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Women'sHealth > Complications with pregnancy > Flashcards

Complications with pregnancy Flashcards

Ectopic

1
Q

What is the beta-hCG level at which an intrauterine pregnancy should be seen on ultrasound?

A

2000 mlU/ml

beta-hCG over this with empty uterus = ectopic

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2
Q

What progesterone level suggests healthy pregnancy?

A

> 25 ng/ml

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3
Q

In a normal pregnancy, the beta-hCG should rise by 50% every ___ hours for the first ___ days of the pregnancy.

A

48

42 days

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4
Q

What conditions must be met prior to methotrexate administration for tx of ectopic pregnancy?

A

hemodynamic stability, non-ruptured ectopic, size <4cm without fetal HR OR <3.5 cm with fetal HR, nl liver enzymes and renal function, nl white cell count

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5
Q

What is the most common chromosomal abnormality in spontaneous abortions?

A

autosomal trisomy

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6
Q

Which systemic diseases are associated with early pregnancy loss?

A

Diabetes Type 1, chronic renal disease, lupus

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7
Q

For a woman with an incompetent cervix, when should a cervical cerclage be placed?

A

14 weeks

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8
Q

Use of misoprostol has been shown to (shorten/lengthen) time to expulsion.

A

shorten

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9
Q

What are appropriate treatments for thyroid storm in pregnancy?

A

PTU, propanolol, sodium iodide, dexamethason

vs - radioactive iodine (I-131) can concentrate in the fetal thyroid

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10
Q

Women without risk factors for type2 or gestational diabetes should be screened (when?)

A

24-28 weeks

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11
Q

Women with risk factors for type 2 or gestational diabetes should be screened when?

A

At their first visit:
50-g oral glucose challenge
+ 100-g oral glucose tolerance test (OGTT)

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12
Q

What is the biggest concern for a pregnant woman with pulmonary hypertension?

A

25-50% risk of death

Mostly from diminished venous return and R ventricular filling

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13
Q

Magnesium toxicity can lead to what complication during labor?

A

Respiratory depression, muscle weakness, loss of DTR, nausea

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14
Q

How do you reverse magnesium toxicity?

A

Calcium gluconate

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15
Q

What 24 hour urine protein value indicates preeclampsia?

A

300 mg

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16
Q

What 24 hour urine protein value indicates severe preeclampsia?

A

5000 mg or 5 g

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17
Q

What is the hallmark of eclampsia syndrome?

A

seizures

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18
Q

What are contraindications for expectant management of severe preeclampsia <32 weeks?

A

thrombocytopenia <100,000, BP not controlled with 2 antihypertensives, non-reassuring fetal surveillance, LFTs elevated >2x normal, eclampsia, persistent CNS symptoms, oliguria

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19
Q

What on tocometer indicates placental abruption

A

tachycardia and sinusoidal HR pattern = fetal anemia

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20
Q

When reducing blood pressure with medications, what is the target diastolic blood pressure?

A

90-100 mg, NOT normal blood pressure

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21
Q

Uncontrolled diabetes can lead to birth defects in which main areas?

A

spine and heart

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22
Q

Why do fetuses in utero to moms with gestational diabetes experience polyhydramnios?

A

high levels of glucose –> polyuria

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23
Q

What medication is indicated for a pt with PPROM but no contractions?

A

ampicillin and erythromycin prolongs latency period by 5-7 days

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24
Q

What medication has been shown to decrease the risk of PPROM?

A

17 alpha-hydroxyprogesterone

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25
Q

When is delivery recommended for pts with PPROM?

A

34 weeks

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26
Q

What is the pH of amniotic fluid?

A

7.1-7.3

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27
Q

What body fluids can cause a falsely positive nitrazine test?

A

semen or blood

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28
Q

What is a common finding in IUGR fetuses determined by doppler ultrasound?

A

systolic/diastolic (S/D) ratio increased

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29
Q

Fetal growth restriction is a risk factor for development of what diseases?

A

Hypertension, stroke, COPD, DMT2, obesity

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30
Q

What defines a threatened abortion?

A

vaginal bleeding and positive preg tests but closed cervix

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31
Q

Medical abortion is associated with (higher/lower) blood loss than surgical.

A

higher

32
Q

Manual vacuum aspiration is effective for termination of pregnancy of what gestational age?

A

less than 8 weeks

33
Q

What antibiotic is given during/after surgical abortion?

A

doxycycline

34
Q

What are risk factors for molar pregnancy?

A

Asian race (1/800 vs 1/1500-2000)
less than 20 yo
decreased consumption of beta-carotene and folic acid

35
Q

What is the standard management for molar pregnancies?

A

suction curettage

36
Q

How many chromosomes are found in a complete mole?

A

46 (empty egg + single or two sperm)

37
Q

How many chromosomes are found in a partial mole?

A

69 (egg + 2 sperm)

38
Q

Partial moles have a (higher/lower) chance of developing into post-molar GTD.

A

lower

39
Q

What is the risk that molar pregnancy progresses to malignant GTD?

