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Women's health > pregnancy complications (15%) > Flashcards

pregnancy complications (15%) Flashcards

1
Q

what is the MC cause of placental abruption + others

A

maternal HTN is MC

smoking, ETOH, cocaine, folate deficiency, high parity, inc age, trauma, chorioamnionitis

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2
Q

what is the presentation of placental abruption

A

3rd trimester painful bleeding, continuous + dark red
severe abd pain, painful uterine ctxs, rigid uterus
fetal bradycardia/distress

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3
Q

how do you dx placental abruption

A

pelvic US

DO NOT DO PELVIC EXAM

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4
Q

what is the tx for placental abruption

A

hospitalize if HD unstable

immediate delivery- C/S preferred

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5
Q

grades of placental abruption (I, II, III)

A

I- mild, slight bleeding
II- moderate/partial
III- complete

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6
Q

what is the major complication of placental abruption

A

DIC

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7
Q

where are ectopic pregnancies most common

A

fallopian tube- ampulla

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8
Q

what is the classic triad of ectopic pregnancy

A

unilateral pelvic/abd pain
vaginal bleeding
amenorrhea

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9
Q

what other dx has a similar presentation to ectopic pregnancy

A

threatened abortion

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10
Q

what is found on PE of ectopic pregnancy

A

CMT

adnexal mass +/- mild uterine enlargement

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11
Q

what should you check to dx ectopic pregnancy

A

serial hcg

TVUS

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12
Q

what does serial hcg show in ectopic pregnancy

A

normal pregnancy- doubles q24-48h

ectopic- doesn’t

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13
Q

what do you see on TVUS in ectopic pregnancy

A

absence of gestational sac

if hcg >2,000, highly suggests ectopic

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14
Q

what is the tx for unruptured, stable ectopic pregnancy

A

methotrexate OR laparoscopic salpingostomy/salpingectomy
rhogam if Rh negative mom
contraception x2mo

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15
Q

what is the tx for ruptured, unstable ectopic pregnancy

A

laparoscopic salpingostomy 1st choice

rhogam if mom is Rh neg

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16
Q

RFs for ectopic

A 
previous abd/tubal surgery/ligation --> adhesions
PID
previous ectopic
endometriosis
IUD use
assisted reproduction
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17
Q

what are the requirements for methotrexate tx of ectopic pregnancy

A

stable
early gestation <4cm
hcg <5000
no fetal tones

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18
Q

CIs for methotrexate tx of ectopic

A

ruptured/unstable
hcg >5000
fetal heart tones
noncompliant pt

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19
Q

dosing options for methotrexate

A

multiple dose- MTX + leucovorin x4 doses; monitor day 0 then odd days; hcg should drop 15% btw2 successive draws

single dose- monitor hcg on days 0, 4, 7; should drop by day 4-7

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20
Q

what causes incompetent cervix

A

premature cervical dilation

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21
Q

RFs for incompetent cervix

A

previous cervical trauma
uterus defects
DES exposure in utero
multiple gestations

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22
Q

when does incompetent cervix usu occur

A

2nd trimester

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23
Q

presentation of incompetent cervix

A

bleeding, vaginal discharge

painless dilation + effacement of cervix

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24
Q

tx of incompetent cervix

A

cerclage + bed rest esp if prior hx

+/- weekly 17-alpha-hydroxyprogesterone injxn if preterm birth hx

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25
Q

when should cerclage be done

A

h/o incompetent cervix

develop short cervix (25mm or less) before 24wks

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26
Q

types of placenta previa

A

partial- covers part of cervix
complete- total coverage
marginal w.i 2-3cm of the os

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27
Q

presentation of placenta previa

A

3rd trimester painless bleeding, bright red
resolves w.i 1-2hrs
no and pain, uterus soft + contender
normal fetal HR/no distress

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28
Q

dx of placenta previa

A

pelvic US

DON’T DO PELVIC EXAM

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29
Q

tx of placenta previa

A

hospitalize to stabilize + bed rest
tocolytics (mag sulf), betamethasone if 24-24wks to inc lung maturity
C/S

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30
Q

RFs for placenta previa

A

multiparity
inc age
smoking

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31
Q

what is vasa previa

A

fetal vesels traverse fetal membranes over cervical os

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32
Q

what is the presentation of vasa previa

A

ROM –> painless vaginal bleeding + fetal bradycardia/distress

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33
Q

dx of vasa previa

A

pelvic US

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34
Q

tx of vasa previa

A

immediate C/S

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35
Q

what causes gestational diabetes

A

placental release of growth hormone, corticotropin releasing hormone + human placental lactogen –> antagonizes insulin

