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OB/GYN > Obstetric Complications > Flashcards

Obstetric Complications Flashcards

1
Q

pregnancy that implants outside uterine cavity

A

ectopic pregnancy

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2
Q

MCC place for ectopic pregnancy

A

fallopian tubes - Ampulla

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3
Q

leading cause of maternal death in first trimester

A

ruptured ectopic pregnancy

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4
Q

risk factors for ectopic pregnancy**

A
  • history of PID - fallopian tube scarring
  • history of STI
  • previous ectopic pregnancy
  • tubal scarring (surg, TB, etc)
  • current IUD use
  • congenital malformation
  • smoking
  • assisted reproductive technology
  • in utero DES exposure
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5
Q

diagnosis of ectopic pregnancy

A
  • urine hCG to start
  • speculum and bimanual exam
    • adnexal mass, bleeding
  • US (transvaginal best)
    • no intrauterine sac
    • ectopic sac or cardiac activity
    • complex adnexal mass
    • fluid in cul de sac
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6
Q

chemical diagnosis of ectopic pregnancy**

A
  • inadequate rise of hC
    • <66% q48h in first 6-7 weeks
  • progesterone < 5 ng/mL
    • 5-25 ng/mL unclear
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7
Q

management of ectopic pregnancy

A
  • ensure pt. hemodynamically stable
  • determine if ruptured
  • give RhoGAM if pt. D-
  • medical vs. surgical
    • methotrexate
      • hemodynamically stable
      • < 3.5 cm
      • compliant for follow-up
      • intrauterine pregnancy ruled out
    • surgical
      • laparotomy (unstable)
      • laparoscopy (stable)
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8
Q

salpinectomy vs. salpinostomy

A

complete or partial removal of fallopian tube

vs.

removal while sparing tube

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9
Q

relative contraindications of methotrexate

A
  • fetal cardiac activity
  • hCG > 15,000
  • > 3.5 cm
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10
Q

absolute contraindications of methotrexate

A
  • hemodynamically unstable/rupture
  • leukopenia
  • thrombocytopenia
  • active renal/hepatic dz
  • active peptic ulcer dz
  • possible concurrent viable uterine pregnancy
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11
Q

antepartum hemorrhage

A
  • placenta previa
  • placenta acreta
  • abruption placentae
  • uterine rupture
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12
Q

postpartum hemorrhage

A
  • uterine atony
  • retained placental tissue
  • genital tract trauma
  • uterine inversion
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13
Q

dystocia

(dysfunctional or difficult labor)

A
  • uterine contractility/expulsive forces
  • cephalopelvic disproportion
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14
Q

obstetric complications

A
  • premature/preterm labor
  • premature rupture of membranes
  • intrauterine growth restriction
  • posterm pregnancy
  • intrauterine fetal demise
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15
Q

triad of maternal death

A

obstetrical hemorrhage

hypertension

infection

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16
Q

single most important cause of maternal death worldwide

A

hemorrhage

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17
Q

placenta implants of cervical os

A

placenta previa

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18
Q

types of placenta previa

A

complete, partial, marginal

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19
Q

Dx and Tx of placenta previa

A
  • Dx
    • US
    • painless bleeding
  • Tx
    • pelvic rest
    • low-lying placenta safe for labor, vaginal birth
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20
Q

abnormally implanted, invasive, or adhered placenta

A

placenta accreta

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21
Q

premature separation of placenta from uterine wall

A

placental abruption

(leading cause of hemorrhage in 2nd and 3rd trimester)

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22
Q

S/s and Tx of placental abruption

A
  • S/s
    • back discomfort
    • abdominal cramping
    • vaginal bleeding
    • abdominal pain
  • Tx
    • expedited birth - c-section mostly
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23
Q

2 types and classifications of uterine rupture and Tx

A
  • types
    • primary - no prior scarring
    • secondary - preexisting incision, injury
  • classes
    • complete - all layers separated
    • incomplete - visceral peritoneum intact (aka uterine dehiscence)
  • Tx
    • immediate delivery (MC by laparotomy)
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24
Q

greatest risk for uterine rupture

A

prior c-section

25
Q

blood loss > 500mL in vaginal delivery

A

postpartum hemorrhage

  • early postpartum - during first 24h after delivery
  • late postpartum - 24h to 6w after delivery
26
Q

myometrium cannot contract causing bleeding

(MCC postpartum hemorrhage)

A

uterine atony

27
Q

most important step in controlling atonic hemorrhage

A

immediate bimanual uterine compression 20-30 min

28
Q

pharm agents for uterine atony

A
  • first line
    • oxytocin 10-20mL/min IV until bleeding controlled, then 1-2mL/min until transfer
  • second line
    • methylergonovine 0.2mg IM
29
Q

cause of 5-10% of postpartum hemorrhages associated with placenta accreta

A

retained placental tissue

30
Q

prolapse of fundus through cervix - shock and hemorrhage prominent w/ considerable pain

(what type associated w/ tumors)

A

uterine inversion

(nonpuerperal w/ polypoid leiomyomas)

