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PT2B2 > Lecture 73, 74 - Disease of Pregnancy > Flashcards

Lecture 73, 74 - Disease of Pregnancy Flashcards

1
Q

Where is the most common location for an ectopic pregnancy

A

Ampulla of the Fallopian tube (region of first narrowing)

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2
Q

Risk Factors for Ectopic Pregnancy

A

prior PID (salpingitis, endometritis)

Previous Tubal Ligation

Previous ectopic

Smoking

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3
Q

what is the classic triad of symptoms for ectopic pregnancy

A

amenorrhea, vaginal bleeding, sudden abdominal pain

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4
Q

Dx of Ectopic Pregnancy:
Requisite labs:

Gold standard Dx Procedure

Other dx procedures

A

hCG levels usually rise at a much slower rate based on dates

Gold standard: Laproscopy – direct visualization

D&C - absence of chorionic villi

Ultrasound -

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5
Q

Treatment of Ectopic Pregnancy:

Medical vs Surgical

who gets which method?

A

Medical: Methotrexate (anti folic acid), but has lots of side effects and pt must be followed by HCG tracking to make sure the treatment worked

Surgical – Conservatinve mangement (don;t take out anything) vs Salingectomy

Hemodynamically unstable patients need surgery

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6
Q

Chronic HTN during Pregnancy

outcomes?

A

patient has kind of HTN before pregnancy

25% develop chronic HTN or Pre-eclampsia

usually no complications

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7
Q

Gestational HTN
what is it?
how is it dx?

A

BP > 140/90 after 20th week of gestation (no pre-existing HTN). No proteinuria.

BPs measures at least twice, at least 4 hours apart

Blood pressures should be normalized 6 weeks after delivery

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8
Q

Pre-eclampsia

A

new onset HTN after 20th week of gestation + Proteinura and/or end organ damage (TTP, Kidney damage, Liver damage, Pulm Edema, Visual symptoms; cerebral swelling)

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9
Q

RF for preeclampsia

A

Nulliparty, extremities of age, African american, chronic HTN, Chronic renal disease, DM, Multifetal gestation

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10
Q

Prevention of progression of pre-eclmapsia to eclampsia

A

Mg Sulfate

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11
Q

Eclampsia

A

Pre-eclampsia + seizures

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12
Q

HELLP Syndrome

A

Hemolysis, Elevated Liver Enzymes, Low Platelets

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13
Q

describe what happens to a woman’s blood pressure normally during pregnancy ?

A

drops in BP due to increased volume and drop in vascular resistance, and continues to drop until 32 weeks, until it starts to climb back up

Maternal blood volume almost doubles in pregnancy

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14
Q

pathophysiology of pre-eclampsia in pregnancy

what is the organ at fault?

what are the meditators of a healthy endothelium ?

what are the mediators which inhibit healthy endothelium?

A

Placental Dysfunction – not enough syntiotrophoblasts invasion, therefore the vessels of materanal fetal exchange are not compliant enough. Incomplete invasion of the myometrium

TGFB1 and VEGF = healthy endothelial function

sEng and SFLT1 - bind and deactivate TGFB1 and SFLT1

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15
Q

what organs can be damaged due to poor endothelial funciton during pre-eclampsia?

what is a fatal complication?

A

Kidney – Proteinuria, Increased Cr, and BUN

Brain - HA, , Sz, Stroke

Liver - RUQ Pain, increased LFTs, TTP

Liver Rupture = Fatal

Vessels = Vasocontstriction – Microvascular hemolysis
Edema

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16
Q

what is the only resolution for pre-eclampsia

A

i. The only resolution is delivery bc the source of the problem is the placenta

17
Q

Pre-eclampisa –

mother is at term: what is the treatment?

wmother is preterm: what is the treatment protocol ?

A

If Term –> Mg Sulfate to prevent sz and proceed with delivery

Pre term –>
With severe features: mg sulfate and deliver

Without severe features: expectant management until term or severe

18
Q

PRETERM LABOR –

definition?

A

uterine contractions between 20 and 36 weeks

19
Q

what normally induces contraction in the uterus? describe the cascade

what is inhibiting this cascade?

A

CRH – activates fetal pituitary and adrenal glands –> ACHT and Cortisol —> estrogen and prostaglandins —> Positive feedback with CRH –> other substances that lead to contractions of the myometrium

Inhibitng the cascade;
Progesterone inhibits CRH
CRH BP decreases free CRH

20
Q

what else can induce the contraction process?

