Complications of Pregnancy Flashcards

Question

What are 5 causes of recurrent abortion?

Answer 1

``` Uterine factors Endocrine uncontrolled thyroid or polycystic ovarin Karyotype abnormalities Environmental toxins Autoimmune disease lupus ```

Answer 2

Where the embryonic development arrested at a very early stage or failed altogether Defined sonographically as a gestational sac larger than 25 mm without evidence of embryonic tissue Can present as a missed, inevitable, incomplete or complete abortion

Answer 3

It is an extrauterine pregnancy 98% occur in the fallopian tube Ampullary portion of tube most common Isthmic next most frequent site.

Answer 4

``` previous ectopic pregnancy previous tubal surgery current IUD use tubal ligation, tubal patho in utero DES exposure ```

Answer 5

The prevalence of ectopic pregnancy of woman who go to the ED for first trimester bleeding, pain or both ranges from 6-16%. The overall incidence has increased in the mid twentieth century, plateauing at approx. 20 per 1000 pregnancies in the early 1990’s The rising incidence associated with pelvic inflammatory disease

Answer 6

body forces the pregnancy out the fallopian tube

Answer 7

pregnancy blows out the fallopian tube

Answer 8

body sends the pregnancy out but it gets stuck in the abdomen

Answer 9

Based on measurement of serum HCG & transvaginal ultrasound, Hgb, HCT Accounts for 4-10% of all pregnancy related deaths HCG should double every 48 hours in a normal pregnancy if it doesn’t think its abnormal or ectopic

Answer 10

``` Vaginal bleeding and/or abdominal – pelvic pain Asymptomatic Abnormal menstruation Uterine changes Blood pressure & pulse Temperature Pelvic mass ```

Answer 11

Hemorrhage from ectopic

Answer 12

Dilatation & Curettage Laparoscopy Laparotomy= unstable patients

Answer 13

``` Salpingostomy= open the fallopian tube Salpingectomy= remove the fallopian tube ```

Answer 14

``` < 6 weeks Tubal mass < 3.5 cm in diameter Fetus has died B-HCG < 15,000 mIU Patient has to be willing to do blood work ```

Answer 15

Methotrexate Inhibits DNA synthesis

Answer 16

``` Breastfeeding Immunodeficiency Alcoholism Liver or kidney disease Blood dyscrasias Active pulmonary disease Peptic ulcer ```

Answer 17

Liver dysfunction Stomatitis Gastroenteritis Pneumonitis

Answer 18

Recurrent ectopic 4-28% | Intrauterine pregnancy 38-89%

Answer 19

is a group of conditions in which tumors grow inside a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta

Answer 20

Hydatidiform Mole (complete is MC or partial) Persistent/invasive gestational trophoblastic neoplasia (GTN) Choriocarcinoma Placental site trophoblastic tumors

Answer 21

noninvasive localized tumors that develop as a result of an aberrant fertilization event that leads to a proliferative process They comprise 90% of GTD cases The other three categories represent malignant disease

Answer 22

Originates from one maternal and usually two paternal haploid compliments Fetus of partial mole has triploidy with congenital malformations & IUGR, and it is usually nonviable

Answer 23

Varies worldwide North American & European countries 1 per 1000 to 1500 pregnancies Asia & Latin America 1 per 12 to 500 pregnancies

Answer 24

Extremes in age, older than 35 and < 20 | History of previous GTD

Answer 25

``` Vaginal bleeding Enlarged uterus Pelvic pressure or pain Theca lutein cysts get large, tumors of the ovaries usually bilateral and can get to 10-15mm in size Anemia hyperthyroid preeclampsia before 20 wks ```

Answer 26

``` High levels of hCG Ultrasound Absence of embryo or fetus No amniotic fluid Snowstorm pattern Theca lutein cysts= can produce testosterone ```

Answer 27

Immediate evacuation Measure serum hCG, q2 weeks, once negative , monthly for 6 months. Pregnancy allowed after 6 months

Answer 28

20% of molar pregnancies can develop this Usually limited to the uterus Good prognosis with chemotherapy 3% relapse

Answer 29

uncommon cancer that occurs during pregnancy. A baby may or may not develop in this type of pregnancy

