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Repro > Lecture 6: Complications of Pregnancy > Flashcards

Lecture 6: Complications of Pregnancy Flashcards

1
Q

MC site of ectopic pregnancy

A

Ampulla

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2
Q

What is the classic triad for presentation of Ectopic preg?

What other d/o has these Sxs?

A
  1. Unilateral pelvic/abd pain
  2. Amenorrhea (missed LMP)
  3. Vaginal Bleeding

Also seen w/threatened abortion

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3
Q

Main Sx a/w Atypical presentation of Ectopic preg?

What does this cause?

A

Atypical presentation = shoulder pain –> fluid irritating diaphargm –> peritonitis

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4
Q

Pt comes in to ED and you find out she has an ectopic pregnancy. She is cool, tachycardic, HoTNsive, and has severe abd pain, N/V and is dizzy.on PE you find free fluid in her pelvis.

What type of ecotopic pregancy is this?

A

Ruptured Ecotopic Pregnancy

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5
Q

1500-2000 mIU/mL is called what for the b hCG? What does this level indicate?

Part 2:
What is suspected if b hCG > 1500-2000 and no intrauterine gestational sac is seen?

What does NOT occur w/b hCG levels in ectopic preg?

A

Discrimatory zone
- should see intrauterine sac on US w/b hCG levels 1500-2000

1500-2000 bh CG and no intrauterine gestational sac is seen –> suggests ectopic or noon-viable intrauterine preg

bhCG DONT double every 2 days in ectopic preg (will in norm preg)

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6
Q

2 signs a/w ectopic preg that are seen on PE?

note: +/- uterine enlargement

A
  1. Adenexal mass

2. CMT

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7
Q

if Dx of ecotopic pregnancy is unclear what 2 things should be repeated/when?

A
  1. Repeat b hCG in 48hrs

2. Repeat TVUS - once b hCG above discriminatory zone

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8
Q

How to distinguish ectopic preg from miscarriage?

A

heavy bleeding (miscarriage) –> declining b hCG

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9
Q

What medication is given for Tx of ectopic pregnancy?

A

MTX - Methotrexate

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10
Q

Medical Tx of Ecotopic pregnancy w/MTX:

  • what days do you check b hCG levels
  • how often do you follow them til?
  • what do you do if this method fails (2 options)
A
  • check b hCG levels on Day 1, 4, 7
  • follow b hCG til < 5
  • MTX fails –> 2nd dose or surgery
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11
Q

What are the 2 surgical options (Laparoscopic) for ectopic preg? How are they different?
Which is 1st line Tx?

A

Laparoscopic

  1. Salpingectomy = 1st line
    - remove fallopian tube
  2. Salpingostomy
    - just remove preg
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12
Q

What is GTD (Gestational Trophoblastic Dz)

What is the MC type?

A

abn proliferation of placenta trophoblast

MC = Molar pregnancy

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13
Q

How does GTN differ from GTD

main example?

A

GTN = malignant neoplasm arising from GTN

main example = choriocarcinoma

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14
Q

Preg pt presents w/painless vaginal bleeding, severe N/V. Her labs reveal she is hyperthyroid. Her uterine size > dates, b h CG = 105,000 and on US there is a snowstorm appearance but not fetal parts present. Dx?

A

Dx = Complete Molar Pregnancy

Note: Partial Molar

  • same Sxs
  • fetal tissue present
  • b hCG < 100,000
  • and uterine size is small for dates
  • less risk than Complete for progressing to GTN
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15
Q

How to definitely Dx GTD?

what is the mainstay of Tx for GTD? why done immed?
- what is the other Tx must be given

A

Pathology
- karyotype

Tx = D&C w/suction curettage to remove preg to avoid choriocarcinoma
- must give contraception –> cant get preg for 6 mo

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16
Q

When should you suspect GTD has progressed to GTN?

What is general Tx for GTN?

A

b hCG levels plateau, incr or stay (+)

Tx = chemo

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17
Q

Difference in chemo Tx for Low risk GTN vs high risk?

How do WHO scores differ?

A

Low risk –> single agent

  • MTX or Actinomycin-D
  • lower WHO score (< 6)

High risk dz –> multiple agents

  • EMA-CO
  • higher WHO score (> 6)
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18
Q

3 differences b/t monozygotic and dizygotic twins?

A

Monoxygotic

  • 1 sperm, 1 egg
  • ALWAYS same sex
  • # of sacs/placenta varies

Dizygotic
- 2 sperms, 2 eggs
+/- same sex
- ALWAYS 2 placentas, 2 sacs

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19
Q

early split (0-4 days) –> how many placentas/sacs

late split (> 12 days) –> what?

A

early split –> 2 placentas, 2 sacs

late split –> conjoined twins

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20
Q

What can determine chronicity before 14 wks?

What sign a/w Monochorionic? Dichorionic?

A

US

  • T sign = Monochorionic
  • Lambda = Dichorionic
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21
Q

What 2 major increased risks for multiple gestation babies

Do twins ever make it to due date?

A
  1. stillbirth
  2. neonatal death

NO b/c risks –> deliver all twins early

22
Q

Which type of twins can be delivered the latest?

Which type need inpt management at 24 wks?

