Exam 3 - Ectopic, Hydatidiform Mole, and Hyperemesis Gravidarum Flashcards
What is the mechanism of ectopic pregnancy?
Blastocyst implants anywhere other than the endometrium
- Most commonly in fallopian tubes
- Also in ovaries, abdomen, cervix
Risk factors for ectopic pregnancy
- IUD
- Previous ectopic pregnancy
- Prior tubal surgery
- Pelvic infection
What are the three pillars to ectopic pregnancy presentation?
- Unilateral pelvic pain
- Vaginal bleeding
- Palpable adnexal mass or adnexal tenderness
Physical and lab signs of possible ectopic pregnancy
- Fewer presumptive symptoms
- Pregnancy test likely positive but hCG levels are lower and will rise more slowly
Two signs that would warrant the provider to add ectopic pregnancy on differential
- Vaginal spotting/bleeding
- Abdominal pain
What signs and symptoms would the provider be worried about a possible ruptured ectopic pregnancy?
- Hemorrhage
- Sharp and stabbing sever lower abdominal pain
- Hypotension
- Signs of shock
Can be treated with methotrexate
What is the mechanism of hydatidiform moles (aka molar pregnancies)?
Atypical growth of trophoblastic cells from abnormal union of sperm and egg –> implants in placenta and results in proliferation of abnormal placental tissue
- Contains no fetal tissue (blighted ovum)
- Normally benign but can become malignant
How can hydatidiform moles present on ultrasound?
Uterine cavity filled with edematous, grape-like structure, snowstorm appearance
Signs and symptoms of hydatidiform mole (molar pregnancy)
- Severe and persistent N/V
- Uterine bleeding
- Large for date uterus
- Enlarged tender ovaries
- No fetal heart tones, no fetal activity observed
- No fetal parts palpable
- Preeclampsia before 24 weeks
- Elevated hCG levels
Hydatidiform mole risk factors
- Younger or older maternal age
- Previous history of molar pregnancy
When is vomiting most common for patients with hyperemesis gravidarum?
First 9 weeks of pregnancy
Consequences of hyperemesis gravidarum
- Nausea accompanied by severe vomiting
- Nausea that does not subside
- Vomiting that causes severe dehydration
- Vomiting that does not allow you to keep food down
Risk factors for hyperemesis gravidarum
- Previous history with hyperemesis gravidarum
- Previous molar pregnancy
- Multiple gestation
- Elevated hCG levels
- GI disorders
- Hyperthyroidism
- Pregnancy with psychiatric disorders
True/false: Anxiety, depression, and psychological disorders are causes of hyperemesis gravidarum
False - anxiety, depression, and psychological disorders are consequences of hyperemesis gravidarum
What questions should the provider ask when assessing for hyperemesis gravidarum?
- Frequency of vomiting episodes
- Dietary history
- Medications
- Elimination - constipation, diarrhea
- Hematemesis
- Fever
- Viral infection exposure
- Food contamination exposure
- Abdominal pain
- Eating disorder history
What components of the physical exam should be included when assessing patients wtih hyperemesis gravidarum?
- Weight compared with previous weights
- Vital signs, skin turgor, mucous membranes, tongue
- Abdominal palpation bowel sounds
- Uterine size
What labs should be collected with assessing patients with hyperemesis gravidarum?
- CBC
- Urinalysis for specific gravity and ketones
- Electrolytes
- LFTs
- Rule out hepatitis, pancreatitis, cholestasis
- TSH and T4 to rule out thyroid disease
How would the provider manage patients with hyperemesis gravidarum?
- Replace fluids with saline
- Begin NPO status or give minimal sips of clear fluids, ice chips to rest gut
- If pregnancy weight gain stabilizes, there is no adverse outcome associated with hyperemsis
What fluid formulation should be avoided in patients with hyperemesis gravidarum?
IV fluids containing dextrose
Pharmacological management of hyperemesis gravidarum
- Promethazine (phenergan)
- Prochloperazine (compazine)
- Ondansetron (zofran)
- Metoclopramide (reglan)