A

Inflammation, Over distention (twins), Hemorrhage

21
Q

Risk factors for pre-term delivery:

what is #1

A

1) H/o prior pre term delivery

other: Infection, Placental abn, Smoking, Multiple gestastion, Bleeding during pregnancy

22
Q

Dx of pre term delivery –

what visualization/recording modalitites?

What ultrasound finding?

what is a good serum marker and why?

A

Tocogram - record contractions

Cervical Change – advance in dilation

US; Shorter cervical length

Fetal Fibronectin – Found in the ECM of the amniotic sac; will be present in vaginal secretions in delivery and PTL

If negative == Powerful predictor of not being in pre-term labor

23
Q

what three drugs are administered in the management of PTL,

what are the reasons for each?

A

Steroids – promote lung maturity

Tocolysis – stop contractions long enough to administer steroids

Antibiotics: Prophylaxis for GBS

24
Q

what drugs are used for tocolysis:

mechanisms for each

A

MG Sulfate – competes with calcium

Nifedipien – ca channel blocker

Indomethacin – indomethacin

25
Q

Preterm Premature Rupture of Membranes (PPROM)

what is it

Risks

A

rupture of amniotic membranes prior to onset of labor at < 37weeks

Infection
Cord Prolapse –
Placental abruption – loss of fluid around the baby;
Pulmonary Hypoplasia

26
Q

how is the dx made?

what three things are found

A

pooling - of amniotic fluid in the vagina

Nitrazine positive – alkaline fluid (indicates amniotic fluid)

ferning – NaCl crystals indicating amniotic fluid

27
Q

mangment of PPROM

contraindciations

A

managment:
- watchful waitng
- Abx for GBS
- STeroids for lung maturity
- Tocolysis until completion of steroids

Contraindications -

  • infection already present
  • pregnancy > 34 weeks
28
Q

Placenta previa

common presenting symptom:

management:

A

placenta attachement over or in close proximity to the internal cervical os

painless bleeding in the third trimester

management:
watchful waiting until term
Then proceed with C -section

29
Q

Placental Abruption

common prsenting symptom

what can cause it?
(classically, what behavior causes it in baltimore)

management:

A

Placenta Separates prematurely from the uterine wall before delivery of the infant

Abrupt Painful vaginal bleeding + abdominal discomfort and uterine contracttions in the third trimester

Abrupt Painful vaginal bleeding + abdominal discomfort and uterine contracttions in the third trimester

management:
IV Fluids, blood products
C -section

30
Q

Morbidly Adherent Placenta:

what is it?
what are three subtypes?

most common RF:

A

Defective decidual layer – abnormal attachment and separation after delivery

Placenta Accreta, Increta, Percreta

RF: Previous C section; placenta previa, HTN, Smoking,

31
Q

Placenta Accreta, Increta, Percreta

differences between the three

A

accreta – placenta attaches to myometrium but not penetrating

Increta – placenta penetrates into myometrium

Percreta – placenta penetrates through myometrium and into serosa

32
Q

why is the incidnce of Morbidly Adherent Placenta increasing?

A

Increasing Rate due to increasing rate of C section deliveries

33
Q

MULTIFETAL GESTATION

complications:

A 
PTL -- (due to over distention) 
Spontaenous Abortion 
Gestational DM
Preeclampsia 
Maternal Hemorrhage
34
Q

time line for the following:

Monochorionic and monoamniotic

Dichorionic diamniotic

Conjoined twins

Monochorionic diamniotic

which is at risk for twin twin transufion syndrome

which is at risk for cord entaglement

A

4 day split: Dichorionic + Diamniotic

4-8 day split: Mono chorionic + Diamniotic
- Twin twin infusion

8-13 day split: Monochroic + Monoamniotic
- Cord entanglement

> 13 day split = Conjoined twins

35
Q

Twin-Twin Transfusion Syndrome

what is it
how is it managed?

A

Monochorionic Diamniotioc twins

Vascular anastomoses between the two twins;

Donor: impaired growth, hypovolemia, anemia, etc

recipient: Hypervolemia, CHF, HTN,

Treat: laser separation of the anastamosis

PT2B2 (25 decks)

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