Gestational onset Flashcards by Rose Kalu

Threatened abortion?

Unexplained bleeding ( sometimes days)
Without cervical dilation
BACK ACHE

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During 1st and 2nd trimester what is the main cause of bleeding?

Abortion

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Imminent abortion?

Ruptured membranes
Cervical dilation
Increased bleeding

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Incomplete abortion?

Embryo passes 
Placenta retained ( May require D&C)

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Compete abortion?

All products of conception expelled

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Missed abortion?

Fetus dies in utero, but not expelled
Brownish discharge
Decreased HCG levels
Confirmed by ultra sound

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Ectopic pregnancy treatment?

Methotrexate (IM)

Monitor outp for pain, hCG titers

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Gestational trophoblastic disease?

Treatment?

Placenta characterized by Hydropic (fluid filled) grape like clusters

Treatment: suction evacuation and curettage of uterusn

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Hydatiform mole “Molar pregnancy”?

Less of pregnancy cause risk of developing choriocarcinoma from trophoblastic tissue.

follow up for CA
monitor hCG and for metastasis
curable if treated early

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Gestational trophoblastic disease s/s?

Brown red bleeding
Anemia
Hyperemesis gravidarum **
Preeclampsia 
Absent FHR
Elevated hCG levels 
Low serum alpha-fetoprotein
(Diagnosis buy US)

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Hyperemsis Gravidarum diagnosis?

Intractable vomiting
Dehydration
Ketonuria
Weight loss of 5% of pregnancy weight

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Preeclampsia?

Eclampsia?

Increased BP after 20 weeks gestation accompanied by proteinuria ( encourage high protein diet)

Seizures

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HELLP Syndrome?

associated with, sx, tx?

Hemolysis, Elevated Liver enzymes, Low Platelet count
-associated with preeclampsia
-Sx: (before 36wks) n/v, mailaise, flulike symptoms, epigastric pain
Tx: DELIVERY

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Mild preeclampsia classifications?

BP of 140/90 on two occasions 6 hours apart @20 wks
Proteinuria (3oomg/L)
Edema ( weight gain >1.5 kg/mth) in 2nd trimester

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Sever preeclampsia manifestations?

BP > 160/110 @ 20 wks
Proteinuria ( 3+ or higher)
Oliguria
Visual disturbance
EPIGASTRIC PAIN or RUQ
Elevated liver enzymes

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When is childbirth considered in pt with preeclampsia?

After 34 weeks

What is eclampsia and treatment?

Seizure or com associated with pregnancy

Magnesium Sulfate - bolus of 6g over 20-30 min

Fetal reaction to seizure d/t eclampsia?

Bradycardia
Late decels
Decreased variability
Compensatory tachycardia

(Non-reassuring after 10-15 min consider birth)

What can uncontrolled HTN in pregnant women cause?

Cerebral hemorrhage

What is the intrapartum management of preeclampsia?

Postpartum?

Oxytocin and Mg Sulfate simultaneously
Narcotics for pain
Sims or lithotomy with wedge under R

POST: continue Mg sulfate for 24hrs
Anti hypertensives for BP 150/100
Usually improves rapidly

Check deep tendon reflexes in women with eclampsia/ pre for what?

Clonus

Hyperreflexia (1+ and 2+ normal)

What is considered chronic HTN?

BP 140/90 before pregnancy, before 20 wks, or persist 42 days following childbirth

What is medication treatment for chronic HTN in pregnancy?

Methyldopa
Labetlol
( ACE Inhibitors contraindicated 2nd and 3rd trimester)
LIMIT SODIUM TO 2.4g

What is considered a Gestational HTN?

Transient elevation without proteinuria, preeclampsia

What is Kell (anti-K1) antibody in Rh alloimmunization?

Non RhD antibody which has an increasing incidences of alloimmunization

What is Rh immune globulin?

Marks decrease in the presence of alloimmunization to the RhD antigen in pregnancy

What is erythroblastosis fetalis?

Rh alloimmunization | Increased RBC production- presence of uncleared RBC s (erythroblast)

What are fetal risk to Rh alloimmunization?

Fetal anemia : caused by hemolysis of maternal IgG antibodies Hydrops fetalis- untreated anemia that leads to edema Hyperbilirybinemia/ jaundice (neurological damage) due to RBC destruction

When is Rhogam given?

At 28wks and sometimes after birth

What does the Kleihauer-Betke (rosette) test determine?

The amount of RhD pos blood present in maternal circulation Needed to determine how much Rh immune globulin to administer -Up to 5 dowse can be given in 24hrs

How do you achieve temporary passive immunity in mother with no titer who gave birth to Rh + fetus?

Rh immune globulin injection within 72hrs

ABO Incompatibility?

Type O mother, with type A or B fetus Causes hemolysis of RBC in fetus Results in mild anemia in fetus NOT TREATED ANTEPARTALLY

Toxoplasmosis?

A whited through ingestion of undercooked meat, feline feces, and rarely through infected organ transplant. 1st trimester high rate of spontaneous abortion Last monoth- Highest rate of fetal infection can cause retinochoroiditis if mild or convulsions and death of severe, survivors usually blind or deaf

Rubella?

Immunize live virus prior to pregnancy/ postpartum Fetal risks: IDD, cataracts, deafness, congenital heart defects Elevated IgM antibody titer at birth

CMV?

Most common infection in fetus Found in urine, saliva, cervical mucus, breast milf, semen- ON ISOLATION Dx by seroconversion No tx : If mom is positive and no abx need C/S

Herpes simplex Virus tx?

Antiviral therapy after 36wks gestation Acyclovir C/S

Group B Strep (GBS)?

Found in lower GI and GU tract Cause neonatal stillbirth All women screened at 35/37 wks

Human B19 Parovirus ?

Causes erythemia infectiosum 5th disease symptoms