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OB/GYN > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

Secondary exposure to D antigen results in production of IgG antibodies that freely cross the placenta, enter the fetal circulation, and bind to fetal RBCs

RBCs that are highly bound undergo hemolysis

Large amounts of antibody may result in destruction of large numbers of fetal RBC and fetus may be unable to sufficiently replace the red cells which will cause anemia

A

Rh Incompability

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2
Q

Fluid accumulation in at least two extravascular compartments (pericardial effusion, pleural effusion, ascites, or subcutaneous edema)

A

Hydrops Fetalis

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3
Q

Which antigen is the biggest culprit in Rh compatability?

A

D antigen

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4
Q

Occurs most commonly in a subsequent pregnancy

Destruction of the fetal RBC by maternal antibodies leads to hemolysis, bilirubin release, and anemia

A

Rh Incompability

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5
Q

What is the amount of Rh positive fetal blood required to cause isoimmunization?

A

only 0.1mL

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6
Q

What is the only antigen that can cross the placenta?

A

IgG

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7
Q

What may occur when Rh negative woman is pregnant with Rh positive fetus?

A

Isoimmunization

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8
Q

Any event associated with fetomaternal bleeding can lead to maternal exposure to fetal RBC, which can trigger what?

A

maternal immune response

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9
Q

What is the most common minor antigen associated with hemolytic disease of the fetus?

A

Kell antigen

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10
Q

When anemia is significant in Rh incompatibility, hematopoiesis increases, including alternate sites for RBC production. What is the largest site for alternative RBC production?

A

Key alternate site is liver

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11
Q

List some examples of precipitating events that can result in Rh compatibility

A

Childbirth
Delivery of placenta
Abortion (Threatened, spontaneous, elective, or therapeutic)
Ectopic pregnancy
Bleeding associated with placenta previa or abruption
Amniocentesis
Abdominal trauma
External cephalic version

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12
Q

What is the treatment for Rh incompatibility?

A

RhoGam

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13
Q

What is RhoGam?

A

RhoGam is anti-D immune globulin

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14
Q

When is RhoGam administered?

A

RhoGam is administered at 28 weeks gestation or after complications
and within 72 hours of delivery

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15
Q

If bleeding occurs then will need which test?

A

Kleihauer-Betke test

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16
Q

The Kleihauer-Betke test figures out what?

A

Determines the amount of blood loss per mL of fetal blood into maternal circulation > 30mL

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17
Q

Why is the Kleihauer-Betke test important?

A

This will help to dictate the amount of RhoGam to be used

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18
Q

Pregnancy implants outside of the uterine cavity

A

Ectopic Pregnancy

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19
Q

What is the most common implantation location for ectopic pregnancy?

A

Most common location is the fallopian tubes

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20
Q

Second leading cause of maternal mortality

A

Ectopic Pregnancy

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21
Q

What is the largest risk factor for ectopic pregnancy?

A

PID largest risk factor

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22
Q

What are the risk factors for ectopic pregnancy?

A

History of STDs - PID largest risk factor

Prior ectopic pregnancy!!

IVF and assisted reproductive technology
IUD

Previous tubal surgery or pelvic surgery (Can happen after bilateral tubal ligation)

Endometriosis

Antiretroviral therapy

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23
Q

Rh- mothers with ectopic should be given what?

A

Rh immunoglobulin

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24
Q

What is the recurrent risk for an ectopic pregnancy?

A

25%

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25
Q

What is the risk of infertility for an ectopic pregnancy?

A

25-30%

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26
Q

Loss of fetus <20 weeks

1st trimester: typically genetic cause

2nd trimester: structural (incompetent cervix)

A

Spontaneous abortion

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27
Q

What type of abortion is described below?

Complete expulsion of products of conception

No gestational sac in uterus

Os closed

A

Complete abortion

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28
Q

What type of abortion is described below?

Incomplete expulsion

Some portion of the products of conception remain left behind in the uterus

Os is open

A

Incomplete abortion

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29
Q

What type of abortion is described below?

NO expulsion of sac

Bleeding with or without cramping

Os is open

A

Inevitable abortion

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30
Q

What type of abortion is described below?

Vaginal bleeding

With or without cramping

NO tissue has passed

Os is closed

A

Threatened abortion

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31
Q

What type of abortion is described below?

Embryo or fetus dies but the products of conception are retained

Brownish discharge

NO fetal heart tones

A

Missed abortion

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32
Q

What type of abortion is described below?

Termination of pregnancy before viability intentionally

A

Inducted abortion

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33
Q

3 or more SABs, 2+ SAB in women over 35 need to assess for what?

A

look into underlying disorder/problem

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34
Q

During pregnancy, as the baby grows and gets heavier, it presses on
the cervix

This pressure may cause the cervix to start to open before the baby is
ready to be born

A

Incompetent Cervix

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35
Q

What is the biggest concern with an incompetent cervix?

