OBGYN COMPLICATIONS Flashcards
If a pt is experiencing severe vomiting in pregnancy, that’s often more common in twin pregnancy – what is it? Dx? Tx?
Hyperemesis gravidarum
Dx: occurs in 1st tri, check for signs of dehydration
Tx: Vit B6 or anti-nausea
A pt 28weeks gestation comes to the ED with severe HA and visual disturbances, edema, and nausea. You noted a BP of 160/95 – Dx?
Preeclampsia
What is preeclampsia?
HTN WITH proteinuria and/or end organ damage in a pt OVER 20 WEEKS GESTATION
What if preeclampsia is noted BEFORE 20 weeks gestation?
A molar pregnancy should be considered
What makes it eclampsia?
Pre-eclampsia with seizures
You believe a pt might have preeclampsia, how do you work them up?
ANY pt with HTN + preggo gets this workup =
BP, urine dipstick, platelet count, and LFTs drawn weekly
*24-hour urine protein levels
What is the ultimate treatment of hypertensive disorders in pregnancy?
Delivery of the baby
What is the HELLP syndrome?
Hemolysis, elevated liver enzymes, low platelets
When/How do you treat preeclampsia?
If over 160/110 can treat with methyldopa or labetalol, but typically if over 160/110 give corticosteroids(bethamethasone) for lung maturity and then induction
- Labetalol or hydralazine is best if no greater than 150/100
- MgSO4 inpatient to help decrease the risk of seizures
A pt is in her 3rd tri and she notes painless bleeding at 29 weeks – dx?
Placenta previa (when the placenta is covering the os)
How do you move forward when you suspect placenta previa?
DO NOT DO VAGINAL EXAM OR TRANSVAG u/s
DO a TransABDOMINAL u/s FIRST
How do you treat placenta previa?
if not resolved by 35 weeks do c-section at 38 weeks
- An emergency c-section if severe hemorrhage or fetal distress
Your 29 week pt is also presenting with bleeding in addition to severe pain and contractions – dx?
Placenta abruption (separation of placenta from uterine wall)
How do you treat placenta abruption?
Hemodynamic stabilization and delivery ASAP
How do you treat an incompetent cervix?
cervical cerclage (stitch across the Os)
A pt presents with amenorrhea and spotting, and lower abdominal pain -dx?
Ectopic pregnancy
Where do the majority of ectopic pregnancies occur?
In the fallopian tube
how do we dx an ectopic pregnancy?
Serum hcg levels usually double every 48 hours
- If less than expected, suspect ectopic preggo
* Transvaginal u/s is diagnostic; if hcg is greater than 1,500 but no evidence of intrauterine pregnancy = ectopic
How do we manage an ectopic pregnancy?
Methotrexate
Or
Surgical treatment
A pt presents believing she is possibly 6 weeks pregnant. You check her hcg levels and they are very high and the size of her uterus on palpation feels much larger than 6 weeks -dx?
Molar pregnancy
In a molar pregnancy what are the only chromosomes present?
only chromosomes from the father duplicate
How do you treat a molar pregnancy?
They are dangerous and can be malignant à D&C
How do you screen for gestational diabetes?
random glucose on all preggo women at first visit to look for risk factors
- Repeat at 24-28 weeks with glucose challenge (non-fasting, 50g glucose) with 1-hour f/u
- If greater than 130 then do a 3-hour test
Can you give an ACE or a diuretic to a preggo woman?
NO
What is considered preterm labor?
Before 37 weeks
