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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
Q

Incomplete abortion- treatment

A

Surgical (D&C)
Medical- ex methotrexate
Expectant management- waiting

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26
Q

Missed abortion definition

A

Embryo is not viable prior to 20 weeks

Products of conception retained in uterus

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27
Q

Missed abortion cervical os

A

no dilation

28
Q

Missed abortion symtoms

A

Cramping or bleeding

29
Q

Missed abortion treatment

A

Surgical (D&C)
Medical- ex methotrexate
Expectant management- waiting

30
Q

Septic abortion definition

A

Any embryonic or fetal demis with uterine infection

Retained products of conception or ascending infection- polymicrobial

31
Q

Septic abortion- symptoms

A 
Uterine bleeding 
Fever
Abdominal pain
Cervical motion tenderness
Foul smelling discharge
32
Q

Septic abortion labs and imaging

A 
CBC- Increased leukocytes 
UA
Endocervical cultures
Blood cultures
Abdominal x-ray to r/o uterine perforation 
US- to look for retained POCs
33
Q

Septic abortion - treatment

A

Hospitalization and IV abx w anaerobic and aerobic coverage

D&C if retained POCs

34
Q

Elective abortion - medically

A
  • 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
Q

Elective abortion - surgical

A
  • Suction or surgical curettage

- Dilation and evacuation- 2nd tri abortions- up to 18wks

36
Q

Recurrent pregnancy loss definition

A

3 or more consecutive SABs before 20 wks

Prognosis is good- 60% have chance of viable pregnancy

37
Q

Recurrent pregnancy loss- causes

A 
Genetic
Auto immune
Anatomic
Endocrine
Thrombophilic
38
Q

Anembryonic pregnancy

“Blighted ovum” definition

A

Embryo fails to develop or is resorbed after loss of viability

39
Q

Anembryonic pregnancy

“Blighted ovum”- symptoms

A

Similar to missed or threatened:

  • mild pain/bleeding
  • cervix closed
  • retained non-viable pregnancy (still in uterus)
40
Q

Anembryonic pregnancy

“Blighted ovum” imaging

A

US- diagnosis- empty gestational sac w/o a fetal pole

41
Q

Ectopic pregnancy - definition

A

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
Q

Ectopic pregnancy complications

A
  • tubal rupture
  • hemorrhagic shock
  • death
43
Q

Ectopic pregnancy risk factors

A 
Prior ectopic
PID
Smoking
Anatomic abnormalities
IUD
44
Q

Ectopic pregnancy symptoms

A 
Pain- pelvic or abdominal 
Abnormal uterine bleeding 
Amenorrhea
Syncope
Adnexal mass
Uterine changes
Hemodynamic instability- vital signs
45
Q

Ectopic pregnancy labs and imaging

A

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
Q

Ectopic pregnancy treatment

A

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
Q

Gestational trophoblastic disease definition

A

Group of pregnancy related tumor- rare
Cells are called trophoblasts and come from tissue that is used to form the placenta
Abnormal fertilization

48
Q

Gestational trophoblastic disease symptoms

A

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
Q

Gestational trophoblastic disease - labs

A

HCG titers greater than expected for gestational age

50
Q

Hydatidiform mole- molar pregnancy

A

Molar pregnancy- benign neoplasm derived almost entirely from abnormal placental (trophoblastic) proliferation
- may precede choriocarcinoma

51
Q

Hydatidiform mole- complete

A

Contain no fetal tissue, diffuse trophoblastic proliferation, 46xx or 46xy

52
Q

Hydatidiform mole- partial

A

Contains some fetal tissue, focal trophoblastic proliferation, 69xxx or 69xxy

53
Q

Hydatidiform mole- molar mc in ?

A

early teens (<20yo) or perimenopausal (40)

54
Q

Hydatidiform mole- molar symptoms

A

vaginal bleeding

55
Q

Hydatidiform mole- labs and imaging complete

A

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
Q

Hydatidiform mole- labs and imaging partial

A

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
Q

Hydatidiform mole- labs and imaging grossly and microscopically

A

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
Q

Hydatidiform mole- molar pregnancy treatment

A
  • 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
Q

Invasive mole definition

A

Invasion and/or perforation of the myometrium
Locally destructive
May have emboli to distant sites (brain, lung, etc)

60
Q

Invasive mole complications

A
  • uterine rupture from invasion of myometrium

- malignant choriocarcinoma

61
Q

Invasive mole symptoms

A

vaginal bleeding

62
Q

Invasive mole labs

A

persistent elevated HCG

63
Q

Choriocarcinoma definition

A

Malignant tumor- usually of placenta

Capable of widespread metastasis

64
Q

Choriocarcinoma cause

A

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
Q

Choriocarcinoma treatment

A

Very sensitive to chemotherapy

66
Q

Choriocarcinoma diagnosis

A
  • 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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