First trimester complications Flashcards
a gestational sac or intrauterine fluid collection compatible with pregnancy is visible at
4.5 to 5 weeks of gestation.
DX of pregnancy is based on the following
Detection of HCG in blood or urine.
Identification of pregnancy by ultrasound examination.
Identification of fetal cardiac activity by Doppler Ultrasound (you can hear heartbeat around 10-12 weeks)
Hydatidiform mole
an aberrant placenta composed of multiple grape like vesicles . It is not malignant and does not invade the uterine wall.
clinical features of hydatidiform mole
- uterine bleeding
- uterine size that exceeds expected from gestational age
uterus remains a pelvic organ until ( ) weeks
12, so abdominal trauma should not harm the fetus before this
fetal heart activity by doppler is seen at
10-12 weeks
Chadwicks signs:
Hegar’s sign:
cervical and vaginal cyanosis
lengthening and softening of the
cervix.
Seen in early pregnancy, normal signs bc of hypertrophy
what to do if pt is nauseous in first trimester?
Best tx is to tel pt this is normal and goes away by 11/12 week
severe hyperemesis is associated with….
high levels of BHCG, seen in multiple pregnancies and hydatidiform moles
hyperemesis gravidum
Nausea and vomiting of pregnancy that are associated with systemic effects of dehydration; weight loss (>5% of pre-pregnancy weight); electrolyte abnormalities; ketosis , all appearing before the 10-12th week of gestation
main tx for hyperemesis gravidum
Normal saline; ringers lactate; D5NS (when u/o 100ml/hr)
thiamine, folic acid
zofran
you should be concerned if your pt is vomiting beyond ( ) weeks
12
what should you always check when a pregnant lady comes in?
urine, could have an asymptomatic UTI
how to treat acute HTN?
hydralazine
TORCH
Toxoplasmosis-protozoa found in cat stool, triad of chorioretinitis/hydrocephalus/intracranial calcifications
Other (syphillis, Varicella Zoster, parovirus)
Rubella
Cytomegalovirus-MCC of deafness
Herpes Simplex Virus (HSV)-acquired during the birthing process via contact, skin/eye/encephalitis
What happens to blood volume during pregnancy?
Normal blood volume is about 5 liters, in pregnancy can be about 7.5 liters
Hematocrit can be low in a normal pregnancy bc of dilutional anemia
What happens to BP/CO during pregnancy?
increases, may have resting tachycardia
What happens to the pregnant lady’s ABG?
Pregnant women have higher respiratory rate, blow off more CO2 making CO2 lower (normal 35-45, pregnant may be around 30)
What can happen to aneurysms during pregnancy?
Aneurysm can rupture in pregnancy bc of fibro elastic-lytic enzymes that effects elastic tissue
1st trimester bleeding can be from…?
- ectopic
- spontaneous abortion
- cervical, vaginal patho
- implantation bleed
Abortion
All pregnancies that terminate before the period of fetal viability, i.e. terminate before fetal weight is 500 gram (or less than 20 weeks gestation; or miscarriage spontaneous/induced/TOP)
classic 1st trimester triad of bleeding
Amenorrhea
Vaginal bleeding
Abdominal Pain
MC complication of early pregnancy?
spontaneous abortion
Threatened abortion
A state in which bleeding of intrauterine origin occurs before the twentieth completed week of gestation, with or without uterine contractions, without expulsion of the products of conception and without dilatation of the cervix.
inevitable abortion
: the state in which bleeding of intrauterine origin occurs with continuous and progressive dilatation of the cervix, but without expulsion of the products of conception, before the twentieth week of gestation.
Missed abortion
an abortion in which the embryo or fetus dies in utero before the 20th completed week of gestation, but the products of conception are retained in utero.
-Woman says she was pregnant and then sickness/nausea stopped suddenly
MCC of first trimester mortality
ectopic
Intramural/interstital ectopic
rupture causes massive bleeds bc it is right near the uterus
isthmus ectopic
very narrow so pain is very early on, less bleeding
ampulla ectopic
pain develops later bc it is larger, more bleeding
infundibulum ectopic
very late pain, large ectopic pregnancy
How to dx an ectopic?
Absence of IUP w/ HCG>2k indicates ectopic pregnancy**
Heterotopic Pregnancy:
combined intrauterine and extrauterine pregnancy: mostly in women conceiving through IVF
classic ectopic symptoms
Amenorrhea
Abdominal pain
Vaginal bleeding
How to treat ectopic?
- mainly surgical
- methotrexate is concentrated and used more by cells that are actively dividing
candidates for methtrexate are….
Hemodynamically stable Have hCG level less than 5,000miu/ml No fetal cardiac activity Ectopic mass size less than 3-4 cm Willing and able to comply with post treatment follow-up.
