Complications of pregnancy trigger Flashcards
risk factors include STD, PIC and IUDs
ectopic pregnancy
presents with vaginal bleeding, adnexal mass, abdominal pain and tenderness on the pelvic exam. what is your assumed diagnosis and what other presentations could you see?
ectopic pregnancy
could see hypotension, unresponsive, peritoneal irritation radiating up to R shoulder referral.
would also see bHCG that does not increase 2x every 48 hrs and an US that shows an empty uterus or a donut sign.
pt presents with vaginal bleeding. BP is 86/48 and she is currently unresponsive. on the way to the ER EMS reports pt complaining of pelvic pain radiating to the Right shoulder.
what is the diagnosis and what diagnostics would you get to confirm
ectopic pregnancy
b-hCG does not 2x every 48h as it does normally
U/S: Empty uterus or donut sign
US showing donut sign
ectopic pregnancy
bone marrow depression is a SE of what
Methotrexate usage
also see:
stomatitis
liver
gastroenteritis
seperation pain
which surgery is a complete tubal resection
salpingectomy
which surgery is a removal of ectopic pregnancy while salvaging tubes
salpingostomy
which abortion type presents with an open cervical os and a pregnancy that is unlikely to be viable but is NOT treated with a D&C
inevitable abortion
dont D&C because there is still a small tiny possibility that baby could make it
Death prior to 20 weeks with complete retnetion of POC and a closed cervical os
missed abortion
a 16 week pregant patient presents with complaints of vaginal spotting. on pelvic exam her cervical os is closed. ultrasound shows a viable pregnancy. what is the diagnosis
threatened abortion
an excessively edematous immature placenta is a indication of what
molar pregnancy (hydratiform mole)
also see:
villous stromal edema
trophoblast proliferation
a risk factor for this condition is extremes of reproductive age. including very young OR very old women
molar pregnancy
a patient presents with vaginal bleeding with reports of a positive pregnancy test last week. she has yet to visit her OBGYN but suggests that she is likely only 4 weeks pregnant. lab studies show a hCG of 127,000 and US shows a mass with multiple cystic spaces that seems to be the size of a 12 week old fetus.
what is likely the diagnosis and what is the pathology behind this?
complete molar pregnancy
46 XX or XY
Paternal in origin for both sets
Vag bleeding
Large for date
hCG > 100k
Theca lutein cyst
NO fetal parts with edematous villi
US shows snowstorm appearance (anechoic cystic spaces)
theca lutein cyst is associated with which condition
complete molar pregnancy
a patient presents with vagnial bleeding and reports she might be pregnant but is not sure. HCG is 18,000 and ultrasound shows a multicystic placenta that is thickened. what is the likely diagnosis and what are the key points.
partial molar pregnancy
69 XXX or XXY or XYY
Two paternal haploid and 1 maternal
Missed abortion + small for date
Fetal parts present
what is the confirmatory diagnostic for molar pregnancies
pathology
this can result in thyroid storm and increased risk of hyperemesis gravidarum and preeclampsia/eclampsia.
molar pregnancies
Bleeding occurring with a viable mature fetus after week 24
antepartum bleeding
what complication of pregnancy may be assocaited with an elevated AFP (not fetal complication, pregnancy complication)
placental abruption
rememberthe FETAL complication that occurs with elevated AFP is neural tube defects:)
this is a diagnosis of exclusion
placental abruption
complications of this include consumptive coagulopathy and couvelaire uterus
placental abruption
can also see AKI and hypovolemic shock.
If a mother has placental abruption and they are in hypovolemic shock what is the management
crystalloid and blood transfusion (PRBCs)
general placental abruption management:
if fetus is alive -> c section
if fetus is dead -> vaginal (im assuming c section if shes in hypovolemic shock tho??)
what is the definition of a low lying placenta
2cm outside of os
risk factors for this pregnancy complication includes prior c section, smoking and elevated MSAFP
placenta previa
also:
increased age
increased parity
Painless vaginal bleeding occurring past 2nd trimester is indicative of what
placenta previa
when is digital exam contraindicated
placenta previa because you could puncture the placenta
Abnormally firm adherence to myometrium due to lack/thin decidua basalis and imperfect fibrinoid layer.
placenta accrete syndromes
having placenta previa puts increases the risk of what other complication
placenta accrete syndromes
what confirms placental accrete syndromes
pathology
Painless cervical dilatation in 2nd trimester
cervical insufficiency
a risk factor for this complication is DES exposure
cervical insufficiency!
also prior cervical trauma is a risk factor
what complication of pregnancy requires a swab for infection at time of diagnosis
cervical insufficiency
if a mom has a previous hx of premature births, what should you give her
IM progesterone
if mom has a shortened cervix and youre looking to prevent premature birth, what do you do
vaginal progesterone
membrane rupture BEFORE contractions begin AND before 37 weeks is known as what
PPROM
risk factors include smoking, antepartum bleeding and genital tract infection
PPROM
what complication is treated with ABX therapy + tocolysis + corticosteroids? what are the ABX combo options?
PPROM
- Ampicillin IV then amoxicillin PO
- Erythromycin IV then erythromycin PO
- Erythromycin IV then azithromycin PO
what complication of PPROM means we must immediately deliver? when do we typically want to wait to deliver PPROM babies?
clinical chorioamnionitis (infection) = deliver
typically try to wait until 34 weeks.
what is the MOST dangerous complication of PPROM
cord prolapse
What other conditions can occur in place of proteinuria to qualify for preeclampsia?
Thrombocytopenia
Renal insufficiency
Impaired liver function
Pulmonary edema
New onset HA unresponsive to therapy
what is HELLP and what does it suggest?
Hemolysis, elevated liver enzymes, lower platelets.
suggests preeclampsia superimposed on chronic HTN
proteinuria + new onset HTN after 20 weeks
preeclampsia
complications of neonates born to mothers with this pregnancy complication include:
hypocalcemia
cardiomyopathy
hyperbilirubinemia and polycyhemia
hypoglycemia
pregestational diabetes
also:
RDS and long term cognitive defects
what type of management is preferred in pregestational DM
insulin instead of orals
a t sign on an ultrasound suggests what
monochorionic shared placenta
a twin peak sign on an ultrasound suggests what
fused dichorionic placenta
what is the GABA A receptor modulator that was made for PPD onset in the 3rd trimester
Zuranolone
when should we order an echo in prenatal complications
chronic long term HTN
when should you consider pre-op uterine artery embolization or leaving the placenta in situ until a future hysterectomy
placenta accrete syndrome
