L72 + 73 Flashcards
Most common site for ectopic pregnancy
Tube - ampulla
RFs ecoptic
Use assisted repro tech Prev tube surg // ectopic Infections (PID) Endometriosis Smoking
Presentation of ectopic
Ab pain + skipped period + vag bleeding
Symptoms/vitals will depend on amt of blood loss
How should BhCG change during a normal preg
Double every 48 hrs (66%)
What BhCG means you should be able to see a fetus in the uterus?
> 1500
Treat ectopic
MTX - f/u for BhCG fall Lapro = treat 1. Salpingostomy = remove ectopic 2. Salpinectomy = remove tube D&C - certain det of uterine preg (when don't see fetus on US)
What molecule normally suppresses delivery?
Progesterone -> increase CRH in bound form
Suppress production of ACTH (pit) and cortisol + DHEA (adrenal cortex)
Describe physiology of contractions
Less CRH More ATCH from ant pit -> says adrenals produce 1. Cortisol -> PGE 2. DHEA -> E (now E > P) Changes in the myometrium
How does pre-term birth happen?
Some inflam triggers the normal physiology to start early
TESTQ: what is the def of pre-term labor
Regular uterine contractions causing cervical change before 37 wks
RF pre-term birth
Prev pre-term birth
Multiple kids
Bleeding in preg
What is fetal fibronetin
Swab vagina - amniotic fluid will form crystals on slide
High NEGATIVE predict value - don’t see it, you’re not having pre-term labor
Positive doesn’t tell you anything
Treat pre-term birth
Delay to 34 wks
- IV fluid bolus - if dehydrated, will start contractions
- Tocolysis
- Steroid - promote lung maturity
- Mg - neuro protective in baby
- Grp B strep if you’re moving towards delivery
Meds to stop pre-term labor
Tocolysis
Mg
Nifedipine = Ca CB
Indomethacin = block PG, going to close PDA
CI to tocolysis
Infection - just deliver
Sig vag bleeding
After 34 wks - just deliver
What is PPROM
Preterm premature rupture of membranes
Dx by fluid coming out of the vagina
2 tests to confirm PPROM
pH (nitrazine) - amniotic fluid should be basic
Ferning - shows crystals on slide
Risks of PPROM
Infection - opening in the cervix!
Cord prolapse
Abruption
Pulm hypoplasia - depends on how early the rupture
Treat PPROM
Antibiotics - also helps to stop contractions
Steroids
Tocolysis if contracting
Describe the 4 different types of HTN you might see in preg
> 140/90
Chronic HTN - existing that continues in preg (pre-20 wks)
Gestation HTN - BP returns to normal after delivery
Pre-eclampsia
Eclampsia = seizures during or after delivery
Presentation of pre-eclampsia
HTN + proteinuria or if no proteinuria then one symptom of HTN
What are signs of severe pre-eclamp
Care b/c change management Higher BP TCP ↑LFTs ↑Cr > 1.1 Pulm edema
What is HELLP syndrome
Variant of severe pre-eclamp
Hemolysis + ↑LFTs + TCP
RF pre-eclamp
Never preg before
AA
Twins +
Pathophys of pre-eclamp
Blasts didn’t invade enough into the myometrium
Don’t lose arterial smooth muscle as should
What triggers pre-eclamp
Placenta dysfxn secretes factors that bind ligands normally protective
Endothelial dysfxn -> vessels constrict -> ↑BF velocity -> ↓O2 to fetus
4 organs in addition to placenta effected by pre-eclamp
Kidney - ↑Cr, proteinuria
Brain - swelling = ↑seizures
Liver - swelling, RUQ pain, ↑LFT, TCP
Microvasc hemolysis
Treat pre-eclamp
Get to 34 wks if at all possible
+ Mg = delay delivery + prevent seizure
Long term effects of pre-eclamp
Lifelong ↑vasc risk
Metabolic syndrome or HTN
2 possible causes of bleeding during preg + 1st dx step
Placenta privia or abruption (+pain)
TESTQ: do US, NOT PE b/c you’d increase bleeding risk if privia
Most common complication of twin + pregnancies
Pre-term delivery
Name the 4 types of twin possibilities + what see on US
- Dichor diamnio = 2 separate preg (fraternal twins) lamda sign
- Monochor diamnio = 1 placenta, 2 sacs (identical twins) T sign
- Monochor monoamnio = 1 placenta, 1 sac (identical twins) see no membrane
- Conjoined twins
TESTQ: RF for adherent placenta (placenta privia)
Prev C section - increasing C section rate means this problem is on the rise
Uterine infection
HTN
Smoking
