Preconception Counseling, Infertility, Abortion- Paulson Flashcards
What is the purpose of prenatal care and why is it important?
Purpose is to have a successful pregnancy and mothers receiving prenatal care have lower risk of complications
Is marajuana safe to use in pregancy?
No
What is an important question to consider in preconception counseling?
Discuss a patient’s desire to become pregnant and when
All patients thinking about becoming pregnant should take what?
Folic acid supplements because it may be beneficial in reducing neural tube defects and cardiac anomalies
Are pregnant women able to get live vaccines?
No so it is good to get them done during preconception counseling
Organ development occurs at approx what part of gestational age?
3-10 weeks so in the first trimester
________ is defined as no pregnancy after trying for 12 months with normal sexual activity without contraception
Infertility
Can try IVF in this case
Due date is calculated how?
40 weeks from the first day of the last LMP
What are some common things to expect when pregnant?
- Thyroid issues
- Gerd, constipation, gallstones
- N/V throughout the day
- Decreased BP and inc HR which is why women shouldn’t lay flat on back at night
- Anemia
Supplemental _____ is encouraged during pregnancy because of anemia during pregnancy
iron
What are some cardiac manifestations of being pregnant?
increased CO, lower BP, inc HR, increased venous pressure in lower extremities from compression of IVC by uterus
What are some hematologic manifestations of pregnancy?
-Anemia and hypercoag state (DVT, PE)
Renal manifestations of pregnancy?
-Increased size and increased GFR
Respiratory manifestations of pregnancy?
Increase in tidal volume, inc in inspiratory capacity
Derm manifestations of pregnancy?
Spider angiomas and hyperpigmentation (melasma)
_______ refers to termination of pregnancy before 20 wks
Abortion (spontaneous or therapeutic)
A patient comes in complaining of bright red vaginal bleeding, low back pain and a bHCG level that is falling or not adequately rising. WHat should we be concerned about?
Abortion
This is when all products of conception are expelled before 20 weeks, cervical os is closed.
Complete abortion
This is whsen a pregnancy can not be saved and the treatment is D&C
inevitable abortion
What is the tx for threatened abortion?
Recommended pelvic rest
What is a threatened abortion? And what constitutes a good prognosis?
Possible pregnancy loss
*less cramping/pain have better outcomes typically
This is when only some products of conception are passed before 20 weeks
Incomplete abortion
What is the tx for incomplete abortion?
D& C, methotrexate, expectant management
This is when the embryo is not viable prior to 20 weeks and products of conception are retained in the uterus
Missed abortion
Tx for missed abortion?
D& C, methotrexate, expectant management
A patient presents with uterine bleeding, fever, increased leukocytosis, abdominal pain and foul smelling d/c. She is pregnant. What might this be and what is the best way to dx it?
septic abortion: where the fetus hasn’t survived and there’s also an infection
Abdominal X-ray, U/S and labs
Treatment for septic abortion?
Hospitalization and broad spectrum IV abx. May need D& C for retained POCs (products of conception).
What are three drugs used in elective first trimester abortions?
The three M’s (mmm…. abortion)
-Mifepristone, misoprostol, methotrexate
How to do an elective abortion in the 2nd trimester?
Dilation and evacuation
What is the safest and most effective method for terminating pregnancy of 12 weeks gestation or less?
Suction cutterage
This is when there are 3 or more consecutive spontaneous abortions before 20 weeks
recurrent pregnancy loss
Previously called a “blighted ovum” and when an embryo fails to develop or is resorbed after loss of viability?
Anembryonic pregnancy
How is an Anembryonic pregnancy diagnosed?
U/S will show empty gestational sac w/o a fetal pole
This is the leading cause of pregnancy related death in the first trimester?
Ectopic pregnancy
Where is the mc site of ectopic pregnancy?
Fallopian tubes
These are symptoms of what?
Pain, bleeding, amenorrhea, syncope
Ectopic pregnancy
What imaging should you do for an ectopic pregnancy and what should the bHCG level be at?
Transabdominal U/S and bHCG <1500
What is the tx of choice for ending early ectopic pregnancy?
Methotrexate 500 mg IM
What is the second line tx for ending early ectopic pregnancy?
Surgical-Labroscopy
Snowstorm pattern
Gestational Throphoblastic disease
This is an umbrella term for a group of pregnancy related tumors
Gestational trophoblastic tumors
Preeclampsia in the first or early second trimester may be pathognomonic for what?
Molar pregnancy
A patient presents with uterine bleeding in the first trimester, rapid enlargement of the uterus and HCG titers greater than expected for gestational age. What condition should we think about?
Gestational Throphoblastic disease
This is a benign neoplasm derived almost entirely from abnormal placental proliferation?
Hydatidiform mole (AKA molar pregnancy)
What is a complete Hydatidiform mole?
Contains no fetal tissue and bHCG >50,000
What is a partial Hydatidiform mole?
Contains some fetal tissue and bHCG <50,000
What is the dx of choice for Hydatidiform mole?
U/S
“snowstorm pattern” is described for _____ mole
complete hydatidiform mole
Cystic changes in the placenta are a hallmark finding of _______ mole
partial hydatidiform mole
This is characterized by multiple grapelike vesicles filling and distending the uterus
hydatidiform mole
What is the treatment for a molar pregnancy?
suction and cutterage under GA
- submit path
- prophylactic chemotherapy
What could be indicative of a malignancy after a molar pregnancy?
bHCG rise
-So we want to watch this closely to see if levels rise
This is a malignant tumor usually of the placenta? What is the prognosis?
Choriocarcinoma - high cure rate
**Look for rise in bHCG
What is the tx for choriocarcinoma?
Chemotherapy
