MATERNAL LEC Flashcards
A pregnancy that
happens outside the
UTERUS.
Ectopic Pregnancy
Occurs when a zygote
implants in a location
that can’t support its
growth.
Ectopic Pregnancy
Most common site (95%) of implantation
Ampulla 55%; Isthmic 25%; Fimbrial 17%
Tubal
Pregnancy occurs when a fertilized egg implants on the surface of the
ovary.
ovarian
Extremely rare type (1/15,000); the developing embryo implants and
grows within the abdominal cavity.
abdominal
Rare implantation of a pregnancy in the endocervical canal.
Present with vaginal bleeding, which can be profuse and is often
painless.
cervical
Existence of two simultaneous pregnancies with separate implantation
sites.
One pregnancy is a viable intrauterine pregnancy (uterus)
The other non-viable ectopic pregnancy (outside the uterus).
Heterotopic
- Results from the gradual extension into the uterine cavity of products of
conception that originally implanted in the interstitial portion of the tube.
Tubo-uterine
- A zygote that is originally implanted at the end of the fallopian tube
gradually extends into the peritoneal cavity.
Tubo-abdominal
A zygote that is partly implanted in the tube & partly in the ovary
Tubo-ovarian
Additional symptoms during an ectopic pregnancy include:
Vaginal bleeding
Pain in your lower abdomen, pelvis, and lower back.
Dizziness or weakness.
Reveals extrauterine pregnancy
TVUS
In normal pregnancy, the HCG titer doubles every 48-72 hours;
in ET, it’s lower.
Serial HCG
Determination
Usually negative because HCG present in the urine & serum
level is not enough to be detected by pregnancy test.
. Pregnancy
Test
> 25 ng/ml normal viable pregnancy
<5 ng/ml is often associated with non-viable pregnancy (e.g.,
EP & abortion)
If serum levels are between 5-25 ng/ml, an ultrasound is
necessary
Serum
Progesterone
Levels
Direct visualization of the oviducts & ovaries.
Colpotomy
Extraction of fluid from the rectouterine pouch posterior to the
vagina through a needle.
Diagnose the presence of ruptured ectopic pregnancy
Culdocentesis
Falling hematocrit can discriminate slow internal bleeding from
the sudden hemorrhage of a ruptured tube.
Elevated WBC helps to aid in correct dx as PID and
appendicitis may have the same manifestations as EP.
CBC
For unruptured EP what kind of abortion?
therapeutic abortion is performed
(chemotherapy agent; immune suppressant)
Used to treat cancer, autoimmune diseases, and ectopic
pregnancies
Methotrexate
Stop fertilized eggs from growing, which ends pregnancy
Pregnancy then is absorbed by the body over 4-6 weeks
Does not require the removal of the fallopian tubes
Methotrexate
Methotrexate has been associated with
stomatitis,
gastritis,
hepatic enzyme
elevation,
pneumonitis, &
hematologic toxicity
is given on alternate days to
decrease the hematologic toxicity of Methotrexate.
IM leucovorin (like folic acid)
uncontrollable hemorrhage & severely
damaged tube
Salpingectomy
often for ruptured interstitial or cervical
pregnancy
Hysterectomy
AKA molar pregnancy;
gestational trophoblastic
tumor
Hydatidiform Mole
Eggs do not contain any
chromosomes (absence of half
of the genetic material).
Sperm fertilizes an empty egg☹!
Embryo can’t grow
Complete Molar
An extra set of chromosomes
comes from the father (two
sperm fertilized one egg).
Mother’s 23 chromosomes
remain intact.
Growing embryos start to
develop but can’t SURVIVE!
Partial Molar
Management & Treatment of H mole
D&C with suction
Methotrexate for 1 year to prevent
choriocarcinoma
Characterized by persistent trophoblastic proliferation after
H-mole evacuations
GESTATIONAL TROPHOBLASTIC TUMORS
most severe malignant complication;
requires chemotherapy or radiation.
Choriocarcinoma
locally invasive developing during the 1st
six months
Invasive Mole
*Management of all trophoblastic tumors is
hysterectomy!
AKA ablatio placenta, placenta
abruption & accidental
hemorrhage.
Abruptio Placenta
Abruptio Placenta Most commonly occurs later in
3rd trimester, begins around
28 weeks & lasts until delivery.
placenta does not completely detach from the uterine wall.
Partial placental abruption
placenta completely detaches from the uterine
wall—more vaginal bleeding.
Complete or total placental abruption
dissection occurs along the uterine wall & blood escapes
through the cervix
Revealed abruption/Overt
blood is retained behind the placenta & does not
communicate with cervix.
Concealed abruption/Covert
no symptoms abruptio placenta
grade 0
some external bleeding, uterine tetany &
tenderness (may/may not be noted), absence of fetal
distress & shock (minimal separation). abruptio placenta
grade 1
external bleeding, uterine tetany, uterine
tenderness, & fetal distress (moderate separation) abruptio placenta
grade 2
internal & external bleeding (more than
1000cc), uterine tetany, maternal shock, probably
fetal death & DIC (extreme separation). abruptio placenta
grade 3
(most common & first sign)
occurs in 80% of women
vaginal bleeding
concealed AP
Dark red
revealed AP
bright red
rapid loss of more than 1% of
body weight
rapid blood loss results in
Hemorrhage
blood loss amounting to 1.5 – 2 L.
HYPOVOLEMIC SHOCK
occurs
during pregnancy, labor & delivery
Perinatal Hemorrhage
anytime
during pregnancy
Antepartal hemorrhage
before 20 weeks
Early Antepartum hemorrhage
after 20 weeks
Late Antepartum hemorrhage
during
labor
Intrapartal hemorrhage
1st 24h
Early postpartum hemorrhage
after 24h
Late postpartum hemorrhage
termination of pregnancy
before 12 weeks (fetus is
< 500gms)
Abortion
Early abortion
occurs
between 12 to 20 weeks
Late abortion
1st trimester bleeding:
Abortion & Ectopic
Pregnancy
2nd trimester bleeding:
Hydatidiform Mole &
Incompetent Cervix
3rd trimester bleeding
Placenta previa
& Abruptio Placenta
deliberate abortion
Elective or Therapeutic Abortion
abortion by personal
choice
Elective abortion
recommended by MD to protect
mental & physical health
Therapeutic abortions
due to natural
causes; unexpected ending of
pregnancy
Spontaneous Abortion
Prophylaxis to Prevent
Miscarriages
Oral low-dose aspirin
Heparin (SQ)
Possible loss of the
products of conception.
THREATENED ABORTION
SIGNS & SYMPTOMS:
Light vaginal bleeding
(scanty, bright red)
No cervical dilatation
None to mild uterine
cramping
More severe cramps may
lead to inevitable abortion
THREATENED ABORTION
loss of the product of
conception that cannot be
prevented.
INEVITABLE OR
IMMINENT ABORTION
SIGNS & SYMPTOMS
Moderate to profuse bleeding
Moderate to severe uterine
cramping
Open cervix or dilatation of
cervix
Rupture of membranes
No tissue has passed yet
INEVITABLE OR
IMMINENT ABORTION
Spontaneous expulsion of the products of
conception.
COMPLETE ABORTION
SIGNS & SYMPTOMS
Hx of vaginal bleeding, abdominal pain & passage of
tissue.
On examination, the following are noted:
Light bleeding or some blood in the vaginal vault.
No tenderness in the cervix, uterus, or abdomen
None to mild uterine cramping
Closed cervix
Empty uterus on ultrasound
COMPLETE ABORTION
Expulsion of some parts &
retention of other parts of
conceptus in utero.
INCOMPLETE
ABORTION
SIGNS & SYMPTOMS
Heavy vaginal bleeding
Severe uterine cramping
Open cervix
Passage of tissue
Ultrasound shows that
some of the products of
conception are still inside
the uterus
INCOMPLETE
ABORTION
Retention of all products of
conception after the death
of a fetus in the uterus.
MISSED ABORTION
SIGNS & SYMPTOMS
Absence of Fetal Heart
Tone (FHT)
Signs of early pregnancy
symptoms disappearing,
e.g., nausea & breast
soreness
*Common to have no
symptoms (no bleeding or
cramps)
MISSED ABORTION
Infection involving the
products of conception &
the maternal reproductive
organ.
INFECTED ABORTION
SIGNS & SYMPTOMS
Danger signs of infection:
fever
abdominal pain or
tenderness, & foul vaginal
discharge.
INFECTED ABORTION
most common cause
(spread from rectum to
vagina).
E. Coli
a common
infection that occurs
Endometritis
Infection complicates the
dissemination of bacteria &
toxins into the maternal
circulatory and organ
systems.
SEPTIC ABORTION
SIGNS & SYMPTOMS
Foul - smelling vaginal
discharge
Uterine cramping
Fever, chills & peritonitis
Leukocytosis – WBC count,
16,000 to 22,000/uL
SEPTIC ABORTION
