Complications of Pregnancy Flashcards
Define ectopic pregnancy. Where do they usually occur?
- Implantation of pregnancy anywhere except the endometrium
A. > 95% occur in fallopian tubes
B. 55% occur in ampulla
C. Rare sites include cervix, ovary, abdominal or pelvic cavity
What is the most common cause of an ectopic pregnancy?
occlusion of tube 2° to adhesions
What are the risk factors for ectopic pregnancies?
- Prior ectopic pregnancy
- Hx of salpingitis / PID
- Hx of abdominal /pelvic surgery
- IUD use
What are the classic sxs of an ectopic pregnancy?
- Adnexal pain/tenderness
- Amenorrhea or spotting
- +/- palpable adnexal mass
- Sometimes:
A. Dizziness
B. GI sxs
What are the sxs for a ruptured ectopic pregnancy?
- Severe abd pain
- Shoulder pain (Kehr’s sign)
- Tachycardia
- Syncope
- Orthostatic hypotension
What is the timeline for beta hCG level rise?
Normally beta-hCG levels double q 48 hrs
How is an ectopic pregnancy diagnosed?
- Serial levels of beta-hCG are less than expected
- Transvaginal USN diagnostic in 90% of cases
A. Women with beta-hCG titer > 1500 mU/mL should show intrauterine pregnancy (IUP) on transvaginal USN
B. If not seen, ectopic pregnancy is clinical Dx
How is an ectopic pregnancy treated medically?
- Methotrexate used if diagnosed early
- Criteria for methotrexate:
A. Serum hCG titer
How is an ectopic pregnancy treated surgically?
- Laparoscopy preferred
A. Removal of ectopic pregnancy
What is the f/u for an ectopic pregnancy?
Serum b-hCG’s &/or transvaginal USN to exclude any remaining evidence of pregnancy
Define spontaneous abortion. How often does it occur?
- Spontaneous premature expulsion of products of conception
2. Occurs in 15-20% of pregnancies
What are the types of spontaneous abortion?
- Threatened
- Inevitable
- Incomplete
- Complete
- Missed
When do most spontaneous abortions occur?
80% occur in 1st trimester
What are the most common causes of spontaneous abortion?
- 50% of these asst w/ chromosomal abnormalities
- Blighted ovum causes about one out of twomiscarriages
A. Fertilized egg implants in uterus but doesn’t develop into an embryo
What are the characteristics of a threatened abortion?
- Vaginal bleeding: Yes
- Cervix Open: No
- Products of conception passed: No
What are the characteristics of an inevitable abortion?
- Vaginal bleeding: Yes
- Cervix Open: Yes
- Products of conception passed: Not yet, but no way to maintain pregnancy
What are the characteristics of an incomplete abortion?
- Vaginal bleeding: Yes
- Cervix Open: Yes
- Products of conception passed: Partial
What are the characteristics of an complete abortion?
- Vaginal bleeding: Yes
- Cervix Open: Yes
- Products of conception passed: Yes
What are the characteristics of a missed abortion?
- Vaginal bleeding: No
- Cervix Open: No
- Products of conception passed: No, fetal demise has occurred w/o sxs
What are the risk factors for spontaneous abortion?
- Smoking
- Infection
- Maternal systemic disease
- Immunologic factors
- Drug Use
What are the sxs of a spontaneous abortion?
- Uterine size does not correlate appropriately to LMP
- Fundus of uterus may be “boggy” or tender
A. Boggy uterus – more flaccid than expected
How is a spontaneous abortion diagnosed?c
- Serum hCG (Quantitative & Qualitative)
- Serum progesterone
- Transvaginal USN
A. Nonviable pregnancy may include:
-Inappropriate development or interval growth
-Fetal demise - Blood type & Rh
A. R/O sensitization of Rh (-) mom
How is a spontaneous abortion treated?
- Uterus must be emptied
A. D&C may be necessary - F/U pelvic USN, pelvic exam & serum hCG
- Rho-Gam administered to Rh (-) woman if spontaneous abortion
- Septic or infected abortion
A. D&C, medical support & antibiotics
Define gestational trophoblastic disease (GTD)
Proliferation of trophoblastic tissue in pregnant or recently pregnant women
Define trophoblast
- Outermost layer of cells of blastocyst that attaches the fertilized ovum to uterine wall
A. Becomes the placenta
What is the malignant form of gestational trophoblastic disease?
- Choriocarcinoma (malignant)
A. A highly malignant tumor that arises from trophoblastic cells within the uterus.
B. Tends to be invasive and metastasize early and widely through both the venous and lymphatic systems.
What is the benign form of gestational trophoblastic disease?
- Hydatidiform mole-most common (generally benign, but can turn malignant)
A. AKA molar pregnancy - Results from over-production of tissue that is supposed to develop into placenta, but develops into abnormal growth
- Complete & incomplete (partial)
What are the characteristics of a complete hydatidiform mole?
- More common
- Characterized by empty egg & appearance of “grape like vesicles” or a “snowstorm pattern” on USN
- 20% progress to malignancy
What are the characteristics of an incomplete hydatidiform mole?
- Has a nonviable fetus present
2. 10% progress on to malignancy
What are the sxs of GTD?
- (+) hCG
- Vaginal bleeding
- Severe vomiting / hyperemesis
- No fetal movement, no fetal heart tones
- May have HA/visual changes leading to early pre-eclampsia
- Uterine size > dates
How is GTD diagnosed?
- Serum hCG
- Transvaginal USN
- CXR: evaluate for metastasis
What are the hCG levels in GTD?
- In complete molar pregnancy, often greater than 100,000 mU/mL
- Persistently high levels may indicate gestational trophoblastic tumor
What are the usn results in GTD?
- Characterized by empty egg & appearance of “grape like vesicles” or a “snowstorm pattern”
- 20% progress to malignancy
How is GTD treated?
- D & C always indicated
- Effective contraception during f/u period
- Follow hCG weekly until nl for 3-4 wks, then monthly x 6mo
A. Levels should drop consistently & never inc
B. If increase or plateau, need to R/O metastasis
C. Refer to GYN Oncology
D. Reach normal w/in 8-12 wks - Importance of F/U bc 20% molar pregnancies can develop malignancy afterwards
- Instructions not to become pregnant for ≥ 6mo
- Early USN in future pregnancies