Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EOR - OB/GYN > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

25-year-old female, G2 P1001, presents to your office at 11-weeks gestation with vaginal bleeding, mild lower abdominal cramping, and bilateral lower pelvic discomfort. On examination, blood is noted at the dilated cervical os. No tissue is protruding from the cervical os. The uterus by palpation is 8-9 weeks gestation. No other abnormalities are found.

A

Abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Expulsion of all or part of the products of conception before 20 weeks of gestation

A

Spontaneous abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RF of spontaneous abortion

A
  • Fetal RF: Chromosomal abnormalities (MC: trisomy, monosomy X), congenital anomalies
  • Maternal RF: previous spontaneous abortion, smoking, maternal infection, anatomic anomalies (large uterine fibroids), Asherman syndrome, maternal disease, gravidity, fever, prolonged time to achieving pregnancy, BMI <18.5 or >25, celiac disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What labs should be performed for spontaneous abortion?

A
  • Labs: Quantitative β-hCG, CBC, Blood type, Antibody screen, U/S to assess fetal viability and placentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the tx for spontaneous abortion

A
  • Expectant management (<13 wk): allow complete abortion to occur
  • >13 weeks: medical abortion
    • Mifepristone (antiprogestin) or Misoprostol (prostaglandin) - 96% safe and effective
  • D&C (first trimester)
  • Dilation and evacuation (2nd)
  • Surgery required if ineffective or excessive blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 5 types of miscarriages?

A
  • Spontaneous abortion: is an expulsion of all or part of the products of conception before 20 weeks of gestation
  • Threatened abortions: bloody vaginal discharge before 20 weeks of gestation with or without uterine contractions in the presence of a closed cervix
  • Incomplete abortion: dilated cervical os with the passage of some but not all products of conception before 20 weeks of gestation
  • Inevitable abortion: dilated cervical os without passage of tissue before 20 weeks of gestation
  • Missed abortion: death of the fetus before 20 weeks of gestation, with products of conception remaining intrauterine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

a 32-year-old female who presents with sudden onset of left lower abdominal pain that radiates to the scapula and back and is associated with vaginal bleeding. Her last menstrual period was five weeks ago. She has a history of PID and unprotected intercourse

A

Ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Implantation of pregnancy somewhere other than the uterine cavity ⇒ 95% in the fallopian tube (55% in the ampulla of the tube)

A

Ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sx of ectopic pregnancy

A
  • Classic features of an ectopic pregnancy are abdominal pain,bleeding, and adnexal mass in a pregnant woman
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MCC of ectopic pregnancy

A
  • MC cause = occlusion of tube secondary to adhesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RF of ectopic pregnancy

A
  • r/f: hx of previous ectopic, previous salpingitis (caused by PID), previous abdominal or tubal surgery, use of IUD, assisted reproduction, smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

severe abdominal or shoulder pain, peritonitis, tachycardia, syncope, orthostatic HTN

A

Ruptured ectopic pregnancy (medical emergency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dx of ectopic pregnancy

A

Beta HCG is > 1,500, but no fetus in utero

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ultrasound ⇒ Ring of fire sign

A

Sign of ectopic pregnancy

Ultrasound ⇒ Ring of fire sign: The ring of fire sign also known as ring of vascularity signifies a hypervascular lesion with peripheral vascularity on color or pulsed Doppler examination of the adnexa due to low impedance high diastolic flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tx of ectopic pregnancy

A

Methotrexate ⇒ Only if beta HCG < 5,000, ectopic mass is < 3.5 cm, no fetal heart tones, hemodynamically stable, no blood disorders, no pulmonary disease, no peptic ulcer, normal renal function, normal hepatic function, compliant pt that can return for follow up

  • Administration of methotrexate is the appropriate treatment for an ectopic pregnancy unless there are contraindications to the use of the drug. These contraindications include current breastfeeding, active pulmonary disease, immunodeficiency, or hypersensitivity to methotrexate. The drug is a folic acid antagonist that inhibits DNA replication. The effectiveness of administration is similar to surgical treatment without the risk of surgical complications. Indications for methotrexate therapy include a hemodynamically stable patient, hCG levels below 5,000 IU/L, mass <3.5 cm, no fetal cardiac activity, and the ability to comply with post-treatment follow-up. Methotrexate can be administered intravenously, intramuscularly, or orally. It can also be injected into the ectopic pregnancy directly, although this route of administration is not commonly used. Intramuscular administration is the route of administration that is most commonly used for the treatment of ectopic pregnancy.

