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Clin Med > OBGYN: Pregnancy complications > Flashcards

OBGYN: Pregnancy complications Flashcards

1
Q

first 30 days of gestation, levels of HCG?

-afte 30 days what happens

A

doubles every 2.2 days

after 30 days– doubles every 3.5 days

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2
Q

If HCG levels rise by less than ____%= problem with pregnancy

A

53%

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3
Q

HCG level and what to see on TVUS for discrimatory zone

A

HCG level= 2500

TVUS= shuld see a intrauterine pregnancy

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4
Q

what do you see on TVUS with the following HCG levels:

  • 1500
  • 2500
  • 5200*
  • 17,500*
A

1500=gestational sac

2500=intrauterine pregnancy

5200=fetal pole aka spine

17,500=fetal cardiac monitoring

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5
Q

define early pregnancy loss

A
  • nonviable
  • intrauterine pregnancy with either:
  • empty gestational sac OR *gestational sac with embryo or fetus w.o heart beat
  • **first 12 weeks aka first trimester
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6
Q

T/F:

In the first trimester, the terms miscarriage, spontaneous abortion and early pregnancy loss are used interchangeably

A

true

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7
Q

% of women experience early preg loss
MCC?
MC during what trimester

A

10-15%

MCC=chromosomal abnormalities

MC (80%) in firs tri

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8
Q

which type of spontaneous abortion has the potential for a viable fetus

A

threatened abortion

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9
Q

early preg loss < ____ weeks

spontaneous abortion < _____ weeks

A

early preg loss < 12 weeks

spontaneous abortion < 20 weeks

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10
Q

management for early pregnancy loss

A
  1. EXPECTANT MANAGEMENT
    - limited to first trimester
    - 80% body does it on its own
  2. MEDICAL MANAGEMENT
    -mifepristone + misoprostol
    200 mg Mifepristone PO—- 24 hours later take 800 mcg of vaginal misoprostol
  3. SURGICAL MANAGEMENT
    -for women who present with hemorrhage, hemodynamic instability or s/s infection
    -or women who prefer a more immediate completeion of abortion
    **surgical D&C (dilation and curettage) <16 weeks
    OR
    ***Dilation and Evacauation (D&E) >16 weeks
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11
Q

work up + labs for diagnosis of early preg los (5)

A 
CBC, blood type
Rh screen
Beta hCG titers 
Transvaginal ultrasound
Pelvic exam
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12
Q

vaginal bleeding prior to the 20th week
+/- cramps/pain
cervix closed
products of conception are intact

A

Threatened abortion

-50%ish can continue to go on and survive

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13
Q

+pain/cramping
+bleeding
Cervix partially dilated
Products of conception are intact

A

Inevitable abortion
***membranes have ruptured

**mom is RH-, needs RhoGAM

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14
Q

how long can we wait for expectant abortion to occur

**up to how many weeks gestation can we allow for expectant abortion

A

6-8 weeks

up to 12 weeks gestation

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15
Q

+pain/cramps
+bleeding
completely dilated cervix
POC: some expelled

A

incomplete abortion
**some POC remain inside uterus

**mom is RH-, needs RhoGAM

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16
Q

-pain/cramps
-bleeding
-cervix closed
POC intact

A

missed abortion

  • *fetus died— but body did not expel contents yet
  • this is foud out when mom goes for routine sonogram and no fetal HB detected with not rising HCG levels
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17
Q

+pain, prior
+bleeding, prior
Cervix is now closed
POC all expelled from uterus

A

complete abortion

rh- mom needs RHOGAM

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18
Q

+/- Pain
Bleeding–foul smelling with brown discharge
cervix–closed with +CMT
POC some or all remain

A

septic abortion

-mom needs rhogam if rh-

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19
Q

tx for septic abortion

A

surgical D/C or D/E
AND
Broad spec ABX

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20
Q

in NYS– up to how many weeks can you do an elective abortion

A

24 weeks

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21
Q

up to how many weeks can you do an elective medical abortion

A

up to 10 weeks gestation

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22
Q

MOA for mifepristone and misoprostol

A

MIFE: progeterone anagonist—leads to dilation and softening of cervix + placental separation

MISO
*prostaglandin analog— stim uterine contractions

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23
Q

hydatidiform mole=?

A

tumor is benign–80%

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24
Q

list the types of benign/Hydatidiform molar pregnancies
which is MC?
which has highest risk for malignant development?

A
  1. Complete mole–MC–>empty egg with no DNA, it is fertilized by either 1 or 2 sperm (23 chromosomes)
    - no fetal tissue develops
    - carries highest risk of malignant development
  2. partial mole–>egg is fertilized by 2 or 1 sperm— but it duplicated its own chromosomes (69 chromosomes)
    - yes or no produces fetal tissue— but if it does—fetus is abnormal and not viable
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25
Q

define molar pregnancy

A

abnormal placental development that forms a tumor of trophoblastic tissue
-tumor is either bengin (Hydatidiform–MC) or malignant (Gestational trophoblstic neoplasia)

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26
Q

CM for molar pregnancy

-PE findings

A

painless vag bleeding
often preeclampsia B4 20 weeks
hyperemesis gravidarum

PE
*uterine size + date mismatch
*HcG abnormally high—- >100,000
US=snowstorm or cluster of grapes pattern

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27
Q

tx for molar pregnancy

-howlong can the PT not get pregnant again for?

A
  1. surgical D/C
  2. hysterectomy– only for cases where it spread and if wmoan does notwant to get preg again

tell pt to not get pregnant for one year*

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28
Q

HCG monitoring after tx for molar pregnancy

A
  1. weekly monitoring: levels subside within 12-16 weeks
  2. folloiwng 3 normal HCG levels– PT should be followed monhtly x1 yr
  3. tell pt to not get pregnant for one year*
29
Q

what happens if HCG levels start to rise after tx for molar pregnancy

A

start PT on chemo

30
Q

key to successufl management of ectopic preg?

A

early diagnosis

31
Q

first step to diagnosing ectopic preg?

A

obtain HCG levels

(-)= NOT ectopic

32
Q

RF for ectopic pregnancy

-bigest one?

A
  • ****previous ectopic pregnancy
  • pregnancy after tubal ligation of with IUD
  • hx PID
  • Smoking
  • use of assisted reproductive technology
33
Q

ruptured ectopic preg MC results in?

A

tubal rupture– since MC are in FTs
AND
Intraperitoneal hemorrhage

LIFE THREATENING MEDICAL EMERGENCY

34
Q

s/s of acutely ruptured ectopic preg

A
  1. severe abd pain— with abd distention, guarding and rebound tenderness
  2. dizziness
  3. referred shoulder pain–phrenic nerve irritation from blood in peritoneum
  4. hemodynamic instability with tachycardia, diaphoresis, hypotension, loss of consciousness
35
Q

tx prior to surgery for ruptured ectopic preg

A

Insert a large bore (18 gauge) IV and start fluid resuscitation
Order a blood type and cross for imminent transfusion

36
Q

classic triad for probable ectopic preg

A 
prior missed menses 
\+ 
vaginal bleeding 
\+ 
lower abd pain
37
Q

diagnosis for probable ectopi preg

A

HCG level
—- if above 2,500—->then get TVUS–>since it is above 2,500 we would see a intrauterine pregnancy– but if HCG is 2500 and there is nothing in uterus=ECTOPIC

38
Q

tx for probable ectopic preg

A
  1. IM methotrexate
  2. PT returns on day 4 and 7 for HCG tests— should fall at lest 15% b/w these days– then PT is followed weekly until HCG not detected
    * ***if HCG is plateuing or not falling fast enough—- second dose of IM Methotrexate
39
Q

possible ectopic pregnancy

  • usally occurs when
  • CM
  • diagnosis
A

MC clinical presentation

MC occurs during early prergnancy
CM= non specific and mild—- abd pain, abnormal vaginal bleeding–spotting to equivalent of a normal menses

Diagnosis=HCG test —- most likely below discriminatory zone—- so diagnosis cannot be confirmed yet—

