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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
Septic Abortion- labs & imaging
``` Inc luekocytes CBC UA Endocerviacl cultures Blood cultures Abdominal xray U/S - retained POC ```
26
Septic Abortion- treatment
Hosp and IV abx - anaerobic and aerobic cover D&C - POC
27
Elective Abortion- S/S & PE
Missed period
28
Elective Abortion- treatment
``` 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
Anembryonic Pregnancy- pathophysiology
"Blighted Ovum" Embryo fails to develop or resorbed after loss of viability
30
Anembryonic Pregnancy- S/S & PE
Mild pain/bleeding Cervix closed Retained non-viable pregnancy
31
Anembryonic Pregnancy- diagnosis
U/S - empty gestational sac seen w/o a fetal pole
32
Ectopic Pregnancy- pathophysiology
Implantation of fetus in any site other than endometrial vacity - fallopian tubes - most common
33
Ectopic Pregnancy- epidemiology
``` Prior ectopic PID Smoking Anatomic abnormalities IUD ```
34
Ectopic Pregnancy- S/S & PE
Pain - pelvic or abdominal pain Bleeding - abnormal uterine bleeding Amenorrhea Syncope PE: - Adnexal mass - Uterine changes - Hemodynamic instability - hypotensive
35
Ectopic Pregnancy- labs & imaging
CBC B-HCG Blood type/Rh Pelvic U/S Transvaginal US - intrauterine pregnancy at 1500-2000 bHCG Progesterone - <5 - not viable pregnancy
36
Ectopic Pregnancy- treatment
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
Ectopic Pregnancy- prognosis
Complications - tubabl rupture - hemorrhagic shock - death Leading cause of pregnancy dead in first trimester
38
Gestational Trophoblastic Disease- pathophysiology
Group of pregnancy related tumors Rare Abnormal fertilization
39
Gestational Trophoblastic Disease- cause
Trophoblast cells from placenta
40
Gestational Trophoblastic Disease- epidemiology
Women of child-bearing age
41
Gestational Trophoblastic Disease- S/S & PE
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
Gestational Trophoblastic Disease- labs & imaging
bHCG - higher than expected for gestational age
43
Hydatidiform Mole- pathophysiology
Molar Pregnancy Benign neoplasm - placental trophoblastic proliferation
44
Hydatidiform Mole- epidemiology
<20 yo | Perimenopausal - 40yo
45
Hydatidiform Mole- S/S & PE
Vaginal bleeding Complete - no fetal tissue - diffuse trophoblastic proliferation Partial - some fetal tissue - focal trophoblastic proliferation
46
Hydatidiform Mole- diagnosis
"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
Hydatidiform Mole- labs & imaging
Complete bHCG - >50k 46xx or 46XY Partial bHCG <50k 69XX or 69XXY
48
Hydatidiform Mole- treatment
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
Invasive Mole-pathophysiology
Invasion/perf of myometrium | Locally destructive
50
Invasive Mole- S/S & PE
Vaginal bleeding | Emboli - brain, lungs
51
Invasive Mole- labs & imaging
bHCG - persistent inc
52
Invasive Mole- prognosis
Complication - uterine rupture from invasion of myometrium Go on to become choriocarcinoma
53
Choriocarcinoma-pathophysiology
Malignant tumor - placenta Abnormal proliferation of cytotrophoblastic and syncytiotrophoblastic cells - produce bHCG - no chorionic villi
54
Choriocarcinoma- cause
50% - pre-existing molar pregnancy 25% - retained placental cells after abortion 25% - nl placenta after completion of nl pregnancy
55
Choriocarcinoma- S/S & PE
Possible widespread mets
56
Choriocarcinoma- diagnosis
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
Choriocarcinoma- treatment
Chemo - very sensitive | - high cure rate

Clin med sem 2 (30 decks)

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