OB: Pregnancy Complications 15% Flashcards
(SmartyPance)
two signs of threatened abortion
closed cervix
sm amt of vaginal bleeding
“…threatened abortion as evidenced by the closed cervix and small amount of vaginal bleeding. the most appropriate management for threatened abortions is reassurance with OP f/u”
(SmartyPance)
what are signs of abruptio placentae?
hx of HTN
painful antepartum hemorrhage w/ nml u/s
(pt in scenario is at 38 weeks with vaginal bleeding and painful contractions, lower abd and pelvic pain b/w contractions)
(RoshReview)
what is photopsia? What condition is it related to?
visual disturbances such as eye floaters or FLASHES
think PREECLAMPSIA
(RoshReview)
what is the bp requirement for severe HTN related to severe preeclampsia?
> 160/110 mmHg
(RoshReview)
what med can be offered to women with risk factors for preeclampsia to prevent preeclampsia?
aspirin
(RoshReview)
stage of pregnancy to start suspecting preeclampsia
> 20 weeks gestation
(RoshReview)
s/s of preeclampsia
visual disturances (photopsia)
severe HAs
or asymptomatic
pt shows NEW-ONSET HTN (>140/90 mmHg) w/ either PROTEINURIA (>300 mg/24hr)
~or~
SIGNIFICANT END-ORGAN DYSFUNCTION
(RoshReview)
tx for prevention of szs for preeclampsia
magnesium sulfate
(RoshReview)
if a woman <20 weeks gestation has new onset HTN, what should you suspect?
molar pregnancy
(RoshReview)
if a pt >20 weeks gestation has new onset HTN, but an absence of proteinuria, check for the following five items to r/o preeclampsia w/ severe features:
thrombocytopenia (platelet count < 100,000/mcL)
renal insufficiency (serum Cr >1.1 mg/dL)
impaired liver fxn (liver transaminases 2x nml conc)
pulm edema
cerebral/visual symptoms
(PPP 373)
what meds are used for bp control for preeclampsia with severe features?
labetalol
nifedipine
methyldopa
hydralazine alternative
(PPP 373)
preeclampsia w/ severe features: pt is 34-37 weeks gestation, what do we do?
prompt delivery is definitive management
(PPP 373)
preeclampsia w/ severe features: pt is viable to 33+6 weeks gestation, what do we do?
if asymptomatic or well-controlled w/ anti-HTN, expectant mgmt w/ delivery at 34 weeks
if symptomatic or not well-controlled w/ anti-HTN, deliver
(PPP 373)
what is HELLP syndrome?
Hemolytic anemia
Elevated Liver enzymes
Low Platelets
(RoshReview)
“what is the typical fetal response to maternal seizures in eclampsia?”
“bradycardia during and immediately after the sz”
(RoshReview)
define threatened abortion, the position of the cervical os, and whether there is passage of fetal tissue
= “abdominal pain or bleeding in the first 20 weeks of gestation”
closed
none
(RoshReview)
define inevitable abortion, the position of the cervical os, and whether there is passage of fetal tissue
= “abdominal pain or bleeding in the first 20 weeks of gestation”
open
none
(RoshReview)
define incomplete abortion, the position of the cervical os, and whether there is passage of fetal tissue
= “abdominal pain or bleeding in the first 20 weeks of gestation”
open
YES (some products of conception still remain in uterus)
(RoshReview)
define complete abortion, the position of the cervical os, and whether there is passage of fetal tissue
= “abd pain or bleeding in the first 20 weeks of gestation”
closed
complete passage of fetal parts & placenta; uterus contracted
(RoshReview) define missed (delayed miscarriage) abortion, the position of the cervical os, and whether there is passage of fetal tissue
= “in utero death of embryo or fetus prior to 20 weeks of gestation with retention of pregnancy”
closed
none
(RoshReview)
define septic abortion, the position of the cervical os, and whether there is passage of fetal tissue
= “infection of uterus during miscarriage, fever & chills; usually due to Staph. aureus”
open with purulent cervical discharge; uterine tenderness
none (may be incomplete)
(RR) BUZZWORDS
retroplacental hematoma
think PLACENTAL ABRUPTION
(RR)
what is most common potential complication for placental abruption?
DIC
“a placental abruption of >50% significantly increases the risk for acute disseminated intravascular coagulation and fetal death”
(RR) BUZZWORDS
PAINFUL vaginal bleeding (in third trimester)
placental abruption
(RR)
what med is most frequently used for induction of pregnancy?
oxytocin (Pitocin)
(RR)
what is MC SE of oxytocin admin?
tachysystole
(avg of >5 contractions per 10 minutes for >= 30 minutes
treated w/ reduction or d/c of dose of oxytocin)
(PPP 382)
what are two methods of inducing labor during early stages?
prostaglandin gel placed directly on cervix (promotes cervical ripening, may lead to uterine contractions)
balloon catheter or laminaria (dilate the cervix)
(RR)
Pt has hydatidiform mole (molar pregnancy), removed with surgery. What is the management after surgery?
weekly measurements are taken until the hCG level is < 5 mIU/mL
At this point, if the patient had a complete molar pregnancy, hCG levels are obtained monthly for 3 months and then discontinued if undetectable.
If the patient had a partial molar pregnancy, an hCG level is obtained at 1 month and then discontinued if undetectable.
(RR)
how do you prevent alloimmunization in cases of RhD incompatibility
through administration of anti-D immune globulin at 28 weeks of the first and each subsequent gestation.
this is std practice for all pregnant pts at risk
(RR)
if RhD incompatibility is suspected due to parental genetics, what should be measured? what is done next?
maternal anti-D titers
should be measured serially until a critical titer level (usually 1:16 or 1:32) is reached,
Doppler velocimetry of the middle cerebral artery of the fetus should be measured at that time
(RR)
if there is a situation of Rh isoimmunization, what is often seen in subsequent pregnancies?
jaundice
anemia
fetal death
fetal hydrops (abnormal amounts of fluid build up in two or more body areas of a fetus or newborn)
(RR)
how do we treat Rh Isoimmunization?
Anti-D globulin at 28 weeks (and within 72 hrs of delivery if infant is Rh+)
