Gestational

Question 1

Ectopic Most Common Site and RF

Answer 1

Lumen of fallopian tube

Scarring - PID, endometriosis, etc

Question 2

Spontaneous Abortion 3 Causes

Answer 2

Most often chromosomal abnormalities (especially Trisomy 16)
Hypercoagulable states (antiphospholipid syndrome)
Exposure to teratogens (especially within 1st 2 weeks)

Question 3

Teratogen Exposure Timeline (3)

Answer 3

First 2 weeks - spontaneous abortion
Weeks 3-8 - organ malformation
Months 3-9 - risk of organ hypoplasia

Question 4

Placenta Previa

Answer 4

Implantation of placenta in lower uterus overlying cervical os. Causes PAINLESS 3rd trimester bleeding and needs C section usually

Question 5

Placental Abruption

Answer 5

Separation of placenta from decidua prior to delivery. Common cause of still birth and presents with PAINFUL 3rd trimester bleeding and fetal insufficiency. See blood on maternal surface of placenta

Question 6

Placenta Accreta

Answer 6

Improper implantation with little or no intervening decidua, presents with difficult delivery and a shitload of postpartum bleeding so often need hysterectomy

Question 7

Preeclampsia (what it is, symptoms, cause, vascular effect)

Answer 7

Pregnancy-induced HTN, proteinuria, and edema, usually in 3rd trimester
Can be very severe and cause headaches/visual disturbances
Due to abnormality in maternal-fetal vascular interface (have fibrinoid necrosis in vessels of placenta), resolves on delivery

Question 8

Eclampsia (what it is and treatments)

Answer 8

Preeclampsia with seizures. Mandates delivery usually. Treat seizures with IV Magnesium but can give too much, causing decreased DTR, PEdema, cardiac conduction problems

Question 9

HELLP

Answer 9

Preeclampsia with thrombotic microangiopathy (thrombi sheer RBCs) involving liver, characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets. Also generally mandates delivery

Question 10

SIDS (age, 3 RFs)

Answer 10

1 month to 1 year

Sleeping on stomach, cigarette smoke exposure, prematurity

Question 11

Hydatidiform Mole (what it is, presentation w/ and w/out prenatal care, treatment, cancer risk)

Answer 11

Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts
Uterus gets much larger than normal and more hCG than normal
Presents in 2nd trimester with passage of grapelike masses from vagina (if no care)
Absent fetal heart sounds and “snowstorm” appearance on US if care
Tx is D&C
Cancer risk is choriocarcinoma, monitor with Beta hCG testing

Question 12

Choriocarcinoma from Gestation vs. Choriocarcinoma from spontaneous germ cell tumor

Answer 12

Gestational responds well to chemo, spontaneous germ cell does not

Question 13

Complete vs. Partial Mole (genetics, fetal tissue, villous edema, trophoblastic proliferation, risk for choriocarcinoma, hCG levels)

Answer 13

Empty ovum fertilized by 2 sperm - 46 chromosomes vs. normal ovum fertilized by 2 sperm - 69 chromosomes
Absent vs. present
Almost all villi hydropic vs. some
Diffuse, circumferential proliferation vs. focal around hydropic villi
2-3% vs. minimal
Super elevated vs. slightly