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Clin med sem 2 > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

First Trimester Bleeding- pathophysiology

A

App 25% bleed in 1st trimester

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2
Q

First Trimester Bleeding- cause

A 
Implantation into endometrium
Abortion
Ectopic Prego
Molar gestation
Infection
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3
Q

Abortion- pathophysiology

A

Termination or pregnancy before 20 weeks

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4
Q

Abortion- cause

A

Spontaneous (SAB)

Therapeutic (TAB)

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5
Q

Abortion- S/S & PE

A 
Vaginal bleeding - bright red
Low back pain
Abdominal pain/cramping
Cervical dilation
Passage of products of conception 
bHCG dec or not rising 
Abnormal U/S - empty gestational sac, lack of fetal growth, no CV activity
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6
Q

Complete abortion- pathophysiology

A

All products of conception expelled before 20w

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7
Q

Complete abortion- labs & imaging

A

HCG levels

Products of conception - sent to path

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8
Q

Complete abortion- treatment

A

Observe for further bleeding

- if minimal - no further tx needed

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9
Q

Inevitable abortion- pathophysiology

A

Pregnancy cannot be saved

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10
Q

Inevitable abortion- S/S & PE

A

Products of conception not yet passed
Bleeding
Mod/severe uterine cramping
Cervical os - dilated

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11
Q

Inevitable abortion- treatment

A

D&C
Blood type, cross and match
- high risk for bleeding, will need blood products
Rh status

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12
Q

Inevitable abortion- prognosis

A

Poor

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13
Q

Threatened Abortion- pathophysiology

A

Possible Pregnancy Loss

- can continue w/out further probs

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14
Q

Threatened Abortion- S/S & PE

A 
No product of conception passed
Bleeding before 20w
\+/- abdominal cramping/pain
Uterine size compatible w/ dates
Cervical os - closed
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15
Q

Threatened Abortion- treatment

A

Pelvic rest

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16
Q

Incomplete Abortion - S/S & PE

A

Only some products of conception are passed - <20w
Heavy bleeding
Mod/severe cramping
Cervical os - dilated

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17
Q

Incomplete Abortion- treatment

A

Surgery - D&C
Medical - methrotrexate
Expectant management - watchful waiting

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18
Q

Incomplete Abortion- prognosis

A

Poor

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19
Q

Missed abortion- pathophysiology

A

Embryo not viable <20w

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20
Q

Missed abortion- S/S & PE

A

Product of conception retained in uterus
Cramping or bleeding
No cervical dilation

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21
Q

Missed abortion- treatment

A

Surgery - D&C
Medical
Expectant management

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22
Q

Septic Abortion- pathophysiology

A

Embryonic or fetal demis w/ uterine infection

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23
Q

Septic Abortion- cause

A

Retained products of conception or ascending infection

Polymicrobial

24
Q

Septic Abortion- S/S & PE

A 
Bleeding
Fever
Abdominal pain
CMT
Foul smelling discharge
25
Q

Septic Abortion- labs & imaging

A 
Inc luekocytes
CBC
UA
Endocerviacl cultures
Blood cultures
Abdominal xray 
U/S - retained POC
26
Q

Septic Abortion- treatment

A

Hosp and IV abx
- anaerobic and aerobic cover
D&C - POC

27
Q

Elective Abortion- S/S & PE

A

Missed period

28
Q

Elective Abortion- treatment

A 
PO:
Mifepristone - RU486 
- inhibits progesterone receptors 
Misoprostol - induces uterine contractions and expulsion of POC
- used alone or in combo
Methotrexate - stops fast growing cells
- combo w/ misoprostol 
Surgery:
Surgical urrettage
Suction Curettage
- Safest and most effective - <12w
- Dilation of cervix by instruments 
- low failure rate
-<1% risk of complications 
Dilation and evaculation
- more common 2nd tri
- <18w output
29
Q

Anembryonic Pregnancy- pathophysiology

A

“Blighted Ovum”

Embryo fails to develop or resorbed after loss of viability

30
Q

Anembryonic Pregnancy- S/S & PE

A

Mild pain/bleeding
Cervix closed
Retained non-viable pregnancy

31
Q

Anembryonic Pregnancy- diagnosis

A

U/S - empty gestational sac seen w/o a fetal pole

32
Q

Ectopic Pregnancy- pathophysiology

A

Implantation of fetus in any site other than endometrial vacity
- fallopian tubes - most common

33
Q

Ectopic Pregnancy- epidemiology

A 
Prior ectopic
PID
Smoking
Anatomic abnormalities
IUD
34
Q

Ectopic Pregnancy- S/S & PE

A

Pain - pelvic or abdominal pain
Bleeding - abnormal uterine bleeding
Amenorrhea
Syncope