Which type must you do C-section for delivery?

Note: if vertex-breech –> can do vaginal or C-section
if vertex-vertex do vaginal

A

Dichorionic/Diamniotic
- delivered latest (38 wks)

Monochorionic/Monoamniotic

  • need inpt management
  • must do C-section
23
Q

What is the name of the screening test done at 1st prenatal visit for DM?

A

GCT (1 hr Glucola)

24
Q

What type of GDM needs medication as Tx?
- what med is preferred?

What can the other type be controlled with?

A

A2 GDM - Medication
- insulin preferred

A1 GDM - controlled w/diet

25
Q

If a growth scan shows EFW > 4500 g why is a C section done

A

risk of shoulder dystocia

26
Q

What test is done to screen the mother for pre-DM/DM postpartum at 6-12 wks?

A

75 OGTT Test

27
Q

What are the 3 types of Pregnancy induced HTN?

What is difference b/t chronic HTN and pregnancy induced?

A
  1. Gestational HTN
  2. Pre-eclampsia
  3. Eclampsia

Chronic present < 20 wks GA
Pregnancy induced > 20 wks GA

28
Q

When can pre-eclampsia occur (2 pds)

A
  1. Intrapartum

2. postpartum (6 wks after delivery)

29
Q

Which type of HTN has BP > 160/110

A

Pre-eclampsia w/SEVERE Features

30
Q

Which 2 types of HTN dont have proteinuria

A

Gestational HTN

Chronic HTN

31
Q

What the nemonic for Liver Findings for Pre-eclampsia w/SEVERE Features? what does it stand for?

Other major sign = edema of vasculature, lungs, brain

A

HELLP
Hemolysis (incr LDH)
Elevated Liver enzymes
Low Platelets

32
Q

How does the presentation of Eclampsia differ from Pre-eclampsia w/SEVERE Features?

Therefore what is the overall Tx for eclampsia? Med for seizures?

A

Eclampsia has same Sxs as Pre w/SEVERE Features + SEIZURES –> life threat

Tx= delivery ASAP
- med for seizures = Mag sulfate

33
Q

Do any pts w/HTNsive d/o make it to their due date? why?

A

NO - incr risk of stillbirths

34
Q

4 BP Meds used in pregnant women w/HTN?

A
  1. Labetalol
  2. Methyldopa
  3. Nifedipine
  4. Hydralazine
35
Q

What is the Kleihauer-Betke Test?

A

Test that determines dose of Rhogam needed based on amt of exposure

36
Q

What is considered preterm labor?

Definition of labor (2 things)

A

preterm labor: < 37 wks

Labor = regular contractions + progressive cervical changes (effacement and dilation)

37
Q

Preg pt at 36 wks presents w/ cramping, back pain, pelvci pressure, vaginal d/c and uterine contractions. Her cervix is dilated 4 cm and is 85% effaced…Dx?

A

Preterm Labor

38
Q

4 Tests used to Dx PTL

Note: Dx PTL –> admit
- BEDREST NOT INDICATED

A
  1. Nitrazine pH paper test (turns blue)
  2. Fern Test –> delicate crystallization
  3. Presence of Fetal Fibronectin
  4. L:S ratio < 2:1 (immature lungs)
39
Q

What 2 meds should be given for PTL if 24-37 wks

A
  1. Antenatal Steroids

2. GBS ppx

40
Q

What is the Med for Antenatal Steroids and GBS ppx

A
  1. Antenatal Steroids –> BMZ

2. GBS ppx –> PCN

41
Q

What medication should be given for PTL if 24-34 wks?

A

Tocolytics

42
Q

What type of Tocolytic is specifically given in 24-32 wk range?

Other 3 Tocolytics?

A

24-32 wks –> Mag sulfate + other Tocolytic

  1. Indomethacin
  2. Nifedipine
  3. Terbutaline
43
Q

What type of Tocolytic is specifically given in 24-32 wk range?

Other 3 Tocolytics?

A

24-32 wks –> Mag sulfate + other Tocolytic

  1. Indomethacin
  2. Nifedipine
  3. Terbutaline
44
Q

definition of PROM - Premature Rupture of Membranes

A

ROM before onset of labor

45
Q

definition of PPROM - Premature Premature Rupture of Membranes

A

ROM before 37 wks AND onset of labor

46
Q

Definition of Prolonged Rutupre of Membranes

A

ROM > 18 hrs

47
Q

How to Dx PROM?

A

Sterile Speculum Exam

- pooling of secretions = water broke

48
Q

3 parts of Sterile speculum exam

What does blue indicate on 2 of these tests?

A
  1. Nitrazine pH Paper Test
  2. Fern Test
  3. AFI
  • blue = amnio fluid –> PRM likely
49
Q

General Management of PROM (3 meds)

When do you usually deliver?

A
  1. BMZ
  2. Tocolytics
  3. Latency ABXs
  • same rules for 1+2 as PTL

Deliver at 34 wks

50
Q

Latency ABXs

  1. what 2 options of IV meds can be given for 1st 2 days
  2. what 2 PO meds given together for next 5 days
A
  1. IV Ampicillin/erythromycin for 2 days then..

2. PO Amoxicillin and Erythromycin for 5 days

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