Answer 30

Check for metastasis Lung, Vagina, Vulva, Kidneys Liver, Ovaries, Brain, Bowel

Answer 31

Immediate evacuation Chemotherapy Methotrexate Actinomycin D

Answer 32

Rare malignant tumors that originate from intermediate cytotrophoblast cells Arise months to years after a term gestation Can occur after a spontaneous abortion or a molar pregnancy Patients present with abnormal uterine bleeding, mass in uterus or amenorrhea Secrete small amounts of B-HCG

Answer 33

70% of tumors are confined to the uterus 30% of patients present with metastatic disease Mortality 50% with metastasis present Prolonged remission possible with combined chemotherapy

Answer 34

Nonmetastatic malignant trophoblastic disease Extremely good prognosis Metastatic disease Remission 45-65%

Answer 35

Twins naturally occur in approximately 1 in 80 pregnancies Triplets naturally occur in approximately 1 in 8,000 pregnancies Multiple pregnancies increasing disproportionately in the US Due to older age & use of fertility treatments

Answer 36

Monozygotic twins unknown Dizygotic twins results from ovulation of multiple follicles Dizygotic twins result from fertilization of 2 separate ova during a single ovulatory cycle Monozygotic twins result from a single fertilized ovum that subsequently divides into 2 separate individuals

Answer 37

Diamniotic, dichorionic placentation occurs with division prior to the morula stage(within 3 days postovulation) Diamniotic, monochorionic placentation occurs with division between days 4-8 days postovulation Monoamniotic, monochorionic placentation occurs with division between 8-12 days postovulation One of the worst types Division at or after day 13 results in conjoined twins Siamese twins

Answer 38

``` same amniotic sac Increases perinatal mortality Cord entanglement Congenital anomalies Discordant birth weight (twin-twin transfusion syndrome) One twin takes things ```

Answer 39

Ultrasound Uterine size Fetal heart sounds

Answer 40

Increase nausea & vomiting Increase blood volume expansion Increase in iron & folate requirements Increase cardiac output due to increase stroke volume and heart rate Displacement of many abdominal viscera Displacement of lungs by elevated diaphragm

Answer 41

``` Abortion Malformations Birth weight lower Prematurity Operative deliver ```

Answer 42

Ventral union 87% (joined in the front)

Answer 43

``` Experienced obstetrician Blood available IV access Anesthesiologist available Pediatrician available OR notified ```

Answer 44

Gestational HTN Chronic HTN Preeclampsia – eclampsia Preeclampsia – eclampsia superimposed on chronic HTN

Answer 45

Increased BP after 20 weeks gestation | No proteinuria

Answer 46

BP 140/90 or higher before pregnancy or before 20 weeks gestation HTN first diagnosed after 20 weeks but persists after 12 weeks postpartum

Answer 47

Syndrome of new onset HTN & either proteinuria or end organ dysfunction, most often after 20 weeks gestation in a previously normotensive woman Eclampsia diagnosed when seizures occur

Answer 48

When chronic HTN develops worsening HTN with new onset of proteinuria or other features of preeclampsia (elevated liver enzymes, low platelets) one of the four causes of maternal death

Answer 49

``` thrombocytopenia pulm edema renal insufficiency systolic >160 diastolic >110 ```

Answer 50

Hemolysis Elevated Liver Enymes Low Platelets

Answer 51

Prevalence of preeclampsia 7. 5 % worldwide 3. 4% in the US

Answer 52

occurrence of seizures in a woman with preeclampsia that cannot be attributed to other causes. The seizures are grand mal and may appear before, during or after labor. Presents with headaches Put on mag sulfate

Answer 53

Termination of pregnancy with the least possible trauma to mother & fetus Birth of an infant who subsequently thrives Complete restoration of health to the mother Antihypertensive therapy Labetalol Hydralazine Anticonvulsive therapy Magnesium sulfate

Answer 54

deliver the baby

Answer 55

Rhesus (Rh) negative woman who deliver an Rh positive baby or who are otherwise exposed to Rh positive RBC’s are at risk for developing anti-Rh antibodies. Rh positive fetuses/neonates of these mothers are at risk for developing hemolytic disease of the fetus and newborn

Answer 56

``` Rh negative (no D antigen) Rh positive (contains D antigen) D antigens are highly immunogenic Individuals who do not produce the D antigen (ie Rh negative) will produce anti-D if they encounter the D antigen (become Rh sensitized) ```

Answer 57

``` 1st pregnancy mom built up antibodies 2nd pregnancy: IgG antibodies cross the placenta Maternal antibodies attach to fetal RBC antigen Hemolysis of fetal RBC’s ```

Answer 58

``` Hepatomegaly Splenomegaly Hyperbilirubinemia fetal jaundice hydrops fetalis ```

Answer 59

Detection of anti-Rh(D) antibody in maternal serum by performing a type and antibody screen The antibody titer is then quantified. If titer is above critical level further evaluation is indicated The titer below which the fetus will not die from hemolytic disease is usually 1:16

Answer 60

serious condition in which abnormal amounts of fluid build up in two or more body areas of a fetus or newborn.

Answer 61

``` Hepatosplenomegaly Portal hypertension Ascites Fetal hypoxia Anemia Congestive cardiac failure Hyperproteinemia secondary to hepatic dysfunction ```

Answer 62

``` Give Rh Immunoglobin: Pregnancy loss Termination of pregnancy Procedure-amniocentesis Any bleeding during pregnancy At 28-29 weeks Following delivery if baby is Rh positive ```

Answer 63

defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy

Answer 64

All pregnant woman are screened using 50-g of glucose Screening is usually done after 26 weeks gestation A value of > 135 mg/dl requires further evaluation with a 3 hour GTT

Answer 65

``` FBS 100-g glucose Values FBS – 95 1 hour – 180 2 hour – 155 3 hour – 140 Need 2 out of 3 to constitute gestational DM If FBS is abnormal patient has GDM ```

Answer 66

A1 Diet controlled gestational diabetes | A2 Insulin treated gestational diabetes

Answer 67

``` Unexplained fetal death Preclampsia Hydramnios Maternal & infant birth trauma Neonatal respiratory problems & metabolic problems (hypoglycemia, hyperbilirubinemia, hypocalcemia) Macrosomia very large babies Operative delivery ```

Answer 68

Fasting blood glucose < 95 mg/dl One-hour postprandial blood glucose < 140 mg/dl Two-hour postprandial blood glucose < 120 mg/dl

Answer 69

``` Diet Insulin Oral anti-hyperglycemic agents Glyburide Metformin ```

Answer 70

Good glucose control Nonstress Tests Biophyisical profile Amniotic fluid index

Answer 71

Avoidance of stillbirth | Avoidance of delivery related complications trauma or shoulder dyslocia

Answer 72

Cesarean section | Neonatal morbidity if < 39 weeks

Answer 73

A1 GDM Deliver by 41 weeks A2 GDM Deliver @ 39 weeks

Answer 74

``` 75 gram oral GTT Fasting < 140 impaired GTT > 140 DM 2 Hour 140 – 199 impaired GTT > 200 DM ```

Answer 75

Refers to rupture of the fetal membranes prior to the onset of regular uterine contractions It may occur at term > 37 weeks or preterm < 37 weeks 3% of pregnancies Associated with 33% of preterm births

Answer 76

``` Sterile speculum exam Leaking of fluid Nitrazine test Fern test ROM Plus, AmniSure ```

Answer 77

Induce labor | Expectant

Answer 78

Previous PPROM (13.5%) Genital tract infection Antepartum bleeding Cigarette smoking

Answer 79

Antenatal corticosteroids-- helps mature the lungs in 2 days Antibiotics Tocolytic drugs-- stop the labor for at least 2 days so that you get better lung maturity

Answer 80

Placenta previa refers to the presence of placental tissue that extends over or lies proximate to the internal cervical os Painless vaginal bleeding 3rd trimester******

Answer 81

``` Previous placenta previa Previous cesarean section Multiple gestation Multiparity many babies Advanced maternal age Infertility treatment Previous abortion Previous intrauterine surgical procedure ```

Answer 82

Suspect with painless vaginal bleeding Do not do digital vaginal exam Obtain ultrasound

Answer 83

Follow with US If uncomplicated deliver between 36-37.6 weeks Unstable deliver by C/S

Answer 84

The separation of the placenta from its site of implantation before delivery of the fetus. Also termed Placental Abruption

Answer 85

The immediate cause of the premature separation of the placenta is rupture of the maternal vessels in the decidua basalis, where it interferes with the anchoring villi of the placenta unknown etiology

Answer 86

``` Abrupt onset of vaginal bleeding with abdominal pain Bleeding can be mild or profuse Contractions Uterus is firm, may be rigid & tender Maternal hypotension Fetal distress DIC ```

Answer 87

U/S and clinically

Answer 88

Nonsevere abruption @ 34 – 36 weeks – deliver Nonsevere abruption @ 36 weeks - deliver **Most by C-section

Answer 89

difficult labor & is characterized by abnormally slow labor Disproportion between the presenting part of the fetus and the birth canal It is a consequence of 4 distinct abnormalities that may exist singly or in combination

Answer 90

abnormalities involving the cervix, uterus, fetus, maternal bony pelvis or other obstructions in the birth canal ACOG simplified into 3 categories: Abnormalities of the powers (uterine contractility & maternal expulsive effort) Abnormalities involving the passenger (the fetus) Abnormalities of the passage (the pelvis)

Answer 91

contracting every 5 min

Answer 92

Hypotonic uterine dysfunction mild contractions | Hypertonic uterine dysfunction uterus contracts and is “too contracted”

Answer 93

Epidural analgesia slow labor down Chorioamnionitis infection

Answer 94

Contracted pelvis | Excessive fetal size small pelvis

Answer 95

women is not pushing forcefully Causes of inadequate expulsive forces Heavy sedation Conduction analgesia

Answer 96

Intrapartum infection Uterine rupture rare Fistula formation due to pushing for long periods and the baby is larger causing lacerations to the vagina + rectum Pelvic floor injury

Answer 97

is an umbilical arterial blood pH of <7.00

Answer 98

FHR patterns are indirect markers of the fetal cardiac and medullary responses to blood volume changes, acidemia and hypoxemia, since the brain modulates heart rate

Answer 99

Category I Observation Category II Intervention, no improvement deliver Category III Deliver Change the position of the patient with category II

Answer 100

Refers to the delivery of a baby through surgical incisions in the abdomen and uterus. Categorized as either primary or repeat C/S rate in the U.S. is about 33%

Answer 101

Failure to progress during labor (35%) dystocia Nonreassuring fetal status (24%) Fetal malpresentation (19%) breach or a face presentation

Answer 102

Abnormal placentation (eg. placenta previa) Maternal infection (eg. Genital HSV active) Multiple gestation Cord prolapse cord comes out first Fetal bleeding diathesis Suspected macrosomia (5000 gms in woman without DM, 4500 gms in woman with DM) Mechanical obstruction to vaginal birth

Answer 103

Anesthesia Spinal(best cause immediate) or epidural 30 min to go into effect General

Answer 104

External incision Low transverse Vertical--- only time is if she already had this Internal incision Low transverse Vertical (This is the incision that matters for subsequent pregnancies)

Answer 105

``` Vertex Only one prior C/S Previous C/S > 18 months Full consent of patient Available OR for emergency C/S Blood available No pitocin ```

Answer 106

Obstetrical emergency that can follow a vaginal delivery or cesarean section Major cause of maternal morbidity Top 3 causes of maternal mortality excessive bleeding that makes the patient symptomatic Occurs in 1-5% of deliveries

Answer 107

Primary (first 24 hours after delivery) | Secondary or delayed (24 hours to 12 weeks after delivery)

Answer 108

``` Overdistension of uterus Uterine infection Uterine relexants Uterine fatigue Uterine inversion Retained placenta trauma coag deficiencys ```

Answer 109

``` Retained placenta Failure to progress during second stage of labor Placenta accreta Lacerations Instrumental delivery Large for gestational age Hypertensive disorders Induction & augmentation of labor ```

Answer 110

Restore or maintain adequate circulatory volume Restore or maintain adequate tissue oxygenation Reverse or prevent coagulopathy Eliminate the obstetric cause of PPH

Answer 111

``` Check for lacerations Retained placenta Treat uterine atony Intrauterine balloon tamponade Laparotomy Hysterectomy ```

Answer 112

``` Hypovolemic shock & organ failure (renal failure, stroke, MI, Sheehan syndrome) Fluid overload (pulmonary edema) Anemia Abdominal compartment syndrome Transfusion related complications (ie: electolyte imbalance) Acute respiratory distress syndrome Anesthesia-related complications sepsis death ```

Answer 113

Secondary postpartum hemorrhage (occurring 24 hours to 12 weeks postpartum) Occurs 0.5-2% Pathogenesis Diffuse uterine atony Subinvolution of placental site (retained products of conception, infection) Bleeding diathesis Choriocarcinoma

Answer 114

10-15% risk of recurrence in a subsequent pregnancy