Surgical treatment: laparoscopy salpingostomy ⇒ emergent situations (rupture) or patient not meeting methotrexate criteria

Follow up testing is crucial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

a 32-year-old G2P1 presents to the clinic at 24 weeks for routine prenatal examination and a 50-g oral GTT yielded results of 153 mg/dL

A

Gestational diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MC complication of gestational diabetes

A

macrosomia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diagnostic criteria for the 100-gram three-hour GTT to diagnose gestational diabetes:

A

Fasting

95

One hour

180

Two hours

155

Three hours

140

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Patients who have fasting blood glucose measurements of greater than 105 mg/ dL or 2-hour postprandial blood sugar measurements of greater than 120 mg/ dL may require insulin.

What is the insulin recommendations?

A
  • Insulin is the treatment of choice - the goal is fasting glucose < 95
  • NPH/Regular 2/3 in AM and 1/3 in PM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Good glucose control is described as

A
  • Good glucose control is described as a 2-hour glucose tolerance test <140 mg/dL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the concerns with the baby when a mother has gestational diabetes?

A

hypoglycemia, shoulder dystocia cardiac abnormalities, respiratory distress syndrome, IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

a 31-year-old who had her LMP 6 weeks ago and has a beta HCG level of 100,000. Ultrasound shows a “snowstorm pattern”

A

Gestational trophoblastic disease (molar pregnancy choriocarcinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Risk factors for molar pregnancies

A

Risk factors for molar pregnancies include maternal age extremes - like younger than 20, or older than 35, and previous molar pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

2 types of benign molar pregnancies

A
  • Benign ⇒ molar pregnancy (also called hydatidiform moles)
    • Complete mole: huge amounts of HCG, missed periods, positive pregnancy test, vaginal bleeding, symptoms of hyperthyroidism, uterus larger than expected for GA
      • “Grape-like” mass or “snow-storm” on transvaginal ultrasound
    • Incomplete mole: secretes more HCG than normal (not as much as a complete mole), uterus NOT larger than expected, most result in spontaneous abortion
      • Both complete and incomplete moles are premalignant conditions that can develop into invasive moles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Malignant molar pregnancy

A

Malignant ⇒ invasive moles, which derive from the benign moles, and choriocarcinoma - which is placental cancer that most frequently occurs in the absence of a molar pregnancy.

  • Invasive moles always develop after a molar pregnancy
  • Choriocarcinoma can also develop after a normal pregnancy
26
Q

Dx of molar pregnancy

A

HCG > 100,000 mIU/ml are diagnostic of molar pregnancy

27
Q

Invasive moles and choriocarcinoma are definitively diagnosed by

A

The diagnosis is made when HCG levels plateau, meaning they remain within 10% of the previous result, over a three week period, or when HCG levels increase more than 10% across three values recorded over two weeks, or when there is still detectable serum HCG up to 6 months after evacuation of a molar pregnancy

28
Q

Stages of invasive molar pregnancy

A
  • Stage I tumors are confined to the uterus, and there are no metastases
  • Stage II tumors extend to the fallopian tubes, the ovaries, or the vagina
  • Stage III tumors have lung metastases, regardless of genital structure involvement
    • Stage IV tumors have metastases in any organs other than the lungs or the genital structures
29
Q

Tx of molar pregnancy

A

Complete and incomplete mole: Treatment for both complete and incomplete moles is uterine evacuation via suction curettage

  • Uterine contents should always be examined histologically
  • Follow up ⇒ measure serum HCG weekly, until it’s undetectable for three consecutive weeks, and then once a month for 6 months. This should be done while the female is on reliable contraception - like the barrier method or oral contraception
  • If HCG levels rise or plateau, there may be a persistent, invasive mole or there may be a choriocarcinoma

Choriocarcinoma: Resect, methotrexate, chemotherapy

30
Q

a 32-year-old, G7P0A3, who is in her thirteenth week of pregnancy. She has lost three consecutive normally formed fetuses before 20 weeks gestation, and she has had three spontaneous first-trimester abortions.

