OBGYN COMPLICATIONS

Question 1

If a pt is experiencing severe vomiting in pregnancy, that’s often more common in twin pregnancy – what is it? Dx? Tx?

Answer 1

Hyperemesis gravidarum
Dx: occurs in 1st tri, check for signs of dehydration
Tx: Vit B6 or anti-nausea

Question 2

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?

Answer 2

Preeclampsia

Question 3

What is preeclampsia?

Answer 3

HTN WITH proteinuria and/or end organ damage in a pt OVER 20 WEEKS GESTATION

Question 4

What if preeclampsia is noted BEFORE 20 weeks gestation?

Answer 4

A molar pregnancy should be considered

Question 5

What makes it eclampsia?

Answer 5

Pre-eclampsia with seizures

Question 6

You believe a pt might have preeclampsia, how do you work them up?

Answer 6

ANY pt with HTN + preggo gets this workup =
BP, urine dipstick, platelet count, and LFTs drawn weekly
*24-hour urine protein levels

Question 7

What is the ultimate treatment of hypertensive disorders in pregnancy?

Answer 7

Delivery of the baby

Question 8

What is the HELLP syndrome?

Answer 8

Hemolysis, elevated liver enzymes, low platelets

Question 9

When/How do you treat preeclampsia?

Answer 9

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

Question 10

A pt is in her 3rd tri and she notes painless bleeding at 29 weeks – dx?

Answer 10

Placenta previa (when the placenta is covering the os)

Question 11

How do you move forward when you suspect placenta previa?

Answer 11

DO NOT DO VAGINAL EXAM OR TRANSVAG u/s

DO a TransABDOMINAL u/s FIRST

Question 12

How do you treat placenta previa?

Answer 12

if not resolved by 35 weeks do c-section at 38 weeks

- An emergency c-section if severe hemorrhage or fetal distress

Question 13

Your 29 week pt is also presenting with bleeding in addition to severe pain and contractions – dx?

Answer 13

Placenta abruption (separation of placenta from uterine wall)

Question 14

How do you treat placenta abruption?

Answer 14

Hemodynamic stabilization and delivery ASAP

Question 15

How do you treat an incompetent cervix?

Answer 15

cervical cerclage (stitch across the Os)

Question 16

A pt presents with amenorrhea and spotting, and lower abdominal pain -dx?

Answer 16

Ectopic pregnancy

Question 17

Where do the majority of ectopic pregnancies occur?

Answer 17

In the fallopian tube

Question 18

how do we dx an ectopic pregnancy?

Answer 18

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

Question 19

How do we manage an ectopic pregnancy?

Answer 19

Methotrexate
Or
Surgical treatment

Question 20

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?

Answer 20

Molar pregnancy

Question 21

In a molar pregnancy what are the only chromosomes present?

Answer 21

only chromosomes from the father duplicate

Question 22

How do you treat a molar pregnancy?

Answer 22

They are dangerous and can be malignant à D&C

Question 23

How do you screen for gestational diabetes?

Answer 23

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

Question 24

Can you give an ACE or a diuretic to a preggo woman?

Answer 24

NO

Question 25

What is considered preterm labor?

Answer 25

Before 37 weeks