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36
Q

RFs for GDM

A 
fhx or personal h/o GDM
spontaneous abortion
infant >4000g at  irth
multiple gestations
obesity
25yo+
AA, hispanic, asian/pacific islander, native american
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37
Q

what are fetal complications of GDM

A 
fetal demise
congenital malformation
premature labor
neonatal hypoglycemia
shoulder dystocia
macrosomia
birth trauma
neonatal hypocalcemia
hyperbili
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38
Q

what are maternal complications of GDM

A

preeclampsia
placental abruption
>50% chance of DM after pregnancy + recurrence in future pregnancies

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39
Q

when should moms be screened for diabetes after giving birth

A

6wks PP + yearly afterword

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40
Q

dx of GDM

A 
50g oral glucose challenge at 24-28wks
>95 fasting
>180 1hr
>155 2hr
>140 3hr
41
Q

tx of GDM

A

glucose monitoring
diet + exercise
+/-insuline (DOC), glyburide

42
Q

insulin indications

A

Fasting >105, PPG >120

43
Q

insulin vs glyburide

A

insulin- doesn’t cross placenta

glyburide- doesn’t cross placenta but higher risk of eclampsia

44
Q

when should mom w GDM be induced

A

38wks if uncontrolled/macrosomia

40wks if controlled/no macrosomia

45
Q

what is the definition of transitional (gestational) HTN

A

HTN w/o proteinuria s/p 20wks GA that resolves 12wks PP

46
Q

tx of transitional HTN

A

may withhold meds

+/- hydralazine or labetalol

47
Q

definition of mild preeclampsia

A

140/90+ on 2 separate occasions, at least 6hr but not >1wk apart
proteinuria (300mg/24h or >1 on dipstick)
s/p 20wks GA

48
Q

definition of severe preeclampsia

A 
160/1100+ on 2 separate occasions, at least 6hr but not >1wk apart 
proteinuria (5000mg/24h)
oliguria (<500ml/24h)
thrombocytopenia 
s/p 20wks GA
49
Q

complications of preeclampsia

A 
DIC
HELLP syndrome (hemolytic anemia, elevated liver, low plts)
50
Q

tx of mild preeclampsia

A

deliver @ 37wks

<34wks = daily wits, BP + dipstick weekly, bedrest, steroids to mature fetal lungs if elective delivery planned

51
Q

tx of severe preeclampsia

A 
prompt delivery + hospitalization 
mag sulf to prevent eclampsia
BP meds (hydralazine, labetalol, nifedipine)
52
Q

what is eclampsia

A

preeclamspia + seizure or coma

53
Q

what are sx of eclampsia

A

abrupt tonic-clonic seizures 1-2min –> post-ictal

hyperreflexia

54
Q

tx of eclampsia

A

ABCDs!
mag sulf for seizures (lorazepam 2nd line)
hydralazine, labetalol for HTN
deliver once mom is stable

55
Q

what is chronic/preexisting HTN

A

HTN before 20wks GA

persists >6wks PP

56
Q

definition of mild chronic/preexisting HTN

A

140/90+ on 2 separate occasions at least 6hr but not >1wk apart

57
Q

definition of moderate chronic/preexisting HTN

A

150/100+ on 2 separate occasions at least 6hr but not >1wk apart

58
Q

definition of severe chronic/preexisting HTN

A

160/110+ on 2 separate occasions at least 6hr but not >1wk apart

59
Q

what should be avoided in tx of chronic/preexisting HTN

A

ACEi

Diuretics

60
Q

tx of mild chronic/preexisting HTN

A

monitor q2-4wks –> weekly @34wks –> deliver at 37wks
weekly NST during 3rd tri
serial BP + urine protein

61
Q

tx of moderate/severe chronic/preexisting HTN

A

meds (methyldopa DOC, labetalol, hydralazine, nifedipine)

62
Q

what are the 4 types of gestational trophoblastic disease

A

molar (benign)
invasive molar
choriocarcinoma
placental site trophoblastic tumor

63
Q

what is the presentation of gestational trophoblastic disease

A

painless vaginal bleeding 6wks-5mo GA
larger uterine size than date indicates
preeclampsia before 20wks
hyperemesis gravidarum, earlier than usu

64
Q

what should you check to dx gestational trophoblastic disease

A

hcg (>100k)
very low maternal AFP
US (snowstorm or cluster of grapes = enlarged cystic chorionic villi, absence of fetal parts + heart sounds)

65
Q

what is the tx of gestational trophoblastic disease

A

surgical uterine evacuation ASAP + follow weekly until hcg undetectable
rhogam if Rh negative mom
avoid pregnancy for 1yr

66
Q

where are the MC mets in choriocarcinoma

A

lung, lower genital tract (purple, black nodules), pelvis (mass)

67
Q

tx of mets caused by choriocarcinoma

A

methotrexate or hysterectomy

68
Q

when should choriocarcinoma mets be suspected

A

if hcg rises or plateaus s/p tx
continued hemorrhage s/p tx
vaginal tumor or pelvic mass

69
Q

what is the MC type of gestational trophoblastic disease

A

hydatiform mole (80% benign)

70
Q

2 types of molar pregnancies and their description

A

complete molar- egg w no DNA fertilized by 1 or 2 sperm (46XX)- all paternal chromosomes, higher risk of choriocarcinoma

partial molar- egg fertilized by 2 sperm or 1 that duplicates chromosomes –> +/-fetal development but always malformed + never viable

71
Q

MC RFs for molar pregnancy

A

prior molar pregnancy
mom <20 or >35yo
asian

72
Q

Rh incompatibility cause

A

Rh- mom + Rh+ dad –> Rh+ baby

mom’s antibodies develop after 1st Rh+ baby + attack RBCs of 2nd Rh+ baby –> blue baby/hemolytic anemia of newborn

73
Q

neonatal sx of hemolytic anemia of the newborn

A 
jaundice
kernicterus
hepatosplenomegaly
fetal hydrops
CHF
74
Q

what is fetal hydrops

A

fluid accumulation in 2 places- pericardial effusion, ascites, pleural effusion, subQ edema

75
Q

when should rhogam be given to mom

A

Rh- mom, antibody negative when:
28wks GA
w.i 72h of delivery
after any potential blood mixing

76
Q

what result of antibody screen suggests fetal hemolysis in Rh incompatibility

A

1:8-1:32

77
Q

what is the definition of morning sickness

A

N/V up to 16wks GA

78
Q

what is hyperemesis gravidarum

A

severe, excessive N.V associated w wt loss, electrolyte imbalance, acidosis (d/t starvation), alkalosis (d/t vomiting)
develops in 1st or 2nd trimester + persists >16wks

79
Q

antiemetics for morning sickness/HEG

A

1st = pyridoxine (vit B6) +/- doxylamine

promethazine, dimenhydrinate

80
Q

what is a spontaneous abortion

A

termination before 20wks GA

81
Q

when is spontaneous abortion MC

A

1st 7wks

82
Q

MC etiology of spontaneous abortion

A

fetal chromosomal abnormalities

83
Q

what is a threatened abortion

A

pregnancy MAY BE VIABLE

no POC expelled, cervix closed

84
Q

tx of threatened abortion

A

bed rest @ home
return if sx persist or POC pass
serial hcg to see if doubling
rhogam if indicated

85
Q

what is an inevitable abortion

A

pregnancy not salvageable

no POC expelled, cervix dilated

86
Q

tx of inevitable abortion

A

D&E/D&C

rhogam if indicated

87
Q

what is an incomplete abortion

A

pregnancy not salvageable
some POC expelled, cervix dilated
boggy uterus

88
Q

what is the tx for incomplete abortion

A

may allow to finish OR D&E/D&C OR pitocin

rhogam if indicated

89
Q

what is a complete abortion

A

pregnancy not salvageable
all POC expelled, cervix closed
pre-pregnancy uterus size

90
Q

tx of complete abortion

A

rhogam if indicated

91
Q

what is a missed abortion

A

fetal demise but still retained in uterus

no POC expelled, cervix closed

92
Q

tx of missed abortion

A

D&E/D&C or misoprostol

93
Q

what is a septic abortion

A

retained POC becomes infected –> infxn of uterus + organs

closed cervix w CMT

94
Q

tx of septic abortion

A

D&E + broad spectrum abx

95
Q

medical options for elective abortion

A

mifepristone –> misoprostol 24-72h later (Safe up to 9wks)

methotrexate –> misoprostol 3-7d later (safe up to 7wks)

96
Q

what is mifepristone

A

anti-progestin

97
Q

what is methotrexate

A

folic acid antagonist

98
Q

what is misoprostol

A

prostaglandin that causes ctx

99
Q

surgical options for elective abortion

A

up to 24wks from LMP

D&C (4-12wks)
D&E (12wks+)

Women's health (7 decks)

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