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MLSCI 263 > LECTURE - High Risk Pregnancies > Flashcards

LECTURE - High Risk Pregnancies Flashcards

1
Q

amniotic fluid

A

intrauterine medium for fetus

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2
Q

primary link between fetus and mother

A

placenta and umbilical cord

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3
Q

hCG doubling

A

every ~2days up to 8 wks

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4
Q

GTD

A

gestational trophoblastic disease (e.g. molar pregnancy)

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5
Q

HELLP

A

hemolysis, elevated liver enzymes, low PLTs

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6
Q

pregnancy-related spectrum of cellular proliferations arising from trophoblasts

A

gestational trophobastic disease

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

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7
Q

ectopic pregnancy

A
  • implantation of fertilized egg in a non-uterine site
  • most commonly = fallopian tube; 97%
  • tube rupture is a potentially life-threatening bleed
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8
Q

pelvic inflammatory disease

A

chronic inflammation due to infection

- chronic salpingitis endometriosis, or appendicitis

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9
Q

symptoms of ectopic pregnancy

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

detection of ectopic pregnany

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

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

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11
Q

treatment of ectopic pregnancy

A
  • pharmacological (methotrexate) or surgery

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

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12
Q

spontaneous abortion

A
  • loss of pregnancy naturally before 20 wks gestation
  • symptoms: vaginal bleeding and abdominal cramping
  • similar presentation to ectopic pregancy
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13
Q

Lab hCG for spontaneous abortions

A

decreased hCG doubling times (similar to ectopic pregnancy)

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14
Q

lab serum progesterone (spontaneous abortion)

A

often low in mothers with an abnormal pregnancy

>50 mmol/L in healthy pregnancy

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15
Q

this can damage many organs

A

pre-eclampsia

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

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16
Q

clinically utility of hCG testing

A
  • early pregnancy
  • ectopic pregnancy
  • miscarriages
  • gestational trophoblastic disease
  • germ cell tumours (AFP)
  • maternal prenatal screen for fetal chromosomal anomalies
  • pituitary adenomas
17
Q

molar pregnancy

A
  • 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)
18
Q

malignant gestational trophoblastic neoplasia

A
  • invasive moles; invade beyond uterus
  • choriocarcinoma = malignancy of placenta; 15-29% complete mole, <1% partial
  • placental-site trophoblastic tumor
  • epithelioid trophoblastic tumor
19
Q

diagnosis of molar pregnancy

A
  • 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
20
Q

treatment for molar pregnancy

A
  • uterine evacuation with suction curettage
    > preserve reproductive function
  • hysterectomy
21
Q

monitor treatment of molar pregnancy (complications)

A
  • anemia, hyperthyroidism
  • measure hCG
    > weekly until undetectable
    > monthly until undetectable for 6 months
    can have persistent neoplasia after molar pregnancy
22
Q

hypertension

A
  • 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

23
Q

pre-existing hypertension

A

hypertension that develops in pregnancy at <20 wks gestation

24
Q

gestational hypertension

A
  • hypertension that develops for the first time at >20 + weeks gestation
  • no proteinuria
  • 5-6%
25
Q

pre-eclammpsia

A
  • 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%
26
Q

proteinuria in preeclampsia

A

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
27
Q

T or F. Preeclampsia only affects the mom

A

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

28
Q

how is preeclampsia resolved?

A

by delivering baby as soon as possible

29
Q

renal tests pre-eclampsia

A
  • increase in serum creatinine
  • increase in serum uric acid

kidneys not filtering properly

30
Q

hepatic tests in pre-eclampsia

A
  • nausea or vomiting
  • right upper quadrant pain
  • increase in AST, ALT, LDH, or bilirubin
31
Q

eclampsia

A

preecclampsia probs + seizures

  • terminal for mom
  • observed in <1% of women with pre-eclampsia
  • investigation similar to pre-eclampsia
  • immediate delivery!!!
32
Q

another possible treatment for preeclampsia but not a certainty

A

MgSO4

33
Q

HELLP syndrome

A

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
34
Q

preterm labour

A
  • <37 wks gestation
  • major cause of neonatal morbidity
  • risk factors
    > previous preterm birth
    > short cervix
    > less than 6 mos since last pregnancy, etc.
35
Q

clinical utility of hCG testing

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

MLSCI 263 (31 decks)

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