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Obstetrics > medical conditions in pregnancy > Flashcards

medical conditions in pregnancy Flashcards

1
Q

placenta previa

A

Pathology
-placenta extends over and covers cervix

Risk

  • prior C section
  • prior previa
  • multiple gestation
  • advanced maternal age

Clinical features
-asymptomatic, diagnosed on 2nd trimester US

Management

  • pelvic rest
  • most resolve due to lower uterine segment lengthening or placental growth toward fundus
  • persistent undergo C section at 36-37 weeks

complications

  • early cervical changes
  • partial detachment
  • massive maternal hemorrhage
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2
Q

Complete hydatidiform mole

A

pathology

  • abnormal fertilization of an empty ovum
  • one sperm duplicates genome
  • or two sperms

Clinical

  • uterine size greater than gestational age
  • first trimester vaginal bleeding
  • markedly elevated beta hCG

US

  • swiss cheese
  • snowstorm
  • no fetus
  • no amniotic fluid
  • theca lutein cysts –> ovarian hyperstimulation

Treatment

  • suction curettage
  • risk of malignant transformation
  • serial monitoring of hCG levels
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3
Q

Second stage arrest of labor

A

Second stage: cervix is 10cm dilated

definition
-insufficient descent after pushing more than 3 hours in nulliparous or 2 hours in multiparous

risk factors

  • maternal obesity
  • excessive pregnancy weight gain
  • DM

Etiology

  • cephalopelvic disproportion
  • malposition (anything other than occiput anterior)
  • inadequat contractions
  • maternal exhaustion

management

  • operative vaginal delivery
  • C section
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4
Q

late decelerations

A
  • sign of uteroplacental insufficiency

- impending fetal hypoxemia and acidemia

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5
Q

uterine tachysystole

A
  • more than 5 contractions in 10 mins
  • can occur spontaneously
  • increased risk with induced or augmented labor (uterotonic agents like oxytocin)

management

  • supportive
  • discontinue uterotonic agents
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6
Q

intraamniotic infection (chorioamnionitis)

A

Risk

  • prolonged rupture of membranes
  • preterm premature rupture of membranes
  • prolonged labor
  • internal fetal/uterine monitoring devices
  • repetitive vaginal examinations
  • presence of genital tract pathogens

Diagnosis

  • maternal fever plus one of the following
  • fetal tachycardia (over 160)
  • maternal leukocytosis
  • purulent amniotic fluid

Management

  • broad spectrum antibiotics
  • delivery

complications

  • maternal: postpartum hemorrhage, endometritis
  • neonatal: preterm birth, pneumonia, encephalopathy
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7
Q

preeclampsia

A

DEFINITION

  • new onset HTN at over 20 weeks gestation
  • proteinuria and or end organ damage

SEVERE FEATURES

  • thrombocytopenia
  • increased creatinine
  • increased transaminases
  • pulmonary edema
  • visual or cerebral symptoms

MANAGE

  • without severe features: delivery at over 37 weeks
  • with severe features delivery at over 34 weeks
  • mg sulfate
  • antihypertensives

NEONATES
-fetal growth restriction

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8
Q

Wernicke encephalopathy

A

ASSOCIATED CONDITIONS

  • chronic alcholism
  • malnutrition
  • hyperemesis gravidarum

PATHOPHYS
-thiamine deficiency

CLINICAL

  • encephalopathy – AMS
  • oculomotor dysfunction
  • postural and gait ataxia
  • absent reflexes

TREATMENT
-IV thiamine then glucose

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9
Q

hyperemesis gravidarum

A

RISK

  • hydadidiform mole
  • multifetal gestation
  • hx of hyperemesis

CLINICAL

  • sever, persistent vomiting,
  • > 5% weight loss in pregnancy
  • dehydration
  • orthostatic hypotension

LABS

  • hypochloremic metabolic acidosis
  • hypokalemia
  • elevated serum aminotransferases
  • ketonuria
  • hemoconcentration

MANAGE

  • antiemetics
  • fluids
  • thiamine supplementation

COMPLICATIONS
-spontaneous abortion

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10
Q

eclampsia

A

Definition
-severe preeclampsia plus seizures

CLINICAL

  • hypertension
  • proteinuria
  • severe headaches
  • visual disturbances
  • RUQ or epigastric pain
  • 3-4 mins of tonic clonic seizure

MANAGE

  • administer mg sulfate
  • administer antihypertensives
  • deliver the fetus
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11
Q

chronic hypertension

A
  • systolic over 140
  • diastolic over 90
  • prior to conception or 20 weeks gestation
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12
Q

gestational hypertension

A
  • new onset after 20 weeks gestation

- no proteinuria or end organ damage

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13
Q

chronic hypertension with superimposed preeclampsia

A

-chronic hypertension and one of the following

new onset proteinuria or worsening proteinuria at more than 20 weeks gestation

sudden worsening hypertension

signs of end organ damage

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14
Q

Intrahepatic cholestasis of pregnancy

A

PATHOPHYS
-increased estrogen and progesterone causing stasis and decreased bile excretion

CLINICAL

  • develops in 3rd trimester
  • generalized pruritis worse on palms and soles
  • no associated rash
  • RUQ pain

LAB

  • elevated total bile acids
  • elevated transaminases
  • elevated total and indirect bilirubin

OBSTETRIC RISK

  • intrauterine fetal demise
  • preterm delivery
  • meconium-stained amniotic fluid
  • neonatal RDS

MANAGEMENT

  • ursodeoxycholic acid (first line)
  • delivery at 37 weeks gestation
  • antihistamines
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15
Q

Complications of inappropriate weight gain in pregnancy

A

GAIN

  • gestational DM
  • fetal macrosomnia
  • c section

LOSS

  • fetal growth restriction
  • preterm delivery
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16
Q

Uterine inversion

A

-potentially fatal cause of PPH

RISK

  • nulliparity
  • fetal macrosomnia
  • placenta accreta
  • rapid labor and delivery

PATHOGEN
-excessive fundal pressure and traction on umbilical cord before separation

CLINICAL

  • smooth round mass protruding through cervix or vagina
  • unterine fundus in no longer palpable
  • hemorrhagic shock
  • lower abdominal pain

MANAGEMENT

  • agressive fluid replacement
  • manual replacement of uterus
  • placental removal and uterotonic drugs after replacement
17
Q

PPROM

A

Defintion
-membrane rupture at less than 37 weeks

RISK

  • prior PPROM
  • genitourinary infection
  • antepartum bleeding

DIAGNOSIS

  • vaginal pooling or fluid from cervix
  • nitrazine positive fluid
  • ferning on microscopy

MANAGE

  • less than 34 weeks with reassuring fetal–> latency antibiotics, corticosteroids
  • less than 34 weeks non reassuring –> deliverys
  • over 34 weeks –> delivery

COMPLICATIONS

  • preterm labor
  • intraamniotic infection
  • placental abruption
  • umbilical cord prolapse
18
Q

gestational DM

A

Target levels

  • fasting less than 95
  • 1 hour less than 140
  • 2 hour less than 120

treatment

  • diet first
  • insulin, metformin
19
Q

SLE nephritis in pregnancy

A

CLINICAL

  • edema
  • malar rash
  • arthritis
  • hematuria

LAB

  • nephritic range proteinuria
  • urinalysis with RBC and WBC casts
  • low complement levels
  • increased ANA titers

DIAGNOSIS
-renal biopsy

OBSTETRIC COMPLICATIONS

  • preterm birth
  • c section
  • preeclampsia
  • fetal growth restriction
  • fetal demise
20
Q

Neonatal thyrotoxicosis

A

PATHOPHYS

  • transplacental passage of maternal anti-TSH receptor antibodies
  • antibodies bind to infant’s TSH receptors and cause excessive thyroid hormone release

CLINCAL

  • warm, moist, skin
  • tachycardia
  • poor feeding, irritability, poor weight gain
  • low birth weight or preterm birth

DIAGNOSIS
-maternal anti TSH receptor antibodies (500% of normal)

TREAT

  • self resolves in 3 months
  • ethimazole plus beta blockr if symptomatic
21
Q

Antiphospholipid syndrome

A 
DIAGNOSIS
-vascular thrombosis and or 
-pregnancy complication 
PLUS
-anti-cadriolipin antibody
-lupus anticoagulant 
-anti beta 2 glycoprotein antibody

CLINICAL

  • recurrent pregnancy loss
  • prior TIA

MANAGE
-anticoagulation with heparin or warfarin

22
Q

Diabetic nephropathy

A
  • significant proteinuria prior to 20 weeks gestation
  • glomerular hyperfiltration
  • acceleration of renal disease during pregnancy
  • HTN is a common complication due to excess sodium retention and activation of RAAS
23
Q

acute cholangitis

A

ETI
-ascending infection due to biliary obstruction

CLINICAL

  • fever
  • jaundice
  • RUQ pain
  • +/- hypotension, AMS

DIAGNOSIS

  • increased direct bili, alk phos
  • mildly increased aminotransferases
  • biliary dilation on abdominal us or ct scan

TREAT

  • antibiotic coverage of enteric bacteria
  • biliary drainage by ERCP within 24-48 hours
24
Q

acute appendicitis in pregnancy

A

CLINICAL

  • atypical due to cephalad displacement by gravid uterus
  • right mid-to-upper quadrant or right flank pain
  • fever, nausea, vomiting
  • rebound and guarding

obstetric symptoms

  • uterine irritability and contractions
  • fetal tachy (secondary to maternal fever)

RISK

  • delayed diagnosis
  • increased risk of complications

MANAGE
-immediate surgery

25
Q

HIV management during pregnancy

A

ANTEPARTUM

  • HIV viral road every 2-4 weeks after initiation of change of therapy, monthly until undetectable, and then 3 months
  • CD4 cell coutns ever 3-6 months
  • resistance testing if not previously performed
  • ART initiation ASAP
  • avoid amniocentesis unless viral load is less than 1000

INTRAPARTUM

  • avoid artificial ROM, fetal scalp electrode, operative vaginal devliery
  • If viral load is less than 1000, ART and vaginal delivery
  • if viral load is over 1000 copies, ART plus zidovudine and C section

POSTPARTUM

  • mother: continue ART
  • if maternal load was less than 1000 give infant zidovudine
  • if load was over 1000 give infant multidrug ART
26
Q

Ulcerative colitis in pregnancy

A

CLINICAL

  • hematochezia
  • abdominal pain
  • tenesmus (fecal urgency followed by straining and inability to defecate)

PATHOPHYS
-placental cytokines worsen colonic inflammation

FETAL RISK

  • preterm delivery
  • small for gestational age

MANAGEMENT

  • remission before pregnancy
  • most meds used for UC are safe to continue during pregnancy and breastfeeding
  • only exception is SULFASALAZINE
27
Q

Hepatitis C in pregnancy

A

POTENTIAL COMPLICATIONS

  • gestational diabetes
  • cholestasis of pregnancy
  • preterm delivery

MATERNAL MANAGEMENT

  • ribavirin in teratogenic and should be avoided
  • no indication for barrier protection in serodiscordant, monogamous couples
  • HEP A AND B VACCINE

Prevention of VERTICAL transmission

  • strongly associated with maternal viral load
  • c section is not protective
  • scalp electrodes should be avoided
  • breast feeding should be encouraged unless maternal blood present

Obstetrics (5 decks)

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