31
Q

difficult or problematic birth

A

dystocia

32
Q

3 majors causes of dystocia

A
  • inadequate cervical dilation or fetal descent
  • fetopelvic disproportion
  • ruptured membranes w/out labor
33
Q

slower than normal labor

A

labor protraction disorder

34
Q

complete cessation of labor progress

A

arrest disorder

35
Q

measurement of inadequate uterine contractions

A

< 180 Montevideo units

36
Q

1 cause of neonatal morbidity and mortality

A

premature labor

37
Q

known causes of premature labor

A
  1. infection (cervical-vaginal-urinary)
  2. placental (vascular)
  3. psychosocial stress/work strain (fatigue)
  4. uterine stretch (multiple gestations)

also: smoking, cocaine, cervical malformation/incompetence, HTN, DM, obesity

38
Q

reasons for preterm birth

A
  • pre-eclampsia
  • fetal distress
  • small for gestational age
  • placental abruption
39
Q

steps to prevent premature labor

A
  • aggressive control of chronic conditions
  • education about smoking, drug abuse
  • probiotic
  • assess cervical competence
  • vaginal progesterone in weeks 20-36 if short cervix
  • prior preterm labor:
    • vaginal progesterone weeks 16-36
    • IM weekly
40
Q

definition of pre-term labor

A

uterine contractions 4/20min or 8/60min

and

cervix with 2cm dilation or 80% effacement

  • NOT
    • cervical changes absent contractions
    • regular contractions absent cervical change (Braxton Hicks)
  • late s/s:
    • watery/bloody show, mucus plug passage, painless contractions, menstrual-like cramps, low back pain
41
Q

Dx and Tx of pre-term labor

A
  • Dx:
    • US of cervical length (normal is 4cm @ 24w)
    • fetal fibronectin secretions
    • labs: vaginal cultures, UA, C&S, CBCd
  • Tx
    • lateral decubitus position and reassess
    • obs, bed rest, hydration, abx, steroids
    • Tocolytics to stop contractions
42
Q

Uterine Tocolytics

A
  • magnesium sulfate (first line)
  • CCB
    • Nifedipine
  • prostaglandin synthase inhibitor
    • Indomethacin
    • higher fetal effects
43
Q

PROM

A

premature rupture of membranes at least 1 hour before active labor before 37 weeks

44
Q

Dx of PROM

A
  • Nitrazine test- alkaline if amniotic fluid
  • Ferm test- detects salt crystals in amniotic fluid
45
Q

PROM after 37 weeks - Tx

A

IP, fetal monitoring, monitor mother for infection, induce labor to decrease infection risk

consider c-section

46
Q

PROM >34 weeks - Tx

A

IP, fetal monitoring, strict bedrest, induce labor/c-section if indicated

47
Q

PROM <34 weeks - Tx

A

IP, fetal monitoring, steroids (betamethasone or dexamethasone), antibiotics, Tocolytics to inhibit uterine contraction, indiction/c-section if indicated

48
Q

PROM <24 weeks - Tx

A

antibiotics, education of risks, consider termination

49
Q

PROM - indications for immediate delivery

A
  • chorioamnionitis fetal distress
  • placental abruption
  • advanced/prolonged labor
  • cord prolapse
50
Q

estimated fetal weight < 10th percentile

for gestational age on US

A

intrauterine growth restriction (IUGR)

51
Q

Risks of IUGR

A
  • meconium aspiration
  • asphyxia
  • polycythemia
  • hypoglycemia
  • mental retardation
52
Q

Causes of IUGR

A

maternal, placental, fetal

  • maternal
    • poor nutrition, smoking, drugs, EtOH, CVS disease, HTN, DM, obesity
  • placental
    • inadequate substrate transfer: HTN, obesity, CKD, PIH
  • fetal
    • intrauterine infection (listeriosis, TORCH), congenital anomalies
53
Q

Types of IUGR

A
  • symmetric (20%)
    • organs decreased proportionally
    • MC w/ infections and anomalies
  • asymmetric (80%)
    • organs decreased disproportionally (abdomen > head)
54
Q

Dx of IUGR

A
  • fundal height 1’ screening tool
  • US (GOLD standard)
    • abdominal circumference most effective
55
Q

Management of IUGR

A
  • pre-pregnancy: education, prevention
  • antepartum: modifiable risk factors
    • smoking, nutrition, etc
  • labor & delivery: low threshold for c-section
56
Q

name for 42+ weeks from onset of LMP

A

post-term pregnancy

57
Q

Complications of Post-term Pregnancy

A

post-maturity syndrome

  • loss of SQ fat
  • long fingernails
  • dry skin
  • abundant hair
  • macrosomia
    • birth weight > 4000g
    • incr. shoulder dystocia, birth trauma, c-sect.
58
Q

fetal death after 20 weeks but before labor onset

A

intrauterine fetal demise

59
Q

Dx and Tx of Intrauterine Fetal Demise

A
  • Dx
    • absence of fetal movements
    • uterus small for dates
    • fetal heart tones not detected
    • US to confirm these
  • Tx
    • watchful expectancy
      • 80% spontaneous labor in 2-3 weeks of demise
      • labor induction

OB/GYN (7 decks)

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