Complications of Pregnancy Flashcards by Andrea Janney

Symptoms include bright red, heavy bleeding, midline cramping, low back pain, expulsion of products of conception

spontaneous abortion

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Symptoms include slight bleeding, abdominal cramping, cervical os is closed, no products of conception are passed

threatened abortion

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Symptoms include moderate bleeding, uterine cramping, cervical os is dilated, products of conception aren’t passed but passage is inevitable

inevitable abortion

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Symptoms include heavy bleeding, abdominal cramping, low back pain, dilated cervical os, some portion of conception products remain in uterus

incomplete abortion

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Symptoms include bleeding, abdominal cramping, low back pain, expulsion of fetus and placenta

complete abortion

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Pregnancy ceased to develop, but products of conception have not been expelled. Brownish vaginal discharge but no free bleeding. Pain doesn’t develop

missed abortion

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Management of a patient with a threatened abortion

Bed rest from 24 - 48 hours with gradual resumption of usual activities

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Management of patient with missed, inevitable, incomplete abortion

counseling, assess Rh factor, plan for elective termination

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Most common location for ectopic pregnancy

fallopian tube

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Major cause of maternal death during the 1st trimeseter

ectopic pregnancy

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A synthetic form of estrogen. Women exposed to this as a fetus have increased risk of breast CA

Diethylstilbestrol (DES)

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Symptoms include 1-2 months amenorrhea, morning sickness, breast tenderness, diarrhea, sudden, severe pelvic pain that tends to be lateralized. Referred pain to shoulder

ectopic pregnancy

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Pelvic exam reveals: Normal appearing cervix, marked tenderness. Vaginal vault may be bloody, usually brick red to brown in color. Tender adnexal mass may be palpated

ectopic pregnancy

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What lab result will be lower than expected for an ectopic pregnancy?

B-hCG

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virtually diagnostic of an ectopic pregnancy

hCG level of 6,500mU/ml with an empty uterine cavity by U/S

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given systemically as a single dose or multiple doses, is acceptable medical therapy for EARLY ectopic pregnancy and hemodynamically stable

methotrexate

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Most common type of gestational trophoblastic disease

hydatidiform mole

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Benign neoplasm of the chorion in which chorionic villi degenerate and become transparent vesicles containing clear, viscus fluid. Occurs when a single sperm fertilizes an egg without a nucleus

hydatidiform mole

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Which type of hydatidiform mole has a tendency to become choriocarcinoma?

complete

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Symptoms include vaginal bleeding, enlarge uterus, pelvic pain, anemia, theca lutein cysts, hyperemesis gravidarium, no fetal heart tones/activity

hydatidiform mole

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What happens to the B-hCG with hydatidiform mole?

extremely high for gestational age

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On ultrasound there is absence of gestational sac and Characteristic multiple echogenic region “snowy” within the uterus.

hydatidiform mole

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Where does hydatidiform mole metastases to?

lungs. get CXR

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Treatment for hydatidiform mole

D & C immediately. Pathologic exam on curettings.

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How often do you follow B-hCG with hydatidiform mole?

weekly. after two decreasing weekly test can check monthly for six months then every 2 months for one year

Treatment of choice for choriocarcinoma

Highly sensitive to chemotherapy

What do the following have in common: implantation, ectopic pregnancy, impending/complete abortion, cervical/vaginal/uterine pathology?

major causes of first trimester bleeding

Placenta implanted in lower segment of the uterus and extends over or lies proximal to the internal cervical os

placenta previa

Symptoms include painless bright red bleeding in 3rd trimester, may have shock symptoms, VS and FHT stable

placenta previa

Absolutely contraindicated in placenta previa due to potential to bleed out

vaginal or speculum exam. diagnosed with US

Management of placenta previa

IV fluids and Magnesium sulfate and corticosteroids if in labor and < 34 weeks

Partial or complete detachment of a normally implanted placenta at any time prior to delivery. Often during 3rd trimester. Significant cause of mortality

Abruptio Placentae (placental abruption)

Major risk factor for abruptio placentae

smoking

Symptoms include vaginal bleeding, abdominal pain, uterine contractions/tenderness, nonreassuring FHT

Abruptio Placentae (placental abruption)

What do all pregnant women with abdominal pain, uterine contractions and vaginal bleeding need to have ruled out?

Abruptio Placentae (placental abruption)

How is Abruptio Placentae (placental abruption) diagnosed?

ultrasound-retroplacental hematoma

the placenta attaches itself too deeply into the wall of the uterus.

Placenta Accretas

associated with a history of prior cesarean section, history of uterine instrumentation or surgery, or placenta previa

placenta accretas

Risks associated with placenta accretas

preterm delivery and severe postpartum hemmorrhage

Treatment for placenta accretas

Monitor pregnancy with the intent of scheduling a delivery and using a surgery that may spare the uterus

Persistant, severe, intractable vomiting during pregnancy. Peak incident is 8-12 weeks. Should resolve by 20 weeks

Hyperemesis Gravidarum

Management of a patient with Hyperemesis Gravidarum

hospitalization w/bed rest, NPO x 48hrs. Place patient on dry diet as soon as possible

First line medication for Hyperemesis Gravidarum

Pyridoxine (Vitamin B6)

Defined as the presence of elevated blood pressure and proteinuria during pregnancy. Caused by widespread vascular endothelial dysfunction and vasospasm

preeclampsia

What are the three classic elements required for preeclampsia?

HTN, proteinuria, edema

When can preeclampsia-eclampsia occur?

anytime after 20 weeks of gestation and up to 6 weeks postpartum

What is unusual about the thromboxane and prostacycline levels in preeclampsia-eclampsia?

Placenta produces 7x more thromboxane than prostacycline. Normally they are equal

Management of preeclampsia at 36 weeks regardless of severity or lack thereof

delivery

Management of mild preeclampsia

bed rest, low dose ASA, hydralazine or methyldopa to reduce BP

Quantification of severe preeclampsia

B/P: ≥ 160 systolic or ≥ 110 diastolic. Proteinuria: ≥ 500mg/24 hours or 4+ on dipstick. Oliguria of < 500ml/24hrs. Thrombocytopenia

What is HELLP syndrome seen with severe preeclampsia?

hemolysis, elevated liver enzymes, low platelets

Abnormalities of peripheral smear with HELLP

burr cells and schistocytes

Symptoms include: epigastric pain, nausea, RUQ tenderness, edema

HELLP

When does preeclampsia become eclampsia?

presence of seizures

Given to control seizure activity when treating eclampsia

Mg sulfate

Signs of Mg toxicity

decreased DTRs, respiratory rate/depth

How do you reverse Mg toxicity?

Calcium gluconate

labor that begins before the 37th week of pregnancy

preterm labor

Can indicate patients at risk for preterm labor. Retrieved from cervix. It's presence in the 2nd or 3rd trimester is a serious warning of PTL

Fetal fibronectin

Pharmacological treatment for preterm labor that can be safely halted

tocolytics

Visualization of fluid in the vagina of a pregnant women who presents with a history of leaking fluid

rupture of the membranes

Ferning patterns for amniotic and cervical mucous

amniotic = delicate fern pattern. cervical = dense and thick fern pattern

at higher risk of neonatal hypoglycemia, hyperbilirubinemia, hypocalcemia and polycythemia

newborn of DM mother

Effect of pregnancy on maternal thyroxine requirements

increase in women with hypothyroidism diagnosed prior to pregnancy