A

Incompetent cervix

31
Q

Spontaneous, premature dilation or shortening of the cervix during the second or early third trimester (up to twenty-eight wks.) of pregnancy

A

Incompetent cervix

32
Q

Risks of incompetent cervix

A
  • h/o cervical insufficiency, hx of injury, surgery, colonization, DES exposure in utero, anatomic abnormalities
33
Q

PE findings of incompetent cervix

A

Exam -> painless dilation and effacement

  • Significant cervical dilation > 2 cm
  • Minimal contractions until 4 cm
    • Bleeding or vaginal discharge (especially in the 2nd trimester)
34
Q

Dx of incompetent cervix

A

Diagnosed now with transvaginal ultrasound – will see funneling of the cervix

  • Between weeks 18 and 22 weeks, the ultrasound focuses on detecting fetal abnormalities
    • Normally, the cervix should be at least 30 mm in length. Cervical weakness is variably defined. However, a common definition is a cervical length < 25 mm before 24 wks
35
Q

Tx of incompetent cervix

A

Cervical cerclage placed at 12-16 weeks and removed at 36-38 weeks to allow for delivery

  • Culture for G/C and GBS before placement
  • Confirm viable intrauterine pregnancy before placement
  • A cervical pessary is being studied as an alternative to cervical cerclage since there are fewer potential complications
36
Q

a 29-year-old at 36 weeks gestation who arrives at the emergency department with a sudden onset of back pain with uterine contractions that are very close together, one after another. She describes PAINFUL, bright red vaginal bleeding. There is pelvic tenderness on examination which reveals a closed cervix and no evidence of rupture of the membranes.

A

Placental abruption

37
Q

Premature separation of all/section of otherwise normally implanted placenta from the uterine wall after 20 weeks of gestation resulting in hemorrhage

A

Placental abruption

38
Q

MCC of 3rd trimester bleeding

A
  • MC cause of third trimester bleeding
39
Q

RF for placental abruption

A
  • Risk factors for placental abruption include trauma, smoking, hypertension, preeclampsia, and cocaine abuse
  • Primary cause: unknown – maternal HTN, prior history of abruption, maternal cocaine use, external maternal trauma, rapid decompression of overdistended uterus
40
Q

Dx of placental abruption

A

The diagnosis is always clinical, ultrasound is minimally helpful but is usually ordered

  • Ultrasound may show retroplacental blood collection
  • Blood-stained amniotic fluid in the vagina
  • Abruption signs evidenced by fetal heart rate, uterine activity
  • Decelerations may indicate fetal hypoxia, bradycardia
41
Q

Tx of placental abruption

A

Delivery of the fetus and placenta is the definitive treatment, blood type, crossmatch and coag studies as well as placement of large-bore IV line

  • Emergent delivery ⇒ vaginal/cesarean, as indicated
  • Corticosteroids as indicated to enhance fetal lung maturity
  • Expectant management for small abruptions
42
Q

32-year-old woman, G2P1, at 35 weeks’ gestation with a complaint of painless vaginal bleeding that began two hours ago and has delivered a substantial amount of blood with clots. She has had no evident pain or cramping. Upon physical examination, the fetal heart rate is noted to be normal. Her last pregnancy was delivered by emergency cesarean at 37 weeks due to a breech presentation during labor

A

Placenta previa

43
Q

placenta lies very low in the uterus and covers all or part of the cervix

A

Placenta previa

44
Q

Types of placenta previa

A
  • Complete previa: placenta completely covers the internal os
  • Partial previa: placenta covers a portion of the internal os
  • Marginal previa: the edge of placenta reaches the margin of the os
  • Low-lying placenta: implanted in the lower uterine segment in close proximity but not extending to the internal os
  • Vasa previa: fetal vessel may lie over the cervix
45
Q

Painless vaginal bleeding! Usually occurs after 28 weeks of gestation

A

Placenta previa

46
Q

Fetal complications from placenta previa

A

Fetal complications associated with Previa: preterm delivery and its complications, preterm PROM, intrauterine growth restriction, malpresentation, vasa previa, congenital abnormalities

47
Q

Dx of placenta previa

A

ultrasound (transvaginal) - vaginal exam contraindicated ⇒ a digital exam can cause further separation

sonography

48
Q

Tx of placenta previa

A

strict pelvic rest (no intercourse) and modified bed rest, no vigorous exercise

  • Blood transfusion may be necessary so get a type and screen if you discover previa via U/S
  • C-section is preferred delivery
  • Give Rhogam if Rh-
  • Some studies show that delivery between 34-37 weeks may be optimal
49
Q

What differentiates eclampsia from preeclampsia?

