LECTURE - High Risk Pregnancies

Question 1

amniotic fluid

Answer 1

intrauterine medium for fetus

Question 2

primary link between fetus and mother

Answer 2

placenta and umbilical cord

Question 3

hCG doubling

Answer 3

every ~2days up to 8 wks

Question 4

GTD

Answer 4

gestational trophoblastic disease (e.g. molar pregnancy)

Question 5

HELLP

Answer 5

hemolysis, elevated liver enzymes, low PLTs

Question 6

pregnancy-related spectrum of cellular proliferations arising from trophoblasts

Answer 6

gestational trophobastic disease

trophoblasts
= provides nutrients to developing embryo; lining from blastocyst;differentiates to form placenta (first cells to differentiate from egg)

Question 7

ectopic pregnancy

Answer 7

• implantation of fertilized egg in a non-uterine site
• most commonly = fallopian tube; 97%
• tube rupture is a potentially life-threatening bleed

Question 8

pelvic inflammatory disease

Answer 8

chronic inflammation due to infection

- chronic salpingitis endometriosis, or appendicitis

Question 9

symptoms of ectopic pregnancy

Answer 9

• present at 6-10 weeks
• spotting/bleeding
• pelvic pain

Question 10

detection of ectopic pregnany

Answer 10

• US = must be large enough to detect (abnormal)

- lab: low or slowly increasing hCG (serial 48 h tests)

Question 11

treatment of ectopic pregnancy

Answer 11

• pharmacological (methotrexate) or surgery

- after treatment = watch for hCG drop, stay low, and disappear

Question 12

spontaneous abortion

Answer 12

• loss of pregnancy naturally before 20 wks gestation
• symptoms: vaginal bleeding and abdominal cramping
• similar presentation to ectopic pregancy

Question 13

Lab hCG for spontaneous abortions

Answer 13

decreased hCG doubling times (similar to ectopic pregnancy)

Question 14

lab serum progesterone (spontaneous abortion)

Answer 14

often low in mothers with an abnormal pregnancy

>50 mmol/L in healthy pregnancy

Question 15

this can damage many organs

Answer 15

pre-eclampsia

- affects baby and mom (high BP can slow fetal growth, low birth weight, preterm labour, or stillbirth)

Question 16

clinically utility of hCG testing

Answer 16

• early pregnancy
• ectopic pregnancy
• miscarriages
• gestational trophoblastic disease
• germ cell tumours (AFP)
• maternal prenatal screen for fetal chromosomal anomalies
• pituitary adenomas

Question 17

molar pregnancy

Answer 17

• GTD; can be complete or partial
• pre-malignant hydatidiform mole invades uterine wall but stays within uterus
• usually identified before signs and symptoms develop; 1st trimester
  > vag bleeding, nausea/vomit; excessive uterine size (complete mole)

Question 18

malignant gestational trophoblastic neoplasia

Answer 18

• invasive moles; invade beyond uterus
• choriocarcinoma = malignancy of placenta; 15-29% complete mole, <1% partial
• placental-site trophoblastic tumor
• epithelioid trophoblastic tumor

Question 19

diagnosis of molar pregnancy

Answer 19

• chemistry: hCG higher than average (complete mole > partial)
  > monitor hCG for persistent neoplasia (hCG level > 100 000 U/L)
  > karyotype to determine if complete mole (diploid) or partial mole (triploid)
• histology: immunostain for maternal expressed genes = p57, PHLDA2
  > negative is complete mole; positive is partial

Question 20

treatment for molar pregnancy

Answer 20

• uterine evacuation with suction curettage
  > preserve reproductive function
• hysterectomy

Question 21

monitor treatment of molar pregnancy (complications)

Answer 21

• anemia, hyperthyroidism
• measure hCG
  > weekly until undetectable
  > monthly until undetectable for 6 months
  can have persistent neoplasia after molar pregnancy

Question 22

hypertension

Answer 22

• systolic BP > or equal to 140 mmHg and/or
• diastolic BP > or equal to 90 mHg

average of at least 2 measurements, taken at least 15 mins apart

Question 23

pre-existing hypertension

Answer 23

hypertension that develops in pregnancy at <20 wks gestation

Question 24

gestational hypertension

Answer 24

• hypertension that develops for the first time at >20 + weeks gestation
• no proteinuria
• 5-6%

Question 25

pre-eclammpsia

Answer 25

- restricted blood flow to the placenta maybe? so hypertension - gestational hypertension plus new proteinuria or > one or more adverse conditions or >one or more severe complications - 1-2%

Question 26

proteinuria in preeclampsia

Answer 26

screen for renal disease and preeclampsia if at risk - urine dipstick of at least 1+ (high FPs and FNs) - urine total protein (quantitative) = 24 hr urine sample required; significant proteinuria - urine total protein to creatinine ratio = don't need 24 hr

Question 27

T or F. Preeclampsia only affects the mom

Answer 27

F! affects baby as well = slow fetal growth, low birth weight, preterm labour, stillbirth

Question 28

how is preeclampsia resolved?

Answer 28

by delivering baby as soon as possible

Question 29

renal tests pre-eclampsia

Answer 29

- increase in serum creatinine - increase in serum uric acid *kidneys not filtering properly*

Question 30

hepatic tests in pre-eclampsia

Answer 30

- nausea or vomiting - right upper quadrant pain - increase in AST, ALT, LDH, or bilirubin

Question 31

eclampsia

Answer 31

preecclampsia probs + seizures - terminal for mom - observed in <1% of women with pre-eclampsia - investigation similar to pre-eclampsia - immediate delivery!!!

Question 32

another possible treatment for preeclampsia but not a certainty

Answer 32

MgSO4

Question 33

HELLP syndrome

Answer 33

severe presentation of pre-eclampsia (deliver now or eclampsia) - hemolysis, elevated liver enzyme, low PLT count - right upper abdominal pain (liver), nausea, vomiting - death o critical illness up to 25% of the case

Question 34

preterm labour

Answer 34

- <37 wks gestation - major cause of neonatal morbidity - risk factors > previous preterm birth > short cervix > less than 6 mos since last pregnancy, etc.

Question 35

clinical utility of hCG testing

Answer 35

- early pregnancy - ectopic pregnancy - miscarriages - GTD - germ cell tumours (AFP) - maternal prenatal screen for fetal chromosomal abnormalities - pituitary adenomas