Obstetric Complications in Pregnancy Flashcards
Where are most Ectopic Pregnancies and what is a risk factor?
Tubal
– Tubal scarring from PID/surgery/endometriosis
How will an Ectopic Pregnancy present?
Vaginal bleeding + abdominal pain following a missed period
What diagnostics should be ordered with an Ectopic Pregnancy and what will it show?
TVUS = empty uterus
beta-hCG = (+)
If the patient is stable with an Ectopic Pregnancy, what medication should be given?
Methotrexate
If the patient is stable with an Ectopic Pregnancy, what medication should be given?
Methotrexate
What classifies an abortion? Fetal demise?
Expulsion of fetal tissue < 20 weeks = Abortion
– Fetal Demise = > 20 weeks
If the Abortion occurs before 13 weeks, what is a surgical treatment option?
Dilation and Curettage
If the Abortion occurs after 13 weeks, what is a surgical treatment option?
Dilation and Evacuation
What classifies IUGR?
Fetal weight < 10th percentile for gestational age
There are many risk factors for IUGR. What diagnostic should be done and what will it show?
Umbilical A. Doppler Velocimetry = Reversal of flow
What will an Umbilical A. Doppler Velocimetry show with IUGR?
Reversal of flow
What classifies Fetal Macrosomia?
Fetal weight > 95th percentile for gestational age
If the fetus is macrosomic and the mother has GDM, when should the C-section be performed?
If the infant weighs more than 4500g
If the fetus is macrosomic and the mother does NOT have GDM, when should the C-section be performed?
If the infant weighs more than 5000g
What AFI classifies Polyhydramnios?
AFI > 25
How may Polyhydramnios present?
Fundal height greater than expected
What AFI classifies Oligohydramnios?
AFI < 5
Oligohydramnios may present how? What fetal anomalies are often present?
IUGR or fetal distress
= Renal/MSK anomalies, pulmonary hypoplasia and often fetal mortality
What women are at risk for Rh Isoimmunization?
Rh (-) women.. like me with A negative blood
How does Rh Isoimmunization occur?
- Fetal RBCs leak into maternal circulation
- Maternal Anti-Rh IgG antibodies form
- Antibodies cross the placenta
- Hemolysis of Fetal RBCs = Hydrops Fetalis
When is RhoGAM given to Rh (-) mothers?
28 weeks and within 72 hours of delivery
– Also with any ectopics/abortions/mixing of fetal and maternal blood
If the mother is sensitized with Rh Isoimmunization, what tests need to be done often? Treatment options?
Serial US and Amniocentesis to assess fetal anemia
= Preterm delivery or fetal intrauterine blood transfusions
What occurs with a Complete Mole?
Sperm fertilizes an empty ovum
What is the karyotype of a Complete Mole? Will there be fetal tissue present?
46 XX
NO fetal tissue present!
What is the karyotype of a Complete Mole? Will there be fetal tissue present?
46 XX
NO fetal tissue present
What occurs with a Partial Mole?
2 sperm fertilize 1 normal ovum
What is the karyotype of a Partial Mole? Will there be fetal tissue present?
69 XXY
Some fetal tissue is present
What is the karyotype of a Partial Mole? Will there be fetal tissue present?
69 XY
Some fetal tissue is present
How may a Molar pregnancy present?
1st trimester bleeding
Hyperemesis Gravidarum
What may be seen on physical exam/pelvic exam with a Molar Pregnancy?
- Large uterine size
- Bilateral enlarged ovaries due to theca lutein cysts
- Grapelike molar clusters into vagina
What may be seen on physical exam/pelvic exam with a Molar Pregnancy?
- Large uterine size
- Bilateral enlarged ovaries due to theca lutein cysts
- Grapelike Molar clusters into vagina
What is commonly seen on US with a Molar Pregnancy?
Snowstorm appearance with no gestational sac/fetus
What is the treatment for a Molar Pregnancy?
D&C with weekly beca-hCG levels
Sometimes a Molar pregnancy progresses to?
Invasive mole or malignant Choriocarcinoma
How do you treat a Mole that becomes a Choriocarcinoma?
Chemotherapy
What is Chorioamnionitis?
Intramniotic infection
What are 2 risk factors for Chorioamnionitis?
Premature ROM and Prolonged labor
What are the signs of Chorioamnionitis?
Maternal FEVER + 1 of the following:
- Maternal Leukocytosis
- Purulent Amniotic fluid
- Fetal Tachycardia
What are the signs of Chorioamnionitis?
Maternal FEVER + 1 of the following:
- Maternal Leukocytosis
- Purulent Amniotic fluid
- Fetal Tachycardia
What is the treatment for Chorioamnionitis?
Antibiotics + IMMEDIATE delivery