A

Eclampsia is defined as the development of seizures in a woman with preeclampsia

50
Q

What is the time period in which pre-eclampsia may occur?

A

The time period in which pre-eclampsia may occur extends from 20 weeks of gestation to 6 weeks postpartum.

51
Q

Preeclampsia triad

A

Preeclampsia ⇒ classic triad of HTN, (+) PROTEINURIA (+/-) edema (must have HTN and proteinuria) after 20 weeks GA

52
Q

Mild preeclampsia criteria

A
  • BP 140/90 – 160/110
  • Proteinuria - > 300 mg/24 hours or > +1 on dipstick
  • Edema of face hands and feet
  • Delivery is the only cure performed at 34 - 36 weeks - schedule for elective vaginal delivery - A C-section is not necessary unless complications develop
  • Steroids to mature lungs at 26-30 weeks
  • daily weights, BP and dipstick weekly, bed rest
53
Q

Severe preeclampsia criteria

A
    • BP > 160/110
      • Proteinuria > 5g in 24 hours or no urine or 3 +on dipstick
      • Cerebral visual change
      • Pulmonary edema
      • ***HELLP SYNDROME - Hemolysis, elevated liver enzymes, and low platelets
      • DELIVERY IS ONLY CURE - performed at 34 - 36 weeks
      • Hospitalization and START MAGNESIUM SULFATE to prevent eclampsia
      • BP MEDS: started if BP > 180/110 - HYDRALAZINE
54
Q

HTN, + PROTEINURIA + SEIZURES or COMA

A

Eclampsia

55
Q

Tx for eclampsia

A
  • Same diagnostic criteria as pre-eclampsia
    • TREAT with MAGNESIUM SULFATE for seizures
    • Delivery of fetus once the patient is stabilized
    • BP meds: HYDRALAZINE
56
Q

a 28-year-old P1G0 pregnant female presents for a prenatal visit at 37 weeks. The pregnancy has been unremarkable thus far. Her blood pressure (BP) is 148/94 mm Hg, and her urine dipstick shows +1 proteinuria.

A

Pregnancy induced hypertension

57
Q

BP > 150/90 after 20 weeks into the pregnancy that resolves 12 weeks postpartum

A

Gestational hypertension

58
Q

BP > 140/90 prior to 20 weeks of gestation that persist for > 6 weeks postpartum

A

Chronic hypertension

59
Q

Severe pregnancy induced hypertension

A

Severe = Meds if BP > 150/100 - labetalol or intermediate-acting or extended-release nifedipine.

Oral hydralazine may be added if needed to achieve and maintain target blood pressure. Methyldopa is also a safe alternative but is hard to reach BP goals and is limited by sedative effects. Avoid ACEI and diuretics

60
Q

a 25-year-old woman presents at 28 weeks gestation for a scheduled check-up. She states that her baby is moving as much as usual and she is feeling well. On physical exam, you note a gravid uterus that extends 28 cm above the pubic symphysis. Of note, this is this mother’s first pregnancy. Her vitals are within normal limits, she is currently taking a multivitamin and folate and her blood type is A negative

A

Rh incompatability

61
Q

Dx of Rh incompatibility

A

Pregnant women: ABO blood group, RH-D type, indirect erythrocyte Ab screen, indirect Coombs test

  • Fetal monitoring in the 2nd trimester
62
Q

Tx of Rh incompatability

A

Give Rhogam at 28 weeks, within 72 hours of delivery, and during any uterine bleeding throughout pregnancy

  • Given if Rh-negative mother and father Rh-positive or unknown
  • Risk of hydrops fetalis

EOR - OB/GYN (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions