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Clin med FINAL- sem 2 > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Infertility definition

A

No pregnancy after trying for 12m w normal sexual activity without conception

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2
Q

Infertility causes- females and males

A

Female

  • anovulation
  • endometriosis
  • fibroids
  • tubal factor
  • cervical factor

Male
Unexplained

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3
Q

Infertility labs and imaging

A 
History, PE
Semen analysis- sperm concentration, motility, and morphology
Chromosomal studies 
Monitoring of ovulation 
Hormone analysis
Studies of anatomy- hysterosalpingogram
Chromosomal studies
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4
Q

Infertility treatment

A

Assisted reproductive technologies (ART)

  • ovulation induction
  • insemination w sperm
  • in vitro fertilization
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5
Q

First tri bleeding causes

A 
Implantation into the endometrium
Abortion
Ectopic pregnancy
Molar gestation
Infection
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6
Q

Abortion definition

A

termination of pregnancy before 20 wks

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7
Q

Abortion types

A

Spontaneous abortion (SAB)

Therapeutic abortion (TAB)

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8
Q

Abortion symptoms

A

Vaginal bleeding (bright red)
Low back pain
Abdominal pain/cramping
Cervical dilation
Passage of products of conception
bHCG levels falling or not adequately rising
Abnormal US findings (empty gestational sac, lack of fetal growth or cardiac activity)

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9
Q

Abortion treatment

A

Suction curettage- safest and most effective for <12 wks

  • dilation of cervix by instruments
  • <1% risk for complications such as infection and uterine perforation
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10
Q

Complete abortion definition

A

All products of conception expelled before 20wks

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11
Q

Complete abortion cervical os

A

closed

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12
Q

Complete abortion labs and imaging

A

Serial HCG levels until 0

Products of conception- examined and sent for path lab

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13
Q

Complete abortion treatment

A

Observe until no further bleeding

If minimal- no further tx necessary

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14
Q

Inevitable abortion definition

A

Pregnancy cannot be saved

Products of conception not yet passed - poor prognosis

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15
Q

Inevitable abortion cervical os

A

dilated

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16
Q

Inevitable abortion symptoms

A

bleeding

mod to severe uterine cramping

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17
Q

Inevitable abortion treatment

A

D&C
Blood type and crossmatch
Rh status

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18
Q

Threatened abortion definition

A

Either: Possible pregnancy loss or can continue without problems
- unknown prognosis- better if bleeding and cramping resolved
No products of conception passed

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19
Q

Threatened abortion symptoms

A

Bleeding before 20 wks
May or may not have abdominal cramping
Uterine size compatible w dates

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20
Q

Threatened abortion cervical os

A

Cervical os closed

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21
Q

Threatened abortion - treatment

A

Pelvic rest

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22
Q

Incomplete abortion definition

A

Only some products of conception passed before 20 wks - prognosis is poor

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23
Q

Incomplete abortion symptoms

A

Mod to severe cramping

Heavy bleeding

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24
Q

Incomplete abortion cervical os

A

dilated

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25
Incomplete abortion- treatment
Surgical (D&C) Medical- ex methotrexate Expectant management- waiting
26
Missed abortion definition
Embryo is not viable prior to 20 weeks | Products of conception retained in uterus
27
Missed abortion cervical os
no dilation
28
Missed abortion symtoms
Cramping or bleeding
29
Missed abortion treatment
Surgical (D&C) Medical- ex methotrexate Expectant management- waiting
30
Septic abortion definition
Any embryonic or fetal demis with uterine infection | Retained products of conception or ascending infection- polymicrobial
31
Septic abortion- symptoms
``` Uterine bleeding Fever Abdominal pain Cervical motion tenderness Foul smelling discharge ```
32
Septic abortion labs and imaging
``` CBC- Increased leukocytes UA Endocervical cultures Blood cultures Abdominal x-ray to r/o uterine perforation US- to look for retained POCs ```
33
Septic abortion - treatment
Hospitalization and IV abx w anaerobic and aerobic coverage | D&C if retained POCs
34
Elective abortion - medically
- Mifepristone: inhibits progesterone receptors (needed for pregnancy) - Misoprostol: durg that induces uterine contractions and expulsion of POCs- alone or in combo - Methotrexate: stops fast growing cells, used in combo w misoprostol
35
Elective abortion - surgical
- Suction or surgical curettage | - Dilation and evacuation- 2nd tri abortions- up to 18wks
36
Recurrent pregnancy loss definition
3 or more consecutive SABs before 20 wks | Prognosis is good- 60% have chance of viable pregnancy
37
Recurrent pregnancy loss- causes
``` Genetic Auto immune Anatomic Endocrine Thrombophilic ```
38
Anembryonic pregnancy | "Blighted ovum" definition
Embryo fails to develop or is resorbed after loss of viability
39
Anembryonic pregnancy | "Blighted ovum"- symptoms
Similar to missed or threatened: - mild pain/bleeding - cervix closed - retained non-viable pregnancy (still in uterus)
40
Anembryonic pregnancy | "Blighted ovum" imaging
US- diagnosis- empty gestational sac w/o a fetal pole
41
Ectopic pregnancy - definition
Implantation of the uterus in any site other than the endometrial cavity- most commonly the fallopian tubes leading cause of pregnancy related death in 1st tri
42
Ectopic pregnancy complications
- tubal rupture - hemorrhagic shock - death
43
Ectopic pregnancy risk factors
``` Prior ectopic PID Smoking Anatomic abnormalities IUD ```
44
Ectopic pregnancy symptoms
``` Pain- pelvic or abdominal Abnormal uterine bleeding Amenorrhea Syncope Adnexal mass Uterine changes Hemodynamic instability- vital signs ```
45
Ectopic pregnancy labs and imaging
CBC- hemorrhage concern B-HCG- high Blood type/Rh status Pelvic US- no fetus in uterus Transvag US- should show intrauterine pregnancy at B-HCG level of 1500-2000 "discriminatory zone" Progesterone level- <5 not usually a viable pregnancy
46
Ectopic pregnancy treatment
Methotrexate- #1 - monitor LFTs and Cr - close follow up until B-HCG= 0 Surgical- laparoscopy - Salpingostomy- small incision in tube - Salpingectomy- part of tube removed Emergency - sx in ruptured ectopic, transfusion usually required No intercourse
47
Gestational trophoblastic disease definition
Group of pregnancy related tumor- rare Cells are called trophoblasts and come from tissue that is used to form the placenta Abnormal fertilization
48
Gestational trophoblastic disease symptoms
Uterine bleeding Absence of fetal heart tones and structures Rapid enlargement of uterus or uterine size greater than expected for gestational age Preeclampsia in 1st tri or early second tri may be pathognomonic for molar pregnancy
49
Gestational trophoblastic disease - labs
HCG titers greater than expected for gestational age
50
Hydatidiform mole- molar pregnancy
Molar pregnancy- benign neoplasm derived almost entirely from abnormal placental (trophoblastic) proliferation - may precede choriocarcinoma
51
Hydatidiform mole- complete
Contain no fetal tissue, diffuse trophoblastic proliferation, 46xx or 46xy
52
Hydatidiform mole- partial
Contains some fetal tissue, focal trophoblastic proliferation, 69xxx or 69xxy
53
Hydatidiform mole- molar mc in ?
early teens (<20yo) or perimenopausal (40)
54
Hydatidiform mole- molar symptoms
vaginal bleeding
55
Hydatidiform mole- labs and imaging complete
High BHCG bc trophoblastic neoplasms produce HCG Complete - BHCG >50,000, HIGH US- diagnostic Complete- hypoechoic areas= ""snowstorm"" pattern, normal gestational sac or fetus is not present, theca lutein cysts may be seen on ovaries
56
Hydatidiform mole- labs and imaging partial
High BHCG bc trophoblastic neoplasms produce HCG Partial - BHCG <50,000, slight elevation US- diagnostic Partial- focal areas of trophoblastic changes and fetal tissue may be noted, focal cystic changes in placenta= hallmark finding
57
Hydatidiform mole- labs and imaging grossly and microscopically
Analysis of tissue obtained from dilation & evacuation for histology and DNA content Grossly: - multiple grapelike vesicles filling and distending the uterus Microscopically: - edema of villous stroma, avascular villi, and nests of proliferating trophoblastic elements surrounding villi
58
Hydatidiform mole- molar pregnancy treatment
- Termination of molar pregnancy once confirmed - Evacuation w suction and curettage under general anesthesia - Tissue- pathologic evaluation - Prophylactic chemo- controversial - Surveillance- risk of malignant gestational trophoblastic disease - - serial HCG titers - Avoid pregnancy
59
Invasive mole definition
Invasion and/or perforation of the myometrium Locally destructive May have emboli to distant sites (brain, lung, etc)
60
Invasive mole complications
- uterine rupture from invasion of myometrium | - malignant choriocarcinoma
61
Invasive mole symptoms
vaginal bleeding
62
Invasive mole labs
persistent elevated HCG
63
Choriocarcinoma definition
Malignant tumor- usually of placenta Capable of widespread metastasis
64
Choriocarcinoma cause
Pre-existing molar pregnancy Retained placental cells after abortion Normal placenta after completion of a nl pregnancy Abnormal proliferation of cytotrophoblsatic and syncytiotrophoblastic cells (produce B-HCG), no chorionic villi
65
Choriocarcinoma treatment
Very sensitive to chemotherapy
66
Choriocarcinoma diagnosis
- rise in HCG of 10% or greater for >/= values over 2 wks - plateau in >/=4 HCG values over 3 successive wks - HCG levels elevated for 6m post evacuation or - tissue dx of choriocarcinoma

Clin med FINAL- sem 2 (5 decks)

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