Complications of Pregnancy Flashcards
Spontaneous Abortion
Intrauterine pregnancy at less than 20 weeks…After 20 weeks considered still birth
Overall, almost 20% of all clinically recognized pregnancies terminate in spontaneous abortion… MCC of early pregnancy
Threatened Abortion
Os closed, unpredictable outcome Slight bleeding Abdominal cramping Cervical os is CLOSED Uterine size compatible with dates Treat with bed rest
Inevitable Abortion
Os open, products of conception have not passed, pregnancy cannot be saved Moderate bleeding Moderate to severe uterine cramping Low back pain Cervical os is DILATED
Incomplete Abortion
Os open, some products of conception have passed Heavy bleeding Moderate to severe abdominal cramping Low back pain Cervical os is DILATED
Complete Abortion
Os may be open or closed, products of conception have passed
Bleeding may be heavy or minimal
Moderate to severe abdominal cramping
Low back pain
Fetus and placenta are completely expelled
Missed Abortion
Pregnancy did not develop
Lab Work-up For Recurrent Pregnancy Loss
Assessment of uterine structure: HSG, US
Rule out lupus (anticardiolipin antibody, lupus anticoagulant)
TSH
Ectopic Pregnancy Presentation
1-2 months of amenorrhea Morning sickness Breast tenderness Diarrhea, urge to defecate Malaise and syncope Lower abdominal/pelvic pain: Sudden and severe, Especially adnexal (lateralizing to one side) Referral of pain to shoulder
Ectopic Pregnancy Diagnosis & Treatment
Laparoscopy is definitive
Ectopic Pregnancy Medical Management
Methotrexate or Misoprostel given systemically for EARLY ectopic pregnancy who are:
Hemodynamically stable
Are willing and able to comply with post treatment follow-up
Have an hCG ≤ to 5000 mIU/mL
Have no fetal cardiac activity
Size of ectopic is
Hydatidiform mole
Most common Gestational Trophoblastic Disease
Benign neoplasm of the chorion in which chorionic villi degenerate
Occurs when a single sperm fertilizes an egg without a nucleus
Partial – a fetus or evidence of an amniotic sac is present
Complete – no fetus or amnion is found
Have a tendency to become choriocarcinoma
Hydatidiform mole Treatment
D & C immediately
*Weekly quantitative B-hCG
After two decreasing weekly tests, interval is increased to monthly x 6 months, then every 2 months for a total of one year
No further investigation if hCG levels decrease to normal
No pregnancy until hCG levels remain normal for a minimum of 1 year!
Choriocarcinoma
Rare
Highly malignant GTTD
May follow HM, invasion mole, abortion, normal pregnancy, ectopic pregnancy
Causes ulcerating surfaces into the endometrial cavity
Malignant tumor cells enter the circulation and are transported to lungs, brain etc
Presentation of placenta previa
Painless bleeding in 3rd trimester Bright red blood May have shock symptoms if bleeding severe VS stable FHT (fetal heart tones) normal Fetal activity present *NO vaginal or speculum exam should be done Diagnosis best made with ultrasound
Abruptio Placentae (placental abruption) Presentation
Vaginal bleeding: Mild to severe (amount does not correlate with degree of separation)
*Abdominal pain or back pain
Uterine contractions
Uterine tenderness
Nonreassuring fetal heart rate pattern
All pregnant women with abdominal pain, uterine contractions and vaginal bleeding need to have this ruled out
