DLA10- Diseases of Pregnancy

Question 1

Spontaneous Abortion / Miscarriage:

• defined as before (1), but usually before (2)
• mostly due to (3)
• (4) are other important causes

Answer 1

1- 20 wks
2- 12 wks

3- unknown
4- fetal chromosomal anomalies, maternal endocrine factors, physical defects of uterus, systemic disorder affecting vasculature

Question 2

list Sxs of spontaneous abortion / miscarriage

Answer 2

• vaginal bleeding: mild spotting to severe bleeding (possibly leading to shock)
• lower abdominal pain (uterine contractions)
• loss of fetal hear beat on US

Question 3

Most ectopic pregnancies are in (1). (2) is the main predisposing condition, with (3) as other factors.

Answer 3

1- tubal pregnancy, 90% in extrauterine fallopian tubes

2- PID (chronic salpingitis)

3- endometriosis + fibrosis, prior surgery, IUDs

Question 4

(1) are ectopic pregnancy Sxs before rupture, which occurs in (2) time frame. (3) are the Sxs after rupture.

Answer 4

1- Sxs of pregnancy: morning sickness, fatigue, lightheadedness, elevated β-hCG, amenorrhea

2- 2-6 wks

3- vaginal bleeding (or intra-abdominal) –> shock (mimics appendicitis if on R side)

Question 5

list the main diseases of early pregnancy

Answer 5

spontaneous abortion / miscarriage (<20 wks, usually <12 wks)

ectopic pregnancies (2-6 wks)

Question 6

list the main diseases of late pregnancy- brief description

Answer 6

• placenta previa: placenta covers cervical os (no entry to vaginal canal w/o placental rupture –> C-section)
• abruptio placenta: ruptured placenta
• placenta accreta: villi invasion into myometrium (unstable)

Question 7

Placenta Previa:

• (1) definition
• (2) risk factors
• (3) presentation
• (4) Dx

Answer 7

1- placenta implants in lower uterus / cervix –> covers cervical os –> requires C-section

2- previous cases, previous C-section, myometomy, multiple gestation pregnancies

3- painless bleeding / post-coital spotting at >30 wks

4- US (before any 3rd trimester vaginal exams)

Question 8

Abruptio Placenta:

• (1) event at (2) timeframe
• (3) main risk to fetus
• (4) risk to mother
• (5) risk factors

Answer 8

1- placental rupture
2- 3rd trimester

3- ischemia/hypoxia –> fetal death e/o C-section or immediate delivery

4- severe bleed –> hemorrhagic/hypovolemic shock + hypercoagulability/DIC

5- age, HTN, multiparity, trauma, cocaine

Question 9

Placenta Accreta:

• (1) definition
• (2) risk factors
• (3) main risk
• (4) Tx

Answer 9

1- absent plane of separation between placental villi and myometrium (villi invasion)

2- C-sections, placenta previa

3- post-partum hemorrhage

4- hysterectomy

Question 10

Preeclampsia signs

Answer 10

-HTN
-edema
-proteinuria (oliguria)
(5% all pregnancies)

Sxs: HA, visual disturbances, weight gain, n/v, abdominal pain

Question 11

eventual progressions of pre-eclampsia

Answer 11

Eclampsia, 10%- seizures

HELLP, 10%- hemolysis, elevated liver enzymes, low platelets

-note Sxs disappear after labor

Question 12

preeclampsia risk factors

Answer 12

> 35 y/o
multiple pregnancies
pre-existing HTN or DM
hydatidiform mole