A

20%

40
Q

Molar pregnancies are associated with what other condition?

A

ovarian cysts and increase thyroid hormone

41
Q

What is the mechanism for increase in ovarian cysts and TSH suppression?

A

hCG has an alpha subunit similar to LH and TSH

42
Q

What is the most common malformation in babies born to diabetic mothers?

A

cardiac (38%), then MSK, then CNS

43
Q

What is the one diabetic complication that pregnancy worsens?

A

proliferative retinopathy

44
Q

What thyroid medications cross the placenta?

A

thionamides (PTU and methimazole) –> can lead to goiter and hypothyroid in fetus

45
Q

How does acute fatty liver of pregnancy present?

A

late in pregnancy, more in nulliparous, several days of malaise, anorexia, nausea, emesis, jaundice
elevated PT/PTT, bilirubin, ammonia
hypoglycemia

46
Q

How is acute fatty liver in pregnancy treated?

A

delivery - resolves spontaneously

Important to deliver quickly! without delivery –> coma, death from hepatic failure, hemorrhage or renal failure

47
Q

ITP is associated with platelet counts

A

100,000

absence of splenomegaly

48
Q

What platelet count needs to be maintained in pregnant women with ITP to decrease risk of hemorrhagic episode?

A

above 20,000

49
Q

What are the fetal affects of maternal syphilis infection?

A

hepatosplenomegaly, edema, ascites, hyrops, petechiae/purpuric skin lesions, osteochondritis, lymphadenopathy, rhinitis, pneumonia, myocarditis, nephrosis, enlarged placenta

50
Q

What are complications for the fetus of maternal parvovirus infection?

A

hydrops, still birth, fetal anemia

remember the red baby balloon in sketchy

51
Q

Risk factors for placenta previa…

A

prior placenta previa
multiple gestation
advanced maternal age (>35)
prior cesarean delivery

52
Q

Intrahepatic microvesicular fatty infiltration of hepatocytes secondary to abnormal maternal-fetal fatty acid metabolism =

A

AFLP = acute fatty liver of pregnancy

53
Q

Lab findings of AFLP

A 
increased aminotransferases
increased bili
thrombocytopenia
hypoglycemia
DIC
54
Q

Treatment for AFLP

A

immediate delivery

55
Q

What defines a “threatened” abortion?

A

closed cervix, viable fetus on u/s, vaginal bleeding

56
Q

Amphetamine use during pregnancy is associated with what complication?

A 
fetal growth restriction
preeclampsia
abruptio placentae
preterm delivery
fetal demise
57
Q

Complications of asymptomatic bacteriuria:

A

acute pyelonephritis
preterm labor
low birth weight

58
Q

Pathophys of asymptomatic bacteriuria in pregnancy?

A

increased progesterone –> smooth muscle relaxation –> ureteral dilation

59
Q

What is the amniotic fluid volume you are looking for in a biophysical profile?

A

single fluid pocket >2 cm x 1 cm

less than that = oligo

60
Q

A biophysical profile score of 0-4/10 indicates…

A

fetal hypoxia –> from placental dysfunction

61
Q

What are the 5 components of the biophysical profile?

A 
nonstress test
Amniotic fluid volume
fetal movements
fetal tone
fetal breathing movements
62
Q

What is fetal tachycardia defined as?

A

> 160 bpm

63
Q

What are contraindications for a trial of labor?

A

vertical incision cesarean delivery

Abdominal myomectomy with uterine cavity entry

64
Q

Patients with active HSV infection should…

A

undergo C-section

65
Q

What is the next step in a patient at >34 weeks gestation with PPROM?

A

delivery +/- antibiotics if no GBS swab done

66
Q

What is the feared complication of PPROM?

A

chorioamnionitis

67
Q

How do you diagnose intra-amniotic infection?

A

maternal fever + one of the following: fetal tachy (>160), maternal leukocytosis, maternal tachy, purulent amniotic fluid

68
Q

What is the most appropriate management for pregnant patients with prior HSV infection?

A

begin antiviral suppression at 36 weeks - if lesions during labor then C-section

69
Q

SBP >140 and/or DBP >90 prior to 20 weeks gestation…

A

Chronic hypertension

70
Q

New onset elevation of BP at >20 weeks gestation withOUT proteinuria

A

gestational HTN

71
Q

Fetal risks to pregnancy from hypertension…

A

fetal growth restriction, perinatal mortality, oligo, preterm delivery

72
Q

Congenital heart defects are associated with what maternal conditions?

A

maternal diabetes

Family history of CHD

73
Q

What is magnesium used for during labor?

A

seizure prophylaxis

74
Q

What is oxytocin used for during labor?

A

induction, hemorrhage

75
Q

What are adverse effects of oxytocin?

A

hyponatremia, hypotension, tachysystole

76
Q

Oxytocin is similar to ___ (other hormone) –> water retention and hyponatremia

A

ADH

both from posterior pituitary

Women'sHealth (12 decks)

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