Dunn OB/GYN VI Flashcards
heavy bleeding and terrible nausea/vomiting
previous vaginal births
miscarriage
tissue at cervical os
enlarged ovary
ultrasound - snowstorm
very high HCG**
gestational trophoblastic neoplasm
first trimester US
best for determining length of pregnancy
tx of gestational trophoblastic neoplasm
D and C
gestational trophoblastic disease
abnormal proliferation of trophoblast of placenta
benign non-neoplastic trophoblastic lesions
exaggerated placental site
placental site nodule
most common cause gestational trophoblastic disease
hydatidiform mole
-80%
complete, partial, and invasive
gestational trophoblastic neoplasia
GTN
- true neoplasia
- potential for invasion / mets
choriocarcinoma
placental site trophoblastic tumor
epithelioid trophoblastic tumor
curable 85-100% cases**
chorioadenoma sestruens
invasive hydatidiform mole
complete mole
46, XX
XY - if fertilized two sperm
all paternal chromosomes
haploid sperm fertilize empty ovum
no fetal tissue**
incomplete mole
69 XXY
fertilization of ovum with haploid maternal chromosome by two sperm
fetal tissue present**
maternal genes
fetal growth
paternal genes
placental growth
excess - trophoblastic grwoth
incidental finding on endometrial curettage or hysterectomy
benign nonneoplastic trophoblastic lesion
genomic imprinting
certain genes expressed in parent of origin specific manner
DNA methylation, histone mods
occurs in moles
- heterozygote - two sperm
- homozygote - duplicated DNA sperm
complete molar pregnancy
fertilization of empty ovum by two sperm or one duplicated sperm
can become choriocarcinoma
partial molar pregnancy
fertiliation of haploid ovum by two sperm or one duplicatd sperm
presence of fetal tissue
less likely malignant
molar pregnancy complications
most due to very high HCG levels
large overies hyperemesis gravidarum preeclampsia hyperthyroid hemorrhage
asian women and latin american countries
gestational trophoblastic disease
partial mole
less dangerous
small uterus for dates
complete mole
46 XX
no fetal tissue
large uterus for dates
risk fx for GTD
40yo
diet deficient in folate or beta carotene
1st trimester painless bleeding, uterine large, hyperT, hyperemesis gravidarum, preeclampsia
gestational trophoblstic disease
hyperemesis gravidarum
severe nausea and vomiting
-during pregnancy
very high beta-HCG, enlare ovaries, grapelike clusters in vagina, US snowstorm
GTD
Tx for GTD
D and C
- scrape tissue out
- follow beta-hcg levels
- plateau and go up
- repeat D and C or chemotherapy
persistent disease
15-20% after complete
3-5% after partial
theca lutein cyst, large uterus age >40, initial hCG >100,000
follow hCG levels
hcg<5 for 3 weeks
ok to resume pregnancy attempts
23yo F taking OCP
- daily spotting since period
- LMP 1 month ago
cervix - blood from os
tender right ovary
beta-hCG positive
ectopic pregnancy
break through bleeding
diagnosis of exclusion
don’t know cause
normal pregnancy
hCG doubles every 48 hours
first trimester bleed
abnormal pregnancy
hCG stay same, decrease, or increase minimally
threatened abortion
1st trimester bleeding in normal pregnancy
risk with 1st trimester bleeding
miscarriage
abnormal placental implantation
IUGR - intrauterine growth restriction
abnormal pregnancy - in uterus
missed, complete, incomplete abortion
molar pregnancy
incomplete abortion
patient to ER - bleeding heavily
missed abortion
got pregnant
didn’t grow - and haven’t passed tissue yet
complete abortion
get pregnant - but hCG goes down
risk factors for spontaneous abortion
age 45yr 80% risk previous abortion prolonged time to implantation interval prolonged time to conception smoking alcohol cocaine NSAIDs caffeine low folate fever celiac disease
chromosomal abnormalities
50% of spontaneous abortions
most commonly - aneuploidies - trisomy, monosomy, etc.
congenital abnormalities and trauma also causes
maternal cause of spontaneous abortion
uterine structural issue
acute maternal infection
maternal endocrinopathies
hypercoagulable state
vaginal bleeding, pelvic pain, absence of fetal movement, incidental US findings
symptoms for spontaneous abortion
work up for spontaneous abortion
1 - doppler - fetal heart sounds 2 - pelvic exam 3 - pelvic US 4 - hCG level - more than one 5 - blood type antibody - Rh 6 - serum progesterone
CRL >7 no cardiac activity
spontaneous abortion
absence of embryo heartbeat >2weeks after without yolk sac
spontaneous abortion
threatened abortion
diagnostic criteria for spontaneous not met
vaginal bleeding occured and closed os
up to 50% will miscarry
tx - bed rest and expectant management
inevitable abortion
vaginal bleeding, cramphy pelvic pain, dilated cervix
products of conception felt or visualized
tx - medical abortion - misoprostol
D and C surgical abortion
misoprostol
medical abortion tx
complete abortion
hCG has gone down
cervix closed and uterus small
> 12 weeks gestation - common
missed abortion
got pregnant - os closed
then did not feel pregnant anymore
misoprostol or D and C tx
ectopic pregnancy
outside the uterus
-cervix, fallopian tube, ampulla, ovary, abdomen
ampulla - most common
methotrexate
folic acid inhibitor
tx for ectopic pregnancy
risk fx for ectopic pregnancy
previous PID ** chlamydia assisted reproductive technology history of peritonitis smoking previous tubal ligation
tx of ectopic pregnancy
methotrexate - folic acid inhibitor
surgical - removal
same fertility with either tx**
