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SG F3 E5 > OB 3 > Flashcards

OB 3 Flashcards

1
Q

Implantation of developing oocyte outside the endometrial cavity

Dx? and 3 RFs?

A

Ectopic Pregnancy

  • Prior ectopic pregnancy
  • Previous tubal surgery
  • Hx of PID
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2
Q

98% of ectopic occur in Fallopian Tube, if they do not occur here what is the next likely location?

A

Ampullary portion of tube

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3
Q

3 sxs of ectopic?

A
  • Pelvic/abd pain (95%)
  • Vaginal bleeding (60-80%)
  • Orthostatic sxs: dizziness, fainting, wkness d/t blood loss
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4
Q

Medical tx for ectopic pregnancy?

A
  • RhoGAM in Rh neg women
  • Methotrexate IM
    • inhibits DNA synthesis & fetal cell reproduction
    • MUST HAVE these 3 criteria: HCG <5,000, no cardiac activity, sac ,4cm
    • Repeat HCG on days 4 & 7 after Methotrexate (if HCG did not drop by 15%, meds did not work!)
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5
Q

What are contraindications to medical tx for ectopic w/ Methotrexate?

A
  • Renal, liver, pulm compromise
  • At risk for loss to FU (risk of death)
  • Breastfeeding
  • Heterotopic pregnancy
  • Immunodeficiency
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6
Q

Surgical tx for ectopic pregnancy & indications for

A
  • RhoGAM in Rh neg women
  • Laparoscopy vs. Laparotomy (Salpingostomy vs. Salpingectomy)
  • No difference in future reproductive outcomes (based on contralateral tube)
  • Indications: hemodynamically unstable, impending/active rupture, failure of methotrexate, heterotopic pregnancy
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7
Q

Abnormal proliferation of placental epithelium secondary to abnormal fertilization

A

Gestational Trophoblastic Disease

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8
Q

3 RF of Gestational Trophoblastic Disease

A
  • Previous molar pregnancy
  • Advanced maternal age >40
  • Asian/American Indian ancestry
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9
Q

4 types of Gestational Trophoblastic Disease

A
  • Hydatiform Mole
  • Invasive Mole
  • Placental site nodule
  • Choriocarcinoma
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10
Q

Describe a Hydatiform Mole (Gestational Trophoblastic Disease)

A
  • Most common (80% of Gestational Trophoblastic Disease)
  • Paternal genes control placental growth
  • ↑ Genes = ↑proliferation
  • Complete vs. Partial
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11
Q

Describe a complete Hydatiform Mole

(Gestational Trophoblastic Disease)

A
  • Sperm fertilizes an abnormal ooctye = no chromosomes
  • Chromosomes from the sperm duplicate = 2 copies of paternal chrom, 0 maternal chrom
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12
Q

Describe a partial hydatiform mole

A
  • 2 sperm fertilize normal oocyte at same time
  • 2 paternal DNA vs. 1 maternal DNA
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13
Q

Which type of GTD?

Villi from Hydatiform Molar pregnancy invade deeply into myometrium of uterus

  • Is complete or partial more common?
A

Invasive Mole

(Gestational Trophoblastic Disease)

Complete

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14
Q

What occurs following a FT pregnancy?

(Gestational Trophoblastic Disease)

A

Placental site nodule

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15
Q

Dx? Tx?

  • Abnormal uterine bleeding or amenorrhea
  • Uterine size greater than dates
  • Absent fetal heart tones
  • Hyperemesis
  • Pre-eclampsia “like” sxs prior to 20 weeks
A

Choriocarcinoma (gestational troph dz)

  • Caused by persistent complete Hydatiform Mole
  • Can follow any type of pregnancy (abortion, ectopic, normal)
  • HIGHLY malignant epithelial tumor (vascular invasion w/ widespread mets)

Tx: chemo vs. hysterectomy + chemo

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16
Q

What is PE of Choriocarcinoma?

A

Uterine enlargement

+/- adnexal masses

b HCG

US:“snow storm” or “grape like clusters” within the endometrium

17
Q

Tx for Hydatiform Mole? (4)

A
  • Dilation & Curettage
  • Pelvic rest 4-6 weeks
  • Monitor HCG closely x6-12 months
  • Avoid pregnancy for 12 months
18
Q

Describe a placental abruption and the cause

A

Premature separation of a normally implanted placenta after 20th week

  • Cause: rupture of maternal vessels –> accumulation of blood leading to separation of decidua from placental attachment
  • Detached placenta is unable to exchange gas and nutrients leading to fetal compromise
19
Q

Dx? How dx? Tx?

