
Diagnosis- Clinical diagnosis

90
Q

PPROM treatment

A

Treatment- >34 wks- consider steroids, and deliver. Vaginal delivery is ok
<34 wks- rule out infection, give steroids, tocolysis optional, Mg if <32 wks. Latency
antibiotics- antibiotics for 7 days to keep someone pregnant.

91
Q

Preterm Labor

A

Contractions prior to 37 weeks causing cervical dilation 12% incidence

92
Q

Clinical Presentation of preterm labor

A

Typically more than Braxton-Hicks. Painful contractions for 2
consecutive hours every 5-10 minutes required evaluation

93
Q

Evaluation of preterm labor

A

Fetal wellbeing, contractions strength and frequency, serial cervical exams, check
UA, wet mount, CBC for signs of infection. (Infection anywhere in the body can cause
contractions), rule out abruption, infection. Draw GBS if needed

94
Q

Preterm Labor diagnosis

A

Contractions at least 1 every 10 minutes with one of following: >3cm
dilation, or <2cm CL, or 2-3cm CL with +FFN

95
Q

Treatment for preterm labor

A

> 34 wks, admit for observation, consider steroids, GBS
<34 Admit, steroids, tocolysis for 48 hrs, Mg if needed, GBS
Steroids typically Betamethasone, some use Dexamethasone
Tocolytics- Indomethacin (up to 32 wks), Nifedipine, terbutaline
Let it declare, will either progress or not

96
Q

Maternal monitoring after trauma or fall

A

Evaluation- History and physical, ultrasound, abdominal and vaginal exam looking
for trauma injury, signs of abruption, rupture of membrane, fetal evaluation with
monitoring for at least 4 hours. High risk of abruption

Low impact trauma- fall etc- will need 4 hrs of monitoring on L&D, CBC, Coags, Kb,
if all is well, she can go home with precautions

Womens health exam 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions