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Women's Health Clin med > Pregnancy complications > Flashcards

Pregnancy complications Flashcards

1
Q

What is an ectopic pregnancy

A

pregnancy implantation that occurs at another site other than the endometrium

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2
Q

Where are tubal pregnancies located

A

Most are located in the distal 2/3 of tube

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3
Q

What population is at highest risk of ectopic pregnancies

A

Black, non-hispanic

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4
Q

What is the biggest risk factor for ectopic pregnancies

A

50% have no risk factors

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5
Q

What are the risk factors for ectopic pregnancies

A

Prior ectopic
assisted reproduction
damaged fallopian tube
advanced maternal age
smoking
congenital tube defect

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6
Q

How do ectopic pregnancies present

A

abdominal pain and vaginal bleeding roughly 7 weeks after LMP

-can dx with TVUS and + serum HcG

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7
Q

Gestational sac can be seen by TVUS at what HcG level

A

> 1500

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8
Q

Gestational sac can be seen by trans abdominal US at what HcG level

A

> 3500

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9
Q

What is the medical management of an ectopic pregnancy

A

Methotrexate
*comparable to surgery

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10
Q

What is a tube saving surgical procedure for ectopic pregnancies

A

linear salpingostomy

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11
Q

What is a spontaneous pregnancy loss

A

non-viable intrauterine pregnancy with either an empty gestational sac OR gestational sac w/ embryo w/ no heart beat

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12
Q

When do most pregnancy losses occur

A

first trimester

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13
Q

What is the most common cause of spontaneous pregnancy loss

A

fetal chromosome abnormalities

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14
Q

If a mother is RH negative, what should be given

A

Rhogam

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15
Q

What is expectant management

A

Just wait things out and see what happens with the pregnancy

generally takes its course within 8 weeks

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16
Q

What HcG level is indicative of no pregnancy

A

<5

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17
Q

What is medical management of pregnancy loss

A

Intravaginal misoprostol

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18
Q

Which patients cannot have medical management of pregnancy loss

A

> 10weeks along
hemodynamically unstable
allergies to prostaglandins / NSAIDS
Anticoagulated patiens
infection

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19
Q

What is surgical management of pregnancy loss

A

Surgical evacuation preformed in the Office or operating room

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20
Q

What is gestational trophoblastic disease

A

Vaginal bleeding and enlarged uterus

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21
Q

How will gestational trophoblastic disease appear on US

A

Cluster of grapes

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22
Q

What rare complication can be evident by gestational trophoblastic disease

A

thyroid disease

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23
Q

What are the 2 types of gestational trophoblastic disease

A

Hydatidiform mole (molar preg)
Gestational trophoblastic neoplasia

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24
Q

What are the risk factors for gestational trophoblastic disease

A

extremes of age
hx of prior molar preg
hx os spontaneous preg loss

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25
Q

Can people have a normal pregnancy after a gestational trophoblastic disease

A

yes

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26
Q

What is a molar pregnancy

A

tumor that develops in the uterus as a result of a nonviable pregnancy

*generally non-cancerous

*can be complete or partial

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27
Q

What is gestational trophoblastic neoplasia

A

rare form of cancer
-choriocarcinoma
*placental-site trophoblastic tumor

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28
Q

What is the treatment for a molar pregnancy

A

surgical evaluation with D&C procedure (even if its a partial)

*if older = hysterectomy

also chemi/radiation

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29
Q

How long to woman have to wait to become pregnanct after a molar pregnancy

A

1 year

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30
Q

How long should HcG levels be monitored after a molar pregnancy

A

6 months

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31
Q

What are hypertensive disorders of pregnancy

A

gestational hypertension
preeclampsia
eclampsia
chronic HTN
chronic HTN w/ preeclampsia

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32
Q

How do you manage HTN in pregnancy if > 160/110

A

Mehtyldopa
labetolol
hydralazine
nifedipine

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33
Q

Which pregnant patients should labetalol not be used in

A

those with asthma or CHF

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34
Q

Which BP meds are contraindicated in pregnancy and why

A

ACEi
*Cause renal injury in 2nd/3rd trimester

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35
Q

What can be used for antenatal fetal surveillance

A

Non-stress test
US for fetal growth restriction
Biophysical profile

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36
Q

What is considered proteinuria in pregnancy

A

24 hour urine protein >300mg
Urine protein/creatinine >.3

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37
Q

What are severe feature of hypertension in pregnancy

A

severe HTN
Renal insufficiency
pulmonary edema
new onset HA**
visual disturbance
epigastric pain
impaired liver function
TTP>100,000

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38
Q

What is chronic HTN

A

Gestational BP elevated before the 20th week of gestation

*dx first time during pregnancy and doesn’t resolve postpartum

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39
Q

What is the most common cause of intrauterine growth restriction (IUGR)

A

Chronic HTN

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40
Q

What is gestational HTN

A

transient
*returns to normal by 12 weeks into post party period

HTN w/o proteinuria or severe features that develop after 20weeks

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41
Q

What is preeclampsia

A

New onset HTN and proteinuria dx after 20wks
OR
new onset HTN dx after 20 weeks with 1+ severe features

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42
Q

What are signs and symptoms of preeclampsia

A

LUQ / epigastric pain
persistent headache
hyperreflexia+/- clonus
occipital lobe blindness

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43
Q

What can be used to prevent preeclampsia

A

Low dose aspirin after 12 weeks gestation if at high risk for preeclampsia

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44
Q

What are the complications of preeclampsia

A

Seizure
hepatic dysfunction
DIC
Renal dysfunction
pulmonary edema
premature delivery

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45
Q

What is the only cure for preeclampsia

A

delivery… need to get placenta out

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46
Q

what is HELLP

A

Hemolysis
Elevated
Liver enzyme
Low
Platelets

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47
Q

When does HELLP present

A

antepartum or post partum
*preeclampsia variant

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48
Q

What is HELLP associated with

A

poor birthing person outcomes
*increased risk for pulmonary edema and acute renal failure

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49
Q

What is Eclampsia

A

New onset of grand Mal seizures in a patient with preeclampsia

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50
Q

What do you need to rule out before dx with eclampsia

A

hx of seizure disorder
head trauma
ruptured aneurysm
AVM

51
Q

Who is at greatest risk for developing eclampsia

A

preeclampsia with severe features

52
Q

How do you control convulsions in someone with eclampsia

A

magnesium sulfate

53
Q

What are the indications for delivery with eclampsia

A

indicated for unstable birthing
fetal condition

54
Q

What determines the mode of delivery with eclampsia

A

fetal gestational age
fetal presentation
cervical status
mom/fetal condition

55
Q

Why is magnesium sulfate given to someone with eclampsia that is seizing

A

muscle relaxant to prevent uterine contractions

56
Q

Which patients are more likely to have persistent HTN post partum

A

higher urinary protein
serum uric acid
BUN

57
Q

What are some causes of vaginal bleeding in late pregnancy

A

placental abruption
placenta previa
cervical trauma
vaginal infections
“bloody show”

58
Q

What is PPROM

A

preterm premature rupture of membranes

59
Q

What is placental abruption

A

premature separation of normally implanted placenta from uterus

60
Q

What will be seen on US with placenta abruption

A

adherent retro-placental clot with depression / disruption in underlying tissue

61
Q

What is the triad of clinical finding for placental abruption

A

External/occult bleeding (dark)
Uterine pain/ hypertonus
fetal distress/death

62
Q

When does placental abruption typically occur

A

Before onset of labor

63
Q

What increases someones risk for placental abruption

A

Advanced birthing age
gestational HTN
Blunt external trauma
Abruption in prior preg

64
Q

What is the hallmark presentation for placental abruption

A

3rd trimester bleeding

65
Q

What management precautions are used with placental abruption

A

2 large bore IV
4 unit PRBCs
Coat studies
continuous fetal monitoring

66
Q

When is a C-section done with placental abruption

A

If birthing person and fetus are deteriorating

67
Q

What is placenta previa

A

Implantation of placenta over cervical os

68
Q

What is the leading cause of painless 3rd trimester bright red bleeding

A

placenta previa

69
Q

What are the kinds of placenta Previa

A

Total
partial
marginal

70
Q

What are the risk factors for placenta previa

A

Previa in prior pregnancy
advanced maternal age
minority race
prior csection
cocaine/tobacco

71
Q

When is placenta previa typically diagnosed

A

2nd trimester during the anatomy scan

72
Q

If mom is >37 weeks along with placenta previa, how should baby be delivered

A

C section

73
Q

What is monozygotic

A

single fertilized ovum splits
*same sex, genetically identical

74
Q

What is dizygotic

A

Two separate ova are fertilized
*same OR opposite sex

75
Q

What increases chances of multiple gestation

A

advancement in assisted reproductive technology

advanced maternal age

76
Q

What is monochorionic- monochorionic

A

one placenta, one sac, always monozygotic.

*increased risk for twin to twin transfusion syndrome (TTS)

77
Q

What is monochorionic-diamnionic

A

one placenta, two sacs
blood vessels communicate btw fetal circulation

78
Q

What is dichorionic-diamnionic

A

two sacs, two placentas

occurs in most dizygotic twins
*lowest mortality rate

79
Q

What will be seen on physical exam with multiple gestation

A

uterus is larger than date
pollyhydramnios
auscultation of multiple HR

80
Q

Twins grow at the same rate as singletons until what gestational age

A

30-32 weeks

81
Q

How often should growth ultrasounds be completed with twins

A

monthly

82
Q

Are all twin pregnancies considered high risk?

A

yes

83
Q

What is birthing person at increased risk for with twins

A

preeclampsia
GDM
hypertensive disorders

84
Q

If twins are vertex/non-vertex position, how does mom deliver

A

case by case defendant

85
Q

What is gestational diabetes

A

carbohydrate intolerance starting in pregnancy

86
Q

When is screening done for gestational diabetes

A

24-28 weeks

87
Q

how often does glucose have to be monitored with gestational diabetes

A

4x/day

88
Q

How do you treat GDM with >4 abnormal glucose values

A

insulin

*metformin is secondary

89
Q

When should babies be delivered with GDM and why

A

39 weeks because they are at risk for still birth

90
Q

What dietary modifications are used with GDM

A

Small frequent meals and decrease simple carbs

91
Q

What is the postpartum care for GDM

A

at 6-12wks PP: diabetes screen
encourage normal BMI range
breastfeeding
glucose testing Q3 years

92
Q

What is an incompetent cervix

A

Inability of the uterine cervix to retain a pregnancy in the second trimester in the absence of uterine contractions

93
Q

What are the risk factors for an incompetent cervix

A

Prior 2nd trimester preg loss
short cervix
fetal fibronectin testing

94
Q

how will a person with an incompetent cervix and has had a previous second trimester pregnancy loss present

A

Buldging fetal membranes
premature membrane rupture
rapid delivery
rare/absent contraction

95
Q

How will someone with an incompetent service and no 2nd trimester pregnancy loss present

A

painless cervical dilation on physical exam in second trimester

96
Q

How do you manage cervical insufficiency

A

cerclage
*suturing crevice shut

97
Q

What are the contraindications to cerclage

A

Lethal fetal anatomy
intrauterine infection
active bleeding
preterm labor
ruptured membranes
fetal demise

98
Q

What is premature rupture of membranes (PROM)

A

spontaneous rupture of fetal membranes before the onset of labor

99
Q

What is the most common presentation of premature membrane rupture

A

gush of fluid from vagina, followed by persistent uncontrolled leakage

100
Q

What timeline is considered preterm premature rupture of membranes (PPROM)

A

spontaneous rupture prior to onset of labor prior to 37 weeks

101
Q

What associated infection is seen with PPROM

A

bacterial vaginosis

102
Q

What is ferning

A

When fluid allowed to dry on clean slide produces microscopic fern crystallization patter

103
Q

How will fluid PH be in the amniotic sac

A

alkaline (7.15)

104
Q

How do you manage PROM

A

Rule out immediate delivery

105
Q

What is the principal indication for delivery with PROM

A

chrioamnionitis

106
Q

What is the most dangerous risk with PROM

A

Umbilical cord prolapse

107
Q

What test should be done with PPROM

A

US for amniotic fluid to determine fetal presentation, fetal weight/growth

108
Q

What is shoulder Dystocia

A

Obstetrical emergency

Anterior shoulder is stuck

109
Q

What will the presentation be with chorioamnionitis

A

Fever, uterine tenderness, tachycardia, and high WBC count)

110
Q

When is shoulder dystocia diagnosed

A

When the shoulders do not deliver shortly after the fetal head

111
Q

What are the risk factors for shoulder dystocia

A

obesity
long labor
IOL
Forceps / vacuum

112
Q

What tools can be used to deliver shoulder dystocia

A

Prompt reduction of shoulder
suprapubic pressure
episiotomy
intentional fx (last resort)

113
Q

What is the McRoberts maneuver

A

hip hyper flexion and suprapubic pressure

114
Q

What is woods corkscrew

A

180 degree shoulder rotation of posterior shoulder and deliver that shoulder

115
Q

What is the good and bad of maneuvers for shoulder dystocia

A

more maneuvers increases the chance of success but also increases risk for fetal injury

116
Q

What is the danger of taking longer than 5 minutes to deliver the baby

A

increased risk for fetal acidosis and hypoxic ischemic encephalopathy

117
Q

What are fetal complications with shoulder dystocia

A

brachial plexus injury
diaphragmatic paralysis
facial nerve injury
horners syndrome
clavicle fx
death

118
Q

What are the complications for the mom with shoulder dystocia

A

lacerations
postpartum hemorrhage
pubic symphysis separation
uterine rupture

119
Q

What defines a postpartum hemorrhage

A

> 1L blood loss or blood loss associated with s/sx of hypovolemia

120
Q

What are the risk factors for postpartum hemorrhage

A

Prolonged labor / rapid labor
over distended uterus
operative delivery
preeclampsia
chorioamnionitis

121
Q

How can you prevent post partum hemorrhage

A

correct anemia
avoid episiotomy
infant to breast post delivery
active mgmt of 3rd stage of labor

122
Q

What are causes of early postpartum hemorrhage

A

Uterine atony
genital tract trauma
retained placental tissue
coagulation disorders

123
Q

How to you manage uterine atony

A

deliver placenta
uterine massage
removal of clots
give uterotonics (oxytocin)
Bimanual compression
Possible D&C
inspect/repair lacerations

Women's Health Clin med (13 decks)

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