Obstetrics Flashcards
Pathophysiology of Pre-eclampsia
?Placental insufficiency, results in progressive vasospasm - leads to end organ damage if unchecked.
HELLP syndrome Pathophysiology?
Vasospasm in the arterioles, leads to hemolysis (increased LDH) and endothelial injury (low platelets) and decreased perfusion to tissues particularly liver (elevated AST/ALT) and kidney (increased Cr)
Severe features of Pre-eclampsia?
BP >160/ >110, headache, vision changes, RUQ pain, severe proteinuria, seizure
Can have atypical Pre-E - with no HTN
When does blood volume expansion begin?
1st trimester, increases in the 2nd trimester and plateaus at week 30
- Will see a drop in hemoglobin
HR in pregnancy?
Usually increases by 15 beats
Heartburn in pregnancy
Starts to get worse around 35 weeks, try gaviscon - mint (according to Caroline)
Tx for molar pregnancy
U/S and high bHCG, this is a cancer - so do a D&C right a way, trend the bHCG every month, no pregnancy for a year.
(Bunch of grapes on U/S)
Rhogam at?
28 weeks, and after delivery 72 hours
GBS test
35-37 weeks
Morning sickness?
B6 try it, then diclectin
Work up for pre-E
CBC, Cr/eGFR, LDH, ALT/AST, Protein, Pro/Cr, Uric acid lvl
Eclampsia Management
Mg sulfate, give lorazepam until seizure stops, load with hydrazine if high BP, then do c-section.
Lab tests for HELLP
CBC, platelets, LFT and enzymes, Cr/eGFR, Coags, LDH, total bilirubin
Glucose test
At 28 weeks, follow up 6wks and 6months postpartum if GDM
Depression during pregnancy?
Escitalapram, Sertraline
Suspect an ectopic?
Get a beta-HCG, quant, urine, group and screen, and US to confirm an intrauterine
Risk factors for ovarian torsion?
Pregnancy, usually young, usually presents suddenly during activity, N/V, prior Hx of same, abnormal ovaries (large cyst)
Unusual vaginal bleeding?
Make sure it is actually vaginal, are they pregnant? Is it heavy?
If no to the first 2 then this is likely not an emergency - start thinking of things more like fibroids, cancer etc (gyne consult)
When should you see a gestational sac in the uterus
1500 HcG transvaginal
5000 trans abdominal
Less than that have to follow up and check again
Stages on US of pregnancy by weeks
4wk - gestational sac
5wk - yolk sac
6wk - fetal pole ideally with cardiac activity
Threatened abortion
Any first trimester bleed
Inevitable abortion
Cervix open, and no fetal cardiac activity
Incomplete abortion
Some tissue passed or bleeding, but still some products of conception in uterus
Missed abortion
Fetal demise in uterus - but body has not expelled yet - risk of septic abortion
Options for miscarriage tx
Can wait and do nothing if stable and things progressing, can give misoprostol intravaginal , can complete surgery if unstable
Classic triad of ectopic pregnant
Pain, vaginal bleeding, adnexal mass
Ectopic risk factors
Hx of PID/STIs, previous gyne surgery, previous ectopic, smoking (abnormal tubal mobility), infertility, multiple sexual partners, IUD use, advanced maternal age
Heterotopic pregnancy
Both intrauterine, and ectopic, high risk in IVF - ask about fertility treatments
Management of ectopic
Methotrexate - need to be stable with, small sac
Surgical removal - if not
When give rhogam?
If Rh negative - and had a pregnancy - or miscarriage, rhogram lasts for about 3 weeks - don’t have to repeat dose if had it within then, at 28 weeks and then 72 hours delivery, traumatic injury during pregnancy with injury not limited to extremity
Hyperemesis gravidarum DX
5% Weight loss + N/V + ketonuria
Hyperemesis management
Try diclactin, gravol, Maxeran, then zofran
PID Tx
Ceftriaxone and Azithro - consider metronidazole, and follow up
Trauma with pregnant lady
Focus on mother - try to off-load IVC with wedge on the right side, try to clear C-Spine as soon as possible
Physiologic pregnancy and resuscitation
HR and RR increase, BP lower, BV is increased so may lose about 2L before showing
Physiologic WBC elevation, hyper coagulable, delayed gastric emptying - risk of aspiration, bladder is pushed up - more risk of trauma
Low reserve volume = fast desat when sedated
Painful vaginal bleeding post trauma
Concern for placental abruption - monitor for at least 4 hours
Some contractions that subside after a few hours is not uncommon after a trauma
Tests to order on a first trimester bleed?
CBC-D, type and screen, quantitive bHCG, urinalysis, US
Quant zone for being about to see gestational sac on US should be 1500