40
Q

how long should pregnancy be avoided after ectopic pregnancy

A

at least 3 MO

41
Q

incompetent cervix— what is placed and when is it removed

A

cerclage (cervical stich) b/w 12-14 weeks and removed after 34 weeks

42
Q

abrupto placentae

  • define
  • RF
  • CM
  • diagnosis
  • mortality rate
A

premature partial or complete separation of the normally implanted placenta

RF– MC=maternal HTN

CM

  • Third Tri: PAINFUL vaginal bleeding with cramps/ abd pain, back pain, hemodynamic instability VERY quickly.
  • ***lots of bleeding

DIagnosis—- clinical

management=immediate delivery

Mortality rate is 35%

43
Q

fetal and neonatal complications from maternal HTN disorders

A
  • growth restriction
  • prematurity
  • death
44
Q

SBP > than ______ or a DBP > _____ =HTN

A

SBP greater than or equal to 140

DBP greater than or equal to 90

45
Q

define preeclampsia

A

new onset of HTN during pregnancy with proteinuria in the latter half of gestation

46
Q

two essential criteria for diagnosis of preeclampsia

A
  1. develop of HTN (SBP >140 or DBP >90) in a woman whose BP were previously normal—– after the 20th week gestation
  2. development of new onset proteinuria after 20th week of pregnancy
    * proteinuria= more than or equal to 0.3g protein in a timed 24 hour collection
47
Q

what is preeclampsia preceded or associated with?

A

generalized edema— esp HANDS, FACE

48
Q

varient of preeclampsia?

-what is it

A

HELLP SYNDROME–high morbidity

Hemolysis
Elevated LIver enzymes
Low Platelets

49
Q

prodromal s/s of eclampsia

A

severe HA and sustained clonus aka seizures

50
Q

define eclampsia

A

tonic-clonic seizures in woman with preeclampsia that cannot be atrributed to other causes

51
Q

MC time for eclamptic seizures to occur

A

50% occur prior to labor

52
Q

Preeclampsia/HELLP tx

A
  1. bed rest
  2. blood transfuision to tx anemia
  3. continuous monitoring of baby + fetus
  4. BP meds
  5. Mag Sulfate–prev seizures
  6. Corticosteroids for fetal lung developments (BETAMETHASONE)
53
Q

definitive cure for preeclampsia?

A

delivery of fetus

54
Q

tx for woman with preeclampsia without evidence of fetal compromise
-when should she deliver

A

bed rest
observation
*deliver b4 reaching 38 weeks

55
Q

tx for preeclampsia that is severe

-when should she deliver

A

hospitalized for remainder of pregnancy

after 32-34 weeks—>delivery

56
Q

5 serious s/s of preeclampsia

A
  1. SBP >140/90
  2. swelling face/hands
  3. visin changes
  4. migraine like HA
  5. sudden weight gain over 2 pounds/week
57
Q

two most imp maternal issues to manage during delivery with preeclamptic mom?

A
  • seizure prophylaxis——mag

- control of HTN—methyldopa

58
Q

how long is mag given for seizure prophylaxis

A

during delivery and up to 24 hours after

59
Q

what is the one antihypertensive medicaiton we can give during pregnancy

A

methyldopa

60
Q

management of eclampsia

A

INITIAL=protect pt from injury–clear airway, give oxygen,

PHARMACOLOGIC= control BP, prophylaxis for seizures

*once mom is stabilized– we want to delivery— VAGINALLY IS IDEAL

61
Q

define GD

A

glucose intolerance with onset or first recognition during pregnancy

62
Q

what point during pregnancy is fetal hyperglycemia teratogenic

A

embryogenesis

63
Q

when is every preg woman screened for GD and how screened

A

24-28 weeks via glucose challenge test

64
Q

next step if glucose challenge screening test is +

A

diagnostic oral glucose tolerance test—- to confirm

65
Q

gold standard tx for GD?

A

insulin

***PO hypoglycemic agents not recc in pregnancy

66
Q

depressed mood 2-4 days PP, can last up to 10 days with NO thoughts of harming baby

A

PP blues

67
Q

define puerperium

A

first 6 weeks PP

68
Q

major depression, possibly including thoughts of harming baby, starting 2 weeks-2MO PP

A

PP depression

69
Q

tx for PP depression

A

antidepressants and CBT

*resolves around 3-14 MO

Clin Med (52 decks)

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