Gestational Conditions - Part 1 Flashcards
Most severe form of nausea and vomiting in pregnancy
Hyperemesis Gravidarum
Hyperemesis Gravidarum usually begins by _____ of gestation
9-10 weeks
Hyperemesis Gravidarum peaks at _____?
11-13 weeks
Hyperemesis Gravidarum resolves in most cases by _____?
12-14 weeks
Characterized by persistent nausea and vomiting associated with ketosis and weight loss
Hyperemesis Gravidarum
Hyperemesis Gravidarum can cause:
- Volume depletion
- Electrolytes and acid-base imbalances
- Nutritional deficiencies
- Death
Hyperemesis Gravidarum: Symptoms
- Nausea and Vomiting
- Ptyalism
- Fatigue, Weakness, Dizziness
Hyperemesis Gravidarum: History
- Timing, onset, severity, pattern, and alleviating and exacerbating factors
- Past medical conditions, surgeries, medications, allergies, adverse drug reactions, family history, social history (including support system), employment, habits, and diet
- Gynecologic history of symptoms
Hyperemesis Gravidarum: Risk Factors
- Previous pregnancies with hyperemesis gravidarum
- Greater body weight
- Multiple gestations
- Trophoblastic disease
- Nulliparity
Hyperemesis Gravidarum: Medical Care
- Reassurance
- dietary recommendations
- support
- Alternative therapies
- acupressure
- hypnosis
Hyperemesis Gravidarum: Medical Care (Medication)
- Vitamin B-6 10-25 mg 3-4 times daily
- doxylamine 12.5 mg 3-4 times daily (only FDA- approved drug)
- Ginger capsules 250 mg 4 times daily
- Metoclopramide 5-10 mg orally every 8 hours
-widely used - Promethazine 12.5 mg orally or rectally q4h or dimenhydrinate 50-100 mg orally q4-6h
- Ondansetron 4-8 mg orally or IV q8h
Hyperemesis Gravidarum: Medical Care (Nutritional Supplement)
- parenteral or enteral route
- The standard method has been via total parenteral nutrition (TPN)
Hyperemesis Gravidarum: Diet
- Eat when hungry, regardless of normal meal times
- Eat frequent small meals
- Avoid fatty and spicy foods and emetogenic foods or smells
- Increase intake of bland or dry foods
- Eliminate pills with iron
- High-protein snacks are helpful
- Crackers in the morning
- Increase intake of carbonated beverages
- Herbal teas containing peppermint or ginger, other ginger-containing beverages, broth, crackers, unbuttered toast, gelatin, or frozen desserts
- Preconception use of prenatal vitamins may decrease nausea and vomiting associated with pregnancy
Hyperemesis Gravidarum: Activity
- decreased activity
- increased rest
- fresh outdoor air
Ectopic Pregnancy (other name)
Tubal pregnancy;
Cervical pregnancy;
Tubal ligation-ectopic pregnancy
Pregnancy that occurs outside the womb
Ectopic Pregnancy
Ectopic Pregnancy: _____ weeks after missed menstrual period, site ruptures
2-8 weeks
___ trimester bleeding
- Usually occurs _____ of the fallopian tube (_____)
- Ampullar 80%
- Isthmus 12%
- Interstitial/fimbrial 8%
- _____ pregnancy
1st trimester
distal third; Pilliteri
Abdominal
Ectopic Pregnancy: Causes and Risk Factors
- Anything that blocks or slows the movement of the egg through the fallopian tubes
- Birth defect in the fallopian tubes
- Scarring after a ruptured appendix
- Having an ectopic pregnancy before
- Scarring from past infections or surgery of the female organ
Ectopic Pregnancy: Increased Risk Factors
- Age over 35
- Pregnancy with IUD
- Removal of tubal sterilization
- Multiple sexual partners
- Infertility treatment
Ectopic Pregnancy: Symptoms
- breast tenderness
- nausea
- Abnormal vaginal bleeding
- Low back pain
- Mild cramping on one side of the pelvis
- No periods
- Pain in the lower belly or pelvic area (sharp and stabbing)
Ectopic Pregnancy: If the area around the abnormal pregnancy ruptures and bleeds:
- Fainting or feeling faint
- Intense pressure in the rectum
- Low blood pressure
- Pain in the shoulder area
- Severe, sharp, and sudden pain in the lower abdomen
Ectopic Pregnancy: Diagnostic Exams
- Pelvic Exam
- Pregnancy Test
- Vaginal ultrasound
- Blood level HCG
Ectopic Pregnancy: Treatment
- The developing cells must be removed to save the mother’s life
- Treatment for shock may include:
-Blood transfusion- Fluids given through a vein
- Keeping warm
- Oxygen
- Raising the legs
- Surgery
- stop blood loss
- remove the pregnancy
- removal of the fallopian tube (some cases)
- If the ectopic pregnancy has not ruptured:
- Surgery
- Medicine that ends the pregnancy
Ectopic Pregnancy: Prevention
Not really preventable but may reduce risks:
- Practicing safer sex by taking steps
before and during sex
- Getting early diagnosis and treatment of all infections caused by sexual relations (STDs)
- Stop smoking
Loss of pregnancy before 20 weeks of gestation without outside intervention
First trimester bleeding
Viable fetus
- more than 20-24 weeks
- Or weighs at least 500 g
Spontaneous Abortion
Types of Abortion
- Threatened abortion
- Inevitable abortion
- Complete abortion
- Incomplete
- Missed abortion
- Recurrent abortion
Mnemonic: TICIM R
- -bright red and scant vaginal bleeding
- there is the presence of a viable pregnancy with a closed cervix
- Early under 16 weeks
- Late 16-24 weeks
- Avoid sexual intercourse 2 weeks after
Threatened Abortion
- Imminent
- Cervix has dilated
- Membranes have ruptured
- The products of conception remain in utero