A

may lead to miscarriage or premature delivery

High risk for second trimester abortions

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36
Q

What are some risk factors for an incompetent cervix?

A

Cervical surgeries (LEEPs, Cone biopsies)

Cervical lacerations with previous deliveries

Uterine abnormalities

Family history

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37
Q

Procedure that sews the cervix closed to reinforce the weak cervix

Usually performed between week 14-16 of pregnancy and sutures removed between 36-38 weeks

A

Cerclage

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38
Q

Patients are not eligible for cerclage if they have these factors?

A

There is increased irritation of the cervix

The cervix has dilated 4cm

Membranes have ruptured

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39
Q

What are some complications with the cerclage?

A

Uterine rupture

Maternal hemorrhage

Bladder rupture

Cervical laceration

Preterm labor and delivery

Preterm rupture of the membranes

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40
Q

Abnormal premature separation of placenta

A

Abruptio Placentae

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41
Q

What are the types of abruptio placentae?

A

Partial separation (concealed hemorrhage)

Partial separation (apparent hemorrhage)

Complete separation (concealed hemorrhage)

Marginal

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42
Q

Abruptio placentae is associated with the use of which illegal drugs?

A

cocaine and meth

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43
Q

What are some signs and symptoms in abruptio placentae?

A

Sudden, PAINFUL bleeding with uterine pain and contractions

50% fetal distress as well

May have GI symptoms as well

Rigid, hard belly

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44
Q

Which type of abruptio placentae is described below?

Entire placenta separates

Concealed hemorrhage

A

Complete

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45
Q

Which type of abruptio placentae is described below?

Part of the placenta separates

A

Partial separation (concealed hemorrhage)

Partial separation (apparent hemorrhage)

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46
Q

Which type of abruptio placentae is described below?

Separation limited to ledge of placenta

A

Marginal

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47
Q

What are some risk factors for abruptio placentae?

A

Chronic HTN
Multiple gestations
Pre-eclampsia
AMA
Multiparity
Smoking
Chorioamnionitis
trauma

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48
Q

What is is the most common cause of coagulopathy in pregnancy?

A

Abruption

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49
Q

A rare complication of abruptio placentae where the uterine serosa is purple/blue due to blood penetration

A

Couvelaire uterus

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50
Q

Placenta location close or over internal cervical os

A

Placenta Previa

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51
Q

What are the types of placenta previa?

A

Complete
Partial
Marginal
Low lying

52
Q

Placenta previa is associated with what?

A

Associated with an increase in preterm birth and perinatal mortality and morbidity

53
Q

What is the signs/symptoms of placenta previa?

A

PAINLESS vaginal bleeding in third trimester

54
Q

What are some complications of placenta previa?

A

Concomitant placenta accretia, incretia, percreta

bleeding

55
Q

What must be avoided in patients with placenta previa?

A

pelvic/cervical digital exam

Intercourse

Vigorous exercise

56
Q

Glucose intolerance during pregnancy

Impairment of carb metabolism that manifests during pregnancy

A

Gestational Diabetes

57
Q

anti-insulin, produced by placenta

A

Human placental lactogen

58
Q

degrades insulin, produced by placenta

A

Insulinase

59
Q

More than what percentage of mothers return to normal after delivery, and what percentage go on to develop DM later in life?

A

95%
50%

60
Q

Glucose tolerance screening for mothers with gestational diabetes needs to be done when post partum?

A

2-4 months

61
Q

Glucosuria in pregnancy OK, what is the normal amount in pregnancy?

A

Normal: about 300mg/day

62
Q

When is screening and diagnosing gestational diabetes done?

A

24-28 weeks

63
Q

What is the mainstay of treatment in gestational diabetes?

A

Diet

64
Q

High A1c can put a baby at high risk for which birth defects?

A

CV malformations
hypoplastic LE
sacralagenesis

65
Q

Pre-Gestational DM puts patient at higher risk for what complication?

A

Increased risk for pre-eclampsia

66
Q

List some complications of gestational diabetes

A

Macrosomia
IUGR
Excessive weight gain
Pre-eclampsia
Shoulder dystocia
Placental abruption
Pre-term labor
C-section
High risk of stillbirths

67
Q

What is the most common birth defect with a mother with high A1c?

A

Cardiovascular

68
Q

List some reasons of fetal morbidity and mortality of gestational diabetes

A

Higher risk for congenital anomalies
Macrosomia (>4000g)
Neonatal hypoglycemia
Increased frequency of respiratory distress syndrome
Polyhydraminios (amniotic fluid > 2000mL)
Underdeveloped/damage to Isles of Langerhans

69
Q

hypertension that develops for the first time after 20 weeks

140/90 or higher

No proteinuria

A

Pregnancy-Induced Hypertension

70
Q

What percentage of pregnancy-induced HTN patients go on to develop pre-eclampsia?

