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Endo Repro 2 > Preg 2 > Flashcards

Preg 2 Flashcards

1
Q

AMA has inc risk of __ in di/di twins

reserve __ only if abnormal results or US findings

Anatomy survey performed at __

Survey for __ and soft signs of ____

also examine ___

A

aneuploidy

amniocentesis

20 wks GA

structural malformations, fetal aneuploidy

cervical length

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2
Q

Placenta previa

placenta covers ___ of the cervix or extends close enough to ___ of cervix

causes __ when cervix dilates or ___ effaces

this occurs w advanced ___ or ___

usually seen around __ wks gestation, usually __

bleeding is ___

__ and extremes of ___ inc risk for ___

Majority have ___ around 28-30 wks

A

internal os, internal os

bleeding, lower uterine segment

GA, labor

10-20, resolves

painless

intercourse, activity, vaginal bleed

sentinel bleed

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3
Q 
RF for placenta previa
Previous \_\_\_
Multiple \_\_\_
Previous \_\_\_
M
Advanced \_\_
tx for \_\_\_
Previous \_\_\_
A 
placenta previa
gestation
C section
multiparity
maternal age
infertility
IU surgery
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4
Q

Placental abruption
Bleeding at the __ and ___ interface

leads to partial/complete ___ of placenta from ___ prior to delivery of fetus

occurs after ___ GA

if > __% of placenta separates, this leads to

Sx include ___ and ___

__ and/or ___ uterine tone

fetal heart status is ___

Assc w __ and ___ morbidity/mortality

Bleeding is ___ in origin
Fetal distress from loss of ___ and development of __

A

decidua/placental

separation, uterine wall

20wks

50%, fetal distress

vaginal bleeding, ab pain

contractions, excessive

non-reassuring

maternal/fetal

maternal
placental interface/hypoxia

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5
Q 
RF for placental abruption
Previous \_\_
T
P
C/S
P
Premature \_\_\_
A 
placental abruption
trauma
preeclampsia
cocaine/smoking
polyhydramnios
rupture of membranes
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6
Q

Patho Placentation (aka ___)

caused be defetive ___

thin, poorly formed, absent___

usually secondary to ___
scarring/damage of decidua enables ___ to attach directly to ___

RF
Prior __/ ____/ ____

A

placental accreta

decidualization

decidua

prev uterine surgery
placenta/myometrium

Csection/D&C/Myomectomy

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7
Q

Majority are __, attaching to the ___
some are ___, invading into the ___
less are ___, invading through __/__

Risk of accreta inc w ___ and prior ___

even more w ___

Sonographic markers
loss of __ of placenta
Inc ___, __ appearance

Thinning/loss of ___ layer bw uterine wall and ___ (decidua)

Loss of continuous ___ of bladder wall interface

H

A

accreta, myometrium
increta, myometrium
percreta, perimetrium/serosa

placenta previa, C section

2+ prior C section

homogeneity
lacuna, swiss cheese

hypoechoic, placenta

white line

hypervasc

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8
Q

Complications of placentation
Second trimester ___
Preterm ___/___
__ at time of delivery