PE:

  • Adnexal mass
  • Uterine changes
  • Hemodynamic instability - hypotensive
35
Q

Ectopic Pregnancy- labs & imaging

A

CBC
B-HCG
Blood type/Rh
Pelvic U/S

Transvaginal US - intrauterine pregnancy at 1500-2000 bHCG

Progesterone - <5 - not viable pregnancy

36
Q

Ectopic Pregnancy- treatment

A

1st line - Methotrexate

  • 50mg IM
  • monitor LFTs and Cr
  • follow bHCG until 0
  • SE - abdominal pain, bleeding, N/V
  • return to ED if severe pain, dizziness, syncope

Surger - laparoscopy

  • salpingostomy - small incision in tube
  • salpingectomy - part of tube removed

Emergency - suruger, transfusion

No intercourse

37
Q

Ectopic Pregnancy- prognosis

A

Complications

  • tubabl rupture
  • hemorrhagic shock
  • death

Leading cause of pregnancy dead in first trimester

38
Q

Gestational Trophoblastic Disease- pathophysiology

A

Group of pregnancy related tumors
Rare
Abnormal fertilization

39
Q

Gestational Trophoblastic Disease- cause

A

Trophoblast cells from placenta

40
Q

Gestational Trophoblastic Disease- epidemiology

A

Women of child-bearing age

41
Q

Gestational Trophoblastic Disease- S/S & PE

A

Uterine bleeding - 1st tri
Absence of fetal heart tones and structure
Rapid enlargement of uterus or uterine size greater than expected age

Preeclampsia in 1st tri or early 2nd tri - pathognomonic

42
Q

Gestational Trophoblastic Disease- labs & imaging

A

bHCG - higher than expected for gestational age

43
Q

Hydatidiform Mole- pathophysiology

A

Molar Pregnancy

Benign neoplasm - placental trophoblastic proliferation

44
Q

Hydatidiform Mole- epidemiology

A

<20 yo

Perimenopausal - 40yo

45
Q

Hydatidiform Mole- S/S & PE

A

Vaginal bleeding

Complete - no fetal tissue
- diffuse trophoblastic proliferation

Partial - some fetal tissue
- focal trophoblastic proliferation

46
Q

Hydatidiform Mole- diagnosis

A

“U/S:
Complete - snowstorm patter, nl gestation sac or fetus not present, theca lutein cysts
Partial - focal areas of trophoblastic changes and fetal tissues may be noted, focal cystic changes in placenta

Analysis of tissue - histology and DNA contents

  • Grossly - multiple grapelike vesicles filling and distending uterus
  • microscopy - edema of villous stroma, avascular villi, nests of prelerating trophoblastic elements surroudning villi
47
Q

Hydatidiform Mole- labs & imaging

A

Complete
bHCG - >50k
46xx or 46XY

Partial
bHCG <50k
69XX or 69XXY

48
Q

Hydatidiform Mole- treatment

A

Termination - evacuation w/ suction and curettage under general anesthesia
Prophylactic chemo - controversial
Surveillance - risk of malignancy - 20-30%
- monitor: bHCG 48hr-> weekly until <5
- if rise noted - monitor for 6m

Avoid pregnancy

49
Q

Invasive Mole-pathophysiology

A

Invasion/perf of myometrium

Locally destructive

50
Q

Invasive Mole- S/S & PE

A

Vaginal bleeding

Emboli - brain, lungs

51
Q

Invasive Mole- labs & imaging

A

bHCG - persistent inc

52
Q

Invasive Mole- prognosis

A

Complication - uterine rupture from invasion of myometrium

Go on to become choriocarcinoma

53
Q

Choriocarcinoma-pathophysiology

A

Malignant tumor - placenta

Abnormal proliferation of cytotrophoblastic and syncytiotrophoblastic cells

  • produce bHCG
  • no chorionic villi
54
Q

Choriocarcinoma- cause

A

50% - pre-existing molar pregnancy
25% - retained placental cells after abortion
25% - nl placenta after completion of nl pregnancy

55
Q

Choriocarcinoma- S/S & PE

A

Possible widespread mets

56
Q

Choriocarcinoma- diagnosis

A
  1. Rise in HCG >10% or >3 from baseline over 2 weeks
  2. Plateau >4hCG values over 3w
  3. hCG levels inc at 6m post evacuation
  4. tissue diagnosis
57
Q

Choriocarcinoma- treatment

A

Chemo - very sensitive

- high cure rate

Clin med sem 2 (30 decks)

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