  • Abrupt PAINFUL vag bleeding
  • Abd/back pain
  • Contractions
A

Placental Abruption

Dx: clinical and US showing retroplacental hematoma

Tx:

  • Monitor fluids, blood products
  • Continuous fetal monitoring
  • Expectant management (stable mothers w/ no fetal distress)
  • C-section (unstable mother/fetus)
20
Q

Definition of what?

  • Abnormal location of the placenta over or in close proximity to the internal cervical os
A

Placenta Previa

21
Q

What are 4 RF of Placenta Previa?

A
  • Prior C-section
  • Multiple gestation
  • Prior hx of previa
  • Advanced maternal age
22
Q

Presentation of what?

  • PAINLESS vaginal bleeding after 20 weeks gestation
A

Placenta Previa

23
Q

Which type pf Placenta Previa?

  • Located near, but NOT directly adjacent to internal os (can have a normal vag delivery)
A

Low Lying

24
Q

Which type pf Placenta Previa?

  • Internal os is partially covered
A

Partial

25
Q

Which type pf Placenta Previa?

  • Internal os is completely covered (worse one = NO VAG DELIVERY)
A

Complete

26
Q

How is Placenta Previa diagnosed?

A
  • US
  • NEVER do cervical exam bc/ it can hemorrhage!!!
27
Q

Tx for pt w/ PAINLESS vag bleeding after 20 weeks?

A

Placenta Previa

  • Asymptomatic:
    • avoid intercourse & ↓ physical activity
    • educate pt it may resolve w/ advanced gestational age
  • Symptomatic:
    • Admit for close maternal/fetal monitoring
    • Deliver via C-section
28
Q

What is PROM?

A

Premature Rupture of Membranes

  • Rupture of membranes before onset of uterine contractions

(normal)

29
Q

What is Pre-PROM?

A

Rupture of membranes before 37 weeks gestation w/o presence of uterine contractions

(abnormal)

30
Q

What is the MC cause for pre-term delivery?

A

Pre-PROM

(rupture of membranes before 37 weeks gestation w/o presence of uterine contractions)

31
Q

What are the 3 RF of Pre-PROM?

Which one is the biggest RF??

A
  • Genital Tract Infection (Bacterial Vaginosis)***
  • Smoking
  • Previous pre-term delivery
32
Q

Woman at 35 weeks gestation presents w/ “gush” of clear/pale yellow fluid, initially thought it was urine, and is now realizing it is coming from vagina.

What is the dx? How is it diagnosed? (4)

A

Pre-PROM

  • Speculum exam reveals amniotic fluid coming out of cervical os / pooling of fluid in vaginal fornix
  • Sample vaginal fluid & look for “ferning” under microscope
  • pH of vag fluid = 7 - 7.3
    • alpha-fetoprotein (amniotic fluid)
33
Q

Woman at 33 weeks presents w/ gush of yellow fluid, speculum exam reveals amniotic fluid coming from os, under microscope “ferning” is seen.

What is the dx and tx? (3)

A

Pre-PROM

  • Administer corticosteroids to promote lung maturity bc/ gestation is <34 weeks
  • GBS status unknown: abx prophylaxis (Ampicillin 2g or Clinda if pcn allergy)
  • Expectant management until delivery
34
Q

What is the definition of Post-Partum Hemorrhage? (2)

A
  • Vaginal delivery w/ 500cc+ blood loss
  • C-section w/ 1,000cc+ blood loss
35
Q

What is the #1 etiology for Post-Partum Hemorrhage?

What are 2 other causes?

A
  • #1: Uterine Atony (lack of effective contractions following delivery)
  • Trauma (lacerations, uterine rupture)
  • Coagulopathy
36
Q

Dx? What is seen on PE? (4)

  • Weakness
  • Palpitations
    Confusion
  • SOB
  • Syncope
A

Post-Partum Hemorrhage

PE:

  • Tachycardia
  • Oliguria
  • ↓ O2 sats
  • Hypotension
37
Q

Patient w/ uterine atony loses 600 CC of blood after vag delivery and is now tachycardic, hypotensive, weak, confused.

What is dx & tx? (4 things + 3 meds)

A

Post-Partum Hemorrhage

  • Uterine massage
  • IV fluids
  • Oxytocin/Misoprostol/Methergine
  • Blood transfusion
  • Surgery

SG F3 E5 (23 decks)

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