Need for ___
need for ____
inc risk of D, A, S, R, D

A

vaginal bleeding
labor/delivery
hemorrhage

cesarean hysterectomy
blood transfusion
DIC, ARDS, Shock, RF, death

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9
Q

Vasa Previa
Unsupported __ overlying cervix

Assc w __

RF
\_\_ lobe of placenta
\_\_\_ cord insertion
Low lying \_\_
Multiple \_\_
I

Bleeding is ___, ___ of normal
Fetal __ and ___

Mx admit at ___ wks
need ___

A

fetal vessels

fetal mortality

succenturiate
velamentous
placenta
gestation
IVF

fetal blood

distress/demise

30-32 wks
preterm Csection

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10
Q

Succenturiate placenta

Results from focal areas of __ of chorion laeve

Lobes of __ connected by ___ of fetal origin

Bridging vessels w/out protection of ___
more prone to __/__/_

Bleeding is ___

A

non-involution

placenta, vasc bridges

Whartons jelly
tearing/shearing/compression

fetal

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11
Q

Velamentous cord insertion

Umbilical cord inserts into ___ instead of ___

Loss of __, lacks protecting/cushioning of __

more prone to __/__

bleeding is ___

A

amniotic membrane, placenta

wharton’s jelly, umbilical cord

compression/tearing

fetal

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12
Q

Marginal cord insertion

Insertion of ___ into __ of placenta

defined as ___ cm from edge

more common in ___
inc risk of __ and __ and __ and __

A

umbilical cord, margin

1-2cm

multiple gestations
IUGR, preterm delivery, preeclampsia, placenta previa

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13
Q

Placenta previa presents w
Mx modify ___, __ rest, __

Placenta accreta presentation: __ mid gestation
mx

Placental abruption presentation: __ vag bleeding and fetal ___
mx

Velamentous cord insertion present: growth ___, fetal __
mx: serial ___ and ___ testing

marginal cord insertion growth ___
mx w serial __

A

painless vag bleeding
activity, pelvic rest, Csection

spotting no warning
Preterm cesarean hysterectomy

painful, fetal distress
emergent delivert (vag/C)

growth abnorm, fetal distress
growth US, antenatal testing

growth abnorm
growth US

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14
Q

Class D meds have risk to __

such as __ and __

Most sensitive time for majority of organs is ___ period bw __ and __ wks

Ovum period: from __ to ___
___ sensitivity to teratogens
___ connections w maternal blood
Even after cell loss, conceptus can ___ development

Development of mainly ___ structures

Insult results in ___

A

fetus

lisinopril, Paxil

embryonic, 3-8 wks

fert to implant

limited
no direct
regain normal development

extra embryonic structures

miscarriage

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15
Q

Embryonic period from __ to __ wks

__ to teratogens
critical time for ___

fetal period from \_\_ to \_\_
\_\_ time
Morph effects on \_\_ and \_\_\_ and \_\_\_
\_\_\_ deficits
minor \_\_\_
\_\_ effects
A

2-8 wks
highly susceptible
organ develop

9wks, term
palate, teeth, external genitalia
fxnal
morph abnorm
growth
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16
Q 
Common teratogenic meds
A
A
A
B
C
C
C
D
A 
aminopterin
androgenic hormones
ace inhibitors
busulfan
carbamazepine
chlorbiphenyls
cyclophosphamide
DES
17
Q 
Common teratogenic meds
I
I
L
M
P
P
T
T
V
W
A 
isotretinoin
Iodide
Li
Misoprostol
Phenobarbital
Phenytoin
Tetracycline
Trimethadione
Valproic acid
Warfarin
18
Q

Majority of ___ cause birth defects

worst w

inc risk for __, ___, ___

high risk w __ rather than ___

Each drug has __

A

anticonvulsants

valproic acid

IUGR, major malformations, cog defects

polytherapy, monotherapy

different effects

19
Q

__ is worse than AED therapy

Can lead to __ and __/___ hypoxia, eventually __ and ___

do not take pt off ___ when preg

refer to
try to get ___
continually __ pt

A

Seizure

trauma, maternal/fetal, morbid/mortal

AED

neuro
monotherapy
educate

20
Q

ACE inhibitors
First trimester exposure has small risk of ___
CV such as ___ adn __
CNS such as __ and __

Second trimester can impair fetal/neonate ___ fxn
Can lead to __ and __ and ___

Cord compression leads to ___ and ___
Other sx ___ and ___

A

congenital malformations
ASD/VSD
spina bifida/microcephaly

RF
oliguria/anuria/RF

fetal distress/demise
pulm hypoplasia, arthrogryposis

21
Q 
Warfarin effects 
\_\_ hypoplasia
Shortened \_\_\_
Stippling of \_\_\_\_
\_\_ and \_\_ effects
Vulnerable period is \_\_ and \_\_ wks gestation

Thalidomide bw 38-50 LMP
can cause bilateral __ and __ defects
__ more than ___
CHD such as ___

DES can cause abnorm of ___
uterine malform include __ or ___
Adenocarcinoma of __ or ___

A 
nose
distal phalanges
epiphyses
cog/growth
6-9th

limb/limb girdle
UE, LE
conotruncal defect

cervix/vagina
T shaped/uterine hypoplasia
vagina/cervix

22
Q

SSRIs inc __ admissions
can cause ___ of newborn

Paxil inc risk of __ and __ and ___ when used 1st trimester

Isotretinoin
Risk of \_\_\_
Major malfomation of \_\_/\_\_\_/\_\_\_/\_\_
\_\_\_ palsies
\_\_ dysfxn
Vulnerable period \_\_\_
A