A

50% go on to develop pre-eclampsia

71
Q

Predominant physical findings in pregnancy-induced hypertension is what?

A

maternal vasospasm

72
Q

What are some risk factors for developing pregnancy-induced HTN?

A

First pregnancy
Obesity
Age >40
African American
Personal or family history of gestational HTN or pre-eclampsia
DM
Chronic renal failure
You are carrying twins or higher multiples

72
Q

In pregnancy-induced HTN, BP of what we treat with medications because of the high risk of placenta abruption?

A

160/100 or higher

72
Q

What is the diagnostic criteria for pregnancy-induced HTN?

A

Blood pressure of 140/90 or higher

Blood pressure highest when sitting down

NO PROTEIN IN URINE

73
Q

Only safe blood pressure medication in pregnancy is what?

A

Methyldopa

74
Q

In pregnancy-induced HTN, what class of antihypertensives must absolutely be avoided?

A

Absolutely NO ACE INHIBITORS

75
Q

Most common form of hypertension in pregnancy

A

Pre-Eclampsia

76
Q

In pregnancy-induced HTN, what other factor with the high readings is an indication for delivery?

A

IUGR and HTN = deliver

77
Q

What pregnancy complication is 2x more common in AA females than whites?

A

Pre-Eclampsia

78
Q

What are some risk factors for pre-eclampsia?

A

Family history
Primiparity
Previous preeclampsia
Multiple gestations
Advanced maternal age
Diabetes
Obesity
SLE
Chronic HTN

79
Q

What pregnancy complication is hardest thing to control and hard to diagnose?

A

Pre-Eclampsia

80
Q

What is the diagnostic criteria for diagnosing pre-eclampsia?

A

Development of HTN after 20 weeks

Can occur exclusively post-partum

New onset proteinuria, or thormbodcytopenia, impaired liver
function, renal insufficiency, pulmonary edema, cerebral or vascular
disturbances

Progressive

81
Q

What is a normal 24hr protein?

A

100-300mg

82
Q

What is the fetal surveillance in a mother with pre-eclampsia?

A

Ultrasound with amniotic fluid index

NST (non-stress test)

Biophysical profile

83
Q

What maternal labs are drawn to evaluate pre-clampsia?

A

CBC with platelets

BUN/creatinine

LFTs

24 hour urine protein

84
Q

What is the mainstay of treatment in mild to moderate pre-eclampsia?

A

bed rest

85
Q

What is the treatment in severe pre-eclampsia?

A

In most cases, indication for delivery regardless of gestational age or
maturity if this pregnancy

86
Q

In severe pre-eclampsia, initiate what but only if delivery within 24 hours? And why?

A

MgSO4

98% of convulsions will be prevented with MgSO4 (Protects CNS – prevents tonic-clonic seizures)

87
Q

What is the initial drug of choice in managing blood pressure in severe pre-eclampsia?

A

hydralazine

88
Q

BP >160/110 mmHg on 2 occasions at least 6 hours apart while patient is on bed rest

Marked proteinuria usually >5g per 24 hr period, or 3+ or more on two random dips 4 hours apart

-OR-

Diagnostic criteria of pre-eclampsia and one of the following:
Oliguria (<500mL in 24 hour period)
Visual disturbances or HA
Pulmonary edema or cyanosis
RUQ pain
Evidence of hepatic dysfunction
Thrombocytopenia
IUGR
Clonus >3, hyperreflexia

A

Severe pre-eclampsia

89
Q

New onset grand mal seizures before, during, or immediately post-partum

Occurs in a small percentage of patients with pre-eclampsia

Life threatening

Can cause intracellular hemorrhage

A

Eclampsia

90
Q

What are some signs and symptoms of eclampsia?

A

Severe headache
Hyperreflexia
Blurred vision
Photophobia
RUQ or epigastric pain
Altered mental status

91
Q

What is the diagnostic criteria for eclampsia?

A

Hypertension + proteinuria + edema + SEIZURES after 20 weeks

92
Q

What is the treatment of eclampsia?

A

Emergent delivery

Do NOT deliver during seizures, but delivery is the only cure!

93
Q

When initiating MgSO4,, watch for this sign which signals toxicity

A

loss of DTRs

94
Q

Form of severe pre-eclampsia that occurs in 10% of pre-eclampsia patients

Watch out for 🡪 life threatening

A

HELLP Syndrome

95
Q

HELLP Syndrome - what are the factors/signs present?

A

Hemolysis
Elevated LFTs
Low platelets
RUQ pain (don’t assume gallbladder)

96
Q

What form of severe pre-eclampsia has a high mortality and morbidity rate?

A

HELLP Syndrome

97
Q

Defined as neoplasms that derive from abnormal placental
(trophoblastic) proliferation

Empty egg is fertilized by sperm (no maternal DNA present)

AKA molar pregnancy

Rare variation of pregnancy

A

Gestational Trophoblastic Disease

98
Q

This is the only female disease that is responsive to chemotherapy
every single time

A

Gestational Trophoblastic Disease

99
Q

Molar pregnancy can develop where the placenta was and is called what?

A

Placental site tumor

100
Q

What are the risk factors for gestational trophoblastic disease?

A

Women over age 35 or under age 20

Low dietary carotene

Vitamin A deficiency

101
Q

What are the key factors/signs of gestational trophoblastic disease?

A

Clinical picture of pregnancy, but exaggerated (Severe HTN, hyperemesis)

Pathognomic ultrasound findings

Uterine size/date discrepancy

Lack of fetal heart tones at 12 weeks

Specific tumor marker – hCG (Markedly high for LMP)

Pre-eclampsia in first or second trimester pathognomic for molar
pregnancy

102
Q

How does gestational trophoblastic disease typically present?

A

Exaggerated symptoms of pregnancy

Painless second trimester bleeding

Quantitative hCG levels are excessively elevated for gestational age (think 100,000 or greater)

103
Q

What are the two types of gestational trophoblastic disease?

A

Complete Mole
Incomplete/Partial Mole

104
Q

Which type of gestational trophoblastic disease is described below?

No fetal parts

46XX paternal genome

Marked trophoblastic proliferation

15% persistent GTN

More common than partial/incomplete

Snowstorm, cluster of grapes on ultrasound

Can become invasive 🡪 invades myometrium

A

Complete Mole

105
Q

Which type of gestational trophoblastic disease is described below?

Some fetal parts are present

69,xxx or –xxy 1/3 maternal genome

Focal trophoblastic proliferation

<5% persistent GTN

Most often presents as missed abortion

Vaginal bleeding is less common

Uterine growth is less than expected

A

Incomplete/Partial Mole

106
Q

A complete mole that invades myometrium is also referred to as what?

A

Known as persistent metastatic or non-metastatic gestational trophoblastic disease (malignant GTN)

107
Q

What is the treatment for gestational trophoblastic disease?

A

Definitive treatment is prompt evacuation of the uterine contents

May consider hysterectomy if patient desires no more children

Rh- negative patients should be given RhoGam

108
Q

Patient should be on what medication for the first year after treatment for trophoblastic disease?

A

OCP

109
Q

How long should a patient who had trophoblastic disease avoid pregnancy?

A

NO PREGNANCY for one year

110
Q

In a patient who was treated for gestational trophoblastic disease, how long should they be monitored for?

A

Monitor closely for 6-12 months due to predisposition of recurrence

111
Q

What are the monitoring guidelines in a patient who was treated for gestational trophoblastic disease?

A

Quant hCG within 48 hours, then q 1-2 weeks while still elevated (Follow serial hCG weekly to zero); Make sure to go to zero, or else worry about cancer

Then q 4 weeks for one year

If hCG plateaus or rises, that’s an indication of persistent disease (make sure to rule out new pregnancy)

Periodic PE to evaluate for vaginal metastasis and uterine involvement

112
Q

What are the complications of gestational trophoblastic disease?

A

At higher risk for uterine atony and Asherman’s

Choriocarcinoma

Placental Site Tumor

Metastasize to lung

113
Q

Malignant transformation of trophoblastic tissue

1 in 40 molar pregnancies

Rapid myometrial and uterine-vessel invasion with systemic metastases from hematogenous spread

A

Choriocarcinoma

114
Q

Choriocarcinomas are highly sensitive to what treatment?

A

Highly sensitive to chemotherapy!

115
Q

What are the most common sites of metastases for choriocarcinomas?

A

Lung, vagina, CNS, kidney, and liver

116
Q

Very rare form of trophoblastic disease

A

Placental Site Tumor

117
Q

What is the treatment for placental site tumor?

A

Hysterectomy

118
Q

This pregnancy complication results in small bodies, big heads

Brain/head is spared, so blood will be shunted towards it

A

Intrauterine Growth Restriction

119
Q

Round ligament pain presents how in pregnant patients?

A

Sharp groin pain

120
Q

In round ligament pain, which side is most common presentation?

A

Right side most common

121
Q

What is the most common cause of post-term pregnancy?

A

Most common cause is inaccurate estimation of gestational age

122
Q

42 weeks or more

A

Post-Term Pregnancy

123
Q

What is the preferred management for post-term pregnancy?

A

Induction at 41 weeks is the preferred management

124
Q

What are the complications of post-term pregnancy?

A

Higher risk for shoulder dystocia, Erb Duchenne palsy, Klumpe palsy,
paralysis, meconium aspiration syndrome (MAS)

OB/GYN (14 decks)

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