Gestational onset Flashcards
Threatened abortion?
Unexplained bleeding ( sometimes days)
Without cervical dilation
BACK ACHE
During 1st and 2nd trimester what is the main cause of bleeding?
Abortion
Imminent abortion?
Ruptured membranes
Cervical dilation
Increased bleeding
Incomplete abortion?
Embryo passes Placenta retained ( May require D&C)
Compete abortion?
All products of conception expelled
Missed abortion?
Fetus dies in utero, but not expelled
Brownish discharge
Decreased HCG levels
Confirmed by ultra sound
Ectopic pregnancy treatment?
Methotrexate (IM)
Monitor outp for pain, hCG titers
Gestational trophoblastic disease?
Treatment?
Placenta characterized by Hydropic (fluid filled) grape like clusters
Treatment: suction evacuation and curettage of uterusn
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
Gestational trophoblastic disease s/s?
Brown red bleeding Anemia Hyperemesis gravidarum ** Preeclampsia Absent FHR Elevated hCG levels Low serum alpha-fetoprotein (Diagnosis buy US)
Hyperemsis Gravidarum diagnosis?
Intractable vomiting
Dehydration
Ketonuria
Weight loss of 5% of pregnancy weight
Preeclampsia?
Eclampsia?
Increased BP after 20 weeks gestation accompanied by proteinuria ( encourage high protein diet)
Seizures
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
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
Sever preeclampsia manifestations?
BP > 160/110 @ 20 wks Proteinuria ( 3+ or higher) Oliguria Visual disturbance EPIGASTRIC PAIN or RUQ Elevated liver enzymes
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