NICU
Persistent pHTN

omphalocele, craniosynostosis, CHD

preg loss
brain/ear/heart/facial defects
CN 7
cog
1st trimester
23
Q

Gestational DM- begins/recog during __ and assc w inc __/__/__ risks

__ of DM in preg
many women w GDM develop ___

RF
Previous preg w 
FH of \_\_
O
M
Age > 
P
M
Previous 
Previous unexplained
A

preg, maternal/fetal/neonatal

majority
T2DM

GDM
DM
obesity
multiple gestation
25
PCOS
metabolic syndrome
macrosomic infant
perinatal loss
24
Q

Placenta secretes ___ hormones
such as __/__/__/__

Alters maternal ___ to ensure fetus has __ of nutrients

inc maternal ___
dec maternal ___

Maternal comps H, C, O, M

Fetal comps M. O, S
M/H, R, S, M, H, H, H, P

A

diabetogenic
hPL, CRH, GH, P

glucose metab, ample supply

insulin resistance
insulin sens

HTN disorder, Csection, operative delivery, maternal trauma

Macrosomia, operative deliv, shoulder dystocia/trauma, Met/Heme do, RDS, shock, Met syndrome, hypoGly, hyperBilirubin, hypoCa, Polycythemia

25
Q 
Manage GDM
D/E
Log \_\_ and \_\_ and \_\_
I
\_\_ meds

Goal is ___

A

diet/exercise
food, BG, meds
insulin
oral hypoglycemics

euglycemia

26
Q

HTN do of pregnancy characterized by BP >

chronic HTN- hx of __ prior to preg or manifesting < __ wks gestation

chronic HTN w superimposed ___- hx of __ prior to preg/<20 wks GA with new onset ___ or worsening ___/___

Gestational HTN- new onset elevated BP after ___ w/out __ or ___

Preeclampsia- new onset SBP > or DBP > __ on 2 occasions __ apart after 20 wks w
Proteinuria > ___ g in 24hr urine sample or __/__ ratio > __ g or dipstick >___

A

140/90

elevated BP, 20wks

preeclampsia, elevated BP, proteinuria, proteinuria/BP control

20wks GA, proteinuria/other features

140, 90, 4hrs

.3g, protein/creatinine, .3, 1

27
Q

Preeclampsia w severe features
BP > ___ w/wout ___ but w __

BP > ___ w ___ or w severe features

Severe features include
H or V 
A\_\_ or \_\_ pain
P
Platelets < \_\_\_
Elevated \_\_ usually 2x normal
Elevated \_\_\_ to 1.1 or 2x \_\_
A

140/90, proteinuria, severe features

160/110, proteinuria

headache, vis sx
ab, RUQ
pulm edema
100,000
LFT
serum creatinine, patient normal
28
Q

Preeclampsia usually due to impaired ___, or abnormal ___
possibly ___ or ___ dysfxn

CM probably due to ___ of target organs, including B, L, K, P

Maternal Comps of preeclampsia
S
A
T
P
C
L
R
D
A

trophoblast invasion, troph differentiation
placental ischemia, systemic endothelial cell

microangiopathy
Brain, liver, kidney, placenta

seizure
abruption
thrombocytopenia
pulm edema
cerebral hemorrhage
liver hemorrhage
RF
death
29
Q

Fetal comps of preeclampsia
P
I
Fetal __/___

Tx is __
Timing of delivery is a balance bw __ at dx and risk of __ to infant and __ of mother

___ given for seizure proph
BP controlled w ___ safe in preg

A

premature
IUGR
distress/demise

delivery
GA, prematurity, worsening dz

Mg sulfate
antiHTN

30
Q

Post partum hemorrhage
After ___ >500 ml
after ___ >1L

RF
U
including M, P, M
Gestational \_\_\_/\_\_
Placental \_\_\_/\_\_
Prior \_\_\_
A

vaginal delivery
C section

uterine distension
multiples, polyhydramnios, macrosomia
HTN, Preeclampsia
previa/accreta
PP hemorrhage

Endo Repro 2 (24 decks)

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