- There is uterine contractions
- Bleeding within 2 hours and ceases within 2 days
Inevitable Abortion
- Refers to the spontaneous passage of all the products (fetus, membrane, placenta) of conception
- does not require medical treatment
Complete Abortion
Part expelled usually the fetus and membranes and placenta retained
Incomplete Abortion
- Early pregnancy failure
- Characterized by intrauterine fetal death (IUFD) and retention of the products of conception
- Fetus died 4-6 weeks before symptoms
Missed Abortion
- Habitual aborters
- A history of 3 or more spontaneous pregnancy losses at the same gestational age
Recurrent Abortion
Recurrent Abortion: Causes
- Defective ova or spermatozoa
- Endocrine factors
- Decrease Protein-bound iodine (PBI)
- Decrease globulin iodine (GBI)
- Poor thyroid function
- just Luteal phase defect
- Deviations of the uterus
- Septate
- Bicornuate uterus
- Resistance to uterine artery blood flow
- Chorioamnionitis (uterine infections)
- Auto immune disorders
- Lupus anticoagulants
- Anti phospholipid antibodies
Maternal Conditions Associated with Increased Risk
MEDICAL CONDITIONS
a. Hypothyroidism
b. Diabetes mellitus (DM)
c. Polycystic ovary syndrome
d. Thrombophilia
e. Antiphospholipid antibodies
f. Systemic lupus erythematosus (SLE)
SURGICAL EMERGENCIES
a. Septicabortion
b. Appendicitis
INTRAUTERINE CAUSES
a. Ashermansyndrome
b. Fibroids
c. Uterine malformations
- occurs following curettage of the uterus
- Severe degrees of intrauterine adhesions
- leads to obstruction of the uterine cavity and subsequent infertility
Asherman Syndrome
Asherman syndrome: Mild degrees of adhesions are associated with:
- pregnancy loss
- insufficient amount of normal endometrial tissue
for implantation and placental development - defective vascularization of the remaining endometrial tissue caused by fibrosis
- Women with submucosal fibroids (1.8% risk of miscarriage)
- involves a projection of the submucosal fibroids into the uterine cavity
- distortion of the blood supply in the endometrium
- interferes with embryonic implantation
Fibroids
Is the most common malformation of the uterus
Bicornuate Uterus
Maternal Infections
a. Bacterial vaginosis
b. Listeria monocytogenes infection
c. Measles
d. Mumps
e. Coxsackie virus infection
f. Toxoplasma gondii infection (toxoplasmosis)
g. Ureaplasma and Mycoplasma infection
Maternal Conditions Associated with Increased Risk: Obstetric history
a. Maternal age at the time of conception
b. Previous spontaneous abortion
Maternal Conditions Associated with Increased Risk: Diet and lifestyle
a. Caffeine consumption
b. Obesity
c. Smoking
d. Substance abuse
Maternal Conditions Associated with Increased Risk: Medications
a. Selective serotonin reuptake inhibitor (SSRIs) (fluoxetine, citalopram, fluvoxamine, sertraline, and paroxetine)
b. Angiotensin-Converting Enzyme (ACE) inhibitors
Diagnostics
- A detailed history
- Pelvic examination
- Imaging with ultrasound
Treatment
- Expectant management
- Medical evacuation
- Surgical uterine evacuation
Uterine Malformations: Complications
- Hemorrhage
- Intrauterine infection
- Increased risk for depression and anxiety
Hydatid mole
Molar pregnancy
Hydatidiform Mole
- A rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy
- A type gestational trophoblastic disease (GTD)
- A cancerous form of GTD (Choriocarcinoma)
Hydatidiform Mole
Hydatidiform Mole: Risk Factors
- Women with low protein intake
- Older than 35
- Asian heritage
- Blood Group A woman married to Group O man
Hydatidiform Mole: Causes
- Over-production of the tissue that is supposed to develop into the placenta
- Due to problems during fertilization
- The exact cause of fertilization problems is unknown
- A diet low in protein, animal fat, and vitamin A may play a role
Hydatidiform Mole: Types
Partial Molar pregnancy
Complete Molar pregnancy
Hydatidiform Mole: Symptoms
- Abnormal growth of the womb
- Excessive growth in about half of cases
- Smaller-than-expected growth in about a third of cases
- Nausea and vomiting that may be severe enough to require a hospital stay
- Vaginal bleeding in pregnancy during the first 3 months of pregnancy
- Symptoms of hyperthyroidism
- Heat intolerance
- Loose stools
- Rapid heart rate
- Restlessness, nervousness
- Skin warmer and more moist than usual
- Trembling hands
- Unexplained weight loss - Symptoms similar to preeclampsia that occur in the 1st trimester or early 2nd trimester
- High blood pressure
- Swelling in feet, ankles, legs
Hydatidiform Mole: Diagnostics
- Pelvic Examination
- Pregnancy Ultrasound
- Tests
- HCG blood test
- Chest x-ray
- CT or MRI of the abdomen
- Complete blood count
- Blood clotting tests
- Kidney and liver function tests
Hydatidiform Mole: Interventions
Dilatation and Curettage (D & C)
Hysterectomy
Hydatidiform Mole: Possible Complications
Lung problems may occur after a Dilatation and Curettage if the mother’s uterus is larger than 16 weeks gestational size
Complications of molar pregnancy include:
- Preeclampsia
- Thyroid problems
- Molar pregnancy that continues or comes back
Complications related to the surgery to remove a molar pregnancy include:
- Excessive bleeding
- Side effects of anesthesia
