Paulson - Preconception Counseling, Infertility, Abortion, and Maternal-Fetal Physiology Flashcards by Alice Richards

complications that increase morbidity/mortality to mother and/or fetus occur in __% of pregnancies

5-20

How well did you know this?

Not at all

Perfectly

what does preconception counseling include

likelihood of pregnancy in ALL reproductive age women

desire to become pregnant AND when

contraception

quit smoking

healthy weight and diet

limit etoh

review meds

infectious dz

genetic screening options

partner violence

travel hx

ask about drug use

How well did you know this?

Not at all

Perfectly

is marijuana safe in pregnancy

How well did you know this?

Not at all

Perfectly

are varicella/rubella vaccines safe in pregnancy

no →

live vaccines are not safe

How well did you know this?

Not at all

Perfectly

2 vaccines that are safe in pregnancy

pertussis

hep B

How well did you know this?

Not at all

Perfectly

infertility is defined as no pregnancy after __ months of trying w. normal sexual activity w.o contraception

How well did you know this?

Not at all

Perfectly

risk for infertility increases at what age

35 yo

How well did you know this?

Not at all

Perfectly

what is ART

assisted reproductive technologies

How well did you know this?

Not at all

Perfectly

3 types of ART

ovulation induction

insemination w. sperm

in vitro fertilization

How well did you know this?

Not at all

Perfectly

3 types of infertility

female

male

unexplained

How well did you know this?

Not at all

Perfectly

5 causes of female infertility

anovulation

endometriosis

fibroids

tubal factor

cervical factor

How well did you know this?

Not at all

Perfectly

work up for male infertility should include (4)

semen analysis

chromosomal studies

How well did you know this?

Not at all

Perfectly

what might you see on hx for male infertility (6)

sexual dysfxn

etoh/drug use

STDs

cryptochordism/orchiectomy/mumps

neurologic dz

How well did you know this?

Not at all

Perfectly

what might you find on PE for male w. infertility

varicocele

absence of vas deferens

systemic illness

How well did you know this?

Not at all

Perfectly

semen analysis includes (3)

concentration

motility

morphology

How well did you know this?

Not at all

Perfectly

female infertility work up includes (5)

hx/PE

ovulation monitoring

hormone analysis

hysterosalpingogram

chromosomal studies

How well did you know this?

Not at all

Perfectly

cardiac changes associated w. pregnancy (4)

increased CO

lower BP

increased HR

increased venous pressure in LE

How well did you know this?

Not at all

Perfectly

HR in pregnant women increases by ~__ over the course of pregnancy

15 beats/min

How well did you know this?

Not at all

Perfectly

heme changes associated w. pregnancy (5)

50% increased plasma volume

20-30% RBC increase

WBC increase

decreased platelets

hypercoaguable state

How well did you know this?

Not at all

Perfectly

GI changes associated w. pregnancy

n/v

GERD

constipation

delayed gallbladder emptying

How well did you know this?

Not at all

Perfectly

endocrine changes associated w. pregnancy (2)

increased estrogen and thyroid activity

How well did you know this?

Not at all

Perfectly

renal changes associated w. pregnancy

kidneys enlarge

GFR increases

How well did you know this?

Not at all

Perfectly

pulmonary changes associated w. pregnancy

increased tidal volume and inspiratory capacity

How well did you know this?

Not at all

Perfectly

derm changes associated w. pregnancy

spider angiomas and palmar erythema

hyperpigmentation: nipples, umbilicus, linea nigra, melasma/cholasma

How well did you know this?

Not at all

Perfectly

\_\_% of women experience first trimester bleeding

5 causes of first trimester bleeding

implantation into endometrium abortion ectopic pregnancy molar gestation infxn

termination of pregnancy before 20 weeks

abortion

2 types of abortion

spontaneous (SAB) therapeutic (TAB)

sx of abortion (5)

bright red bleeding low back pain abd pain/cramps cervical dilation passage of conception products

lab/imaging findings associated w. abortion

**bHCG** levels falling/inadequately rising **US**: empty gestational sac/lack of cardiac activity/growth

all products of conception expelled before 20 weeks cervical os closed

complete abortion

management of complete abortion

obs for bleeding monitor HCG send conception products to path

pregnancy can not be saved cervical os dilated products of conception NOT passed

inevitable abortion

inevitable abortion has a __ prognosis, and management includes (3)

poor D&C, type and screen, Rh

possible pregnancy loss no products of conception passed cervical os closed pregnancy can continue w.o further problems

threatened abortion

management of threatened abortion

pelvic rest

some products of conception passed cervical os dilated heavy bleeding

incomplete abortion

management options for incomplete abortion

D&C medical or expectant management

embryo not viable prior to 20 weeks products of conception retained in uterus no cervical dilation +/- bleeding

missed abortion

management of missed abortion

D&C medical or expectant management

any embryonic or fetal demise w. uterine infxn

septic abortion

sx of septic abortion

uterine bleeding fever increased leukocytes abd pain cervical motion tenderness foul smelling d.c

septic abortion is usually caused by

retained products of conception ascending polymicrobial infxn

dx for septic abortion

CBC UA endocervical cultures/blood cultures abd xray US

xray for septic abortion rules out

uterine perforation

US for septic abortion rules out

retained products of conception (POC)

tx for septic abortion

admit + IV broad spectrum abx +/- D&C if retained POC

work up for elective abortion must include

complete social and medical hx PE

what does PE include for elective abortion

uterine size/position

3 meds used for elective abortion

mifepristone misoprostol methotrexate

which elective abortion med inhibits progesterone

mifepristone

which elective abortion med induces uterine contractions

misoprostol

which elective abortion med stops fast growing cells

methotrexate

methotrexate must be used in combo w.

misoprostol

surgical options for elective abortion

suction or surgical curretage dilation and evacuation

which surgical option would you use for elective abortion in a second trimester pregnancy

dilation and evacuation

mc, safest, and most effective method for terminating pregnancy of 12 weeks or less

suction curretage

3 or more SABs before 20 weeks

recurrent pregnancy loss

5 possible causes for recurrent pregnancy loss

genetic AI anatomic endocrine thrombophilic

does recurrent pregnancy loss indicate low chance for successful pregnancy

no → ~60% have viable pregnancy

embryo fails to develop or is reabsorbed after loss of viability same-same “blighted ovum”

anembryonic pregnancy

dx for anembryonic pregnancy

**US** showing empty gestational sac w.o fetal pole

sx of anembryonic pregnancy

mild pain/bleeding cervix closed retained non-viable pregnancy

sx of anembryonic pregnancy

mild pain/bleeding cervix closed retained non-viable pregnancy

2 gestational disorders

ectopic pregnancy gestational trophoblastic dz/dz of trophoblastic tissue

gestational trophoblastic dz/dz of trophoblastic tissue includes (3)

hydatidiform mole invasive mole choriocarcinoma

hydatidiform mole can be (2)

complete partial

implantation of the fetus in any site other than the endometrial cavity

ectopic pregnancy

mc site of ectopic pregnancy

fallopian tubes → 95%

rf for ectopic pregnancy (5)

prior ectopic PID smoking anatomic abnormalities IUD

3 complications of ectopic pregnancy

tubal rupture hemorrhagic shock death

leading cause of pregnancy related deaths in first trimester

ectopic pregnancy

what do you think when you see: adnexal mass, uterine changes, hemodynamic instability/vitals

ectopic pregnancy

nearly 100% of ectopic pregnancies are associated w.

pelvic or abd pain

other sx of ectopic pregnancy

amenorrhea syncope

labs to order for ectopic pregnancy dx (3)

CBC bHCG type and screen/Rh +/- progesterone

intrauterine pregnancy at beta HCG level of 1500-2000

transvaginal US findings associated w. ectopic pregnancy

what is the discriminatory zone

bHCG levels 1500-2000

the discriminatory zone for bhcg refers to

the point at which a gestational sac can be visualized

progesterone \< __ suggests non viable pregnancy

first line pharm for ectopic pregnancy

methotrexate

what labs need to be monitored w. methotrexate

LFTs Cr close f.u up bHCG

what level should bHCG be after MTX tx

s.e of MTX

abd pain bleeding n/v

sx of tubal rupture and need for emergent care for pt on MTX

severe pain dizziness syncope

2 surgical options for ectopic pregnancy

salpingostomy salpingectomy

group of rare pregnancy related tumors

gestational trophoblastic dz

sx of gestational trophoblastic dz

abnormal fertilization absence of fetal heart tones/structures HCG higher than expected for gestational age rapid enlargement of uterus

what do you think when you see preeclampsia in first trimester or early second trimester

molar pregnancy *may be pathognomonic*

benign neoplasm derived almost entirely from abnormal placental (trophoblastic) proliferation

hypatidiform mole → molar pregnancy

neoplasm contains no fetal tissue diffuse trophoblastic proliferation 46xx or 46xy BHCG \> 50,000

complete molar pregnancy

neoplasm contains some fetal tissue focal trophoblastic proliferation 69xxx OR 69xxy BCHG \< 50,000

partial molar pregnancy

molar pregnancy is mc in what pt populations

early teens perimenopausal

molar pregnancy may precede

choriocarcinoma

dx for hypatidiform mole (molar pregnancy)

labs hypatidiform mole (molar pregnancy)

BHCG

snowstorm pattern normal gestational sac/fetus not present +/- theca lutein cysts

US findings for complete molar pregnancy

focal areas of trophoblastic changes +/- fetal tissue **focal cystic changes in the placenta**

partial molar pregnancy

hallmark US finding for partial molar pregnancy

focal cystic changes in placenta

multiple grapelike vesicles filling and distending the uterus edema of villous stroma, avascular villi, nests of proliferating trophoblastic elements

histology findings from dilation and evacuation of molar pregnancy

tx for confirmed molar pregnancy

suction and curretage pathologic evaluation of tissue +/- prophylactic chemo surveillance w. HCG labs

invasion and/or perforation of myometrium locally destructive +/- emboli to distant sites persistent elevated HCG

invasive mole

complication of invasive mole

uterine rupture malignant choriocarcinoma

malignant tumor, usually of the placenta abnormal proliferation of cytotrophoblastic and syncytiotrophoblastic cells that produce BHCG

choriocarcinoma

choriocarcioma arises from: 50%: 50%:

pre-existing molar pregnancy retained placental cells post abortion or placenta retention after normal pregnancy

choriocarcinoma is very sensitive to \_\_ and has a __ prognosis

chemo good

choriocarcinoma may be diagnosed in the setting of (4)

1. rise in HCG of 10% or more for 3 or more values over 2 weeks 2. plateau in 4 or more HCG values over 3 weeks 3. HCG levels elevated at 6 mo post evacuation 4. tissue dx