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EOR - Women's Health > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

pregnancy complications to know

A

abortion
ectopic
GDM
trophoblastic dz
incompetent cervix
placenta abruption
placenta previa
preeclampsia/eclampsia
pregnancy induced HTN
Rh incompatability

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2
Q

5 types of abortion

A

spontaneous
threatened
incomplete
inevitable
missed

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3
Q

expulsionof all or part of products of conception before 20 weeks gestation

A

spontaneous abortion

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4
Q

-bloody vaginal d.c before 20 weeks gestation w. or w.o uterine contractions
-cervical os closed

A

threatened abortion

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5
Q

-dilated cervical os
-some passage of products of conception before 20 weeks

A

incomplete abortion

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6
Q

-dilated cervical os
-no passage of products of conception before 20 weeks gestation

A

inevitable abortion

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7
Q

-death of the fetus before 20 weeks gestation
-no products of conception passed
-cervical os closed

A

missed abortion

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8
Q

definition for reccurent spontaneous abortions

A

3 or more consecutive pregnancy losses

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9
Q

80% of spontaneous abortions occur during the first _ weeks of pregnancy

A

12

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10
Q

fetal RF for spontaneous abortion

A

chromosomal abnormalities

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11
Q

2 chromosomal abnormalities mc associated w. spontaneous abortion

A

trisomy
monosomy X

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12
Q

maternal rf for spontaneous abortion (lots!)

A

previous spontaneous abortion
smoking
infxn
anatomic anomalies (ex fibroids)
asherman syndrome
maternal dz
gravidity
fever
prolonged time to achieving pregnancy
BMI < 18.5 OR > 25
celiac

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13
Q

3 sx of spontaneous abortion

A

vaginal bleeding
abd pain
lbp

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14
Q

labs useful in spontaneous abortion (6)

A

b-hCG
CBC
blood type
abs screen
US
placentation

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15
Q

management of spontaneous abortion < 13

A

expectant management

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16
Q

management of spontaneous abortion > 13 weeks

A

medical abortion:
1. mifepristone (angioprogestin)
PLUS misoprostol (PG)
2. 1st trimester: D&C
3. 2nd trimester: dilation and evacuation

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17
Q

32 yo f w. sudden onset LLQ pain that radiates to the back/scapula and vaginal bleeding - LMP was 5 weeks ago - hx PID and unprotected sex

A

ectopic pregnancy

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18
Q

2 mc places for ectopic pregnancies

A
  1. fallopian tubes
  2. ampulla
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19
Q

3 classic sx of ectopic pregnancy

A

abd pain
bleeding
adnexal mass

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20
Q

mc cause of ectopic pregnancy

A

occlusion of tube 2/2 to adhesions

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21
Q

6 rf for ectopic pregnancy

A

-previous hx
-previous salpingitis (PID)
-previosu abd/tubal surgery
-use of IUD
-assisted reproduction
-smoking

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22
Q

5 sx of ruptured ectopic pregnancy

A

severe abd or shoulder pain
peritonitis
tachycardia
syncope
orthostatic HTN

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23
Q

labs for ectopic

A
  • bHCG > 1,500 w.o fetus in utero
  • serial bHCG increases less than expected
  • get baseline bHCG and f/u hormones in 48 hr -> if not doubling -> probs ectopic
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24
Q

expected increase in bHCG

A

it should double q 2 days

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25
Q

at what bHCG level should you be able to see e/o developing intrauterine gestation on US

A

1,500

if not, suspect ectopic

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26
Q

imaging for ectopic

A

transvaginal US

IUP should be visible by 5-6 weeks

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27
Q

what is the ring of fire sign on US

A

hypervascular lesion w. peripheral vascularity -> ectopic

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28
Q

4 indications for MTX tx for ectopic

A

-hemodynamically stable
-hCG < 5,000
-ectopic mass < 3.5 cm
-no fetal cardiac activity
-ability to comply w. post tx/f.u

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29
Q

7 contraindications for MTX for ectopic

A

-current breastfeeding
-active pulmonary dz
-immunodeficiency
-blood disorder
-peptic ulcer
-impaired renal/hepatic fxn
-hypersensitivity to MTX

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30
Q

moa for MTX

A

folic acid antagonist -> inhibits DNA replication

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31
Q

surgical tx of ectopic

A

lparaoscopy salpingostomy

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32
Q

_ is crucial in consideration of tx for ectopic

A

ability of pt to f.u

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33
Q

t/f: GDM is a rf for T2DM post pregnancy

A

t!

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34
Q

mc complication of GDM

A

macrosomia

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35
Q

dx for GDM

A
  1. first prenatal visit: random BG on all pregnant women
  2. 24-48 weeks: non fasting 1 hr 50g OGTT serum glucose level 1 hr later
  3. if 1 hr serum BG > 130 -> 3 hour 100 g OGTT
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36
Q

what indicates positive on a 3 hr 100g OGTT

A

BG >/= the following values at two or more time points:

-fasting: 95
-one hour: > 180
-two hour: > 155
-4 hr: > 140

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37
Q

when should pt’s w. GDM check their BG

A

daily:
after fasting overnight
after each meal

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38
Q

indications for insulin w. GDM

A

-fasting BG > 105
-2 hr post prandial BG > 120

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39
Q

tx of choice for GDM

A

insulin

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40
Q

fasting BG goal for GDM

A

< 95

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41
Q

only oral DM med that is ok in pregnancy

A

glyburide

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42
Q

glyburide increases risk of

A

eclampsia

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43
Q

a macrosomic child should be delivered at _ weeks via _

A

38 weeks
c section

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44
Q

good control of GDM is described as 2 hr OGTT <

A

140

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45
Q

when should FHR be monitored in pt w. GDM

A

weekly

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46
Q

what complications are you worried about for baby in mom w. GDM (5)

A

hypoglycemia
shoulder dystocia
cardiac abnormalities
respiratory distress syndrome
IUGR (intrauterine growth restriction)

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47
Q

gestational trophoblastic dz includes (2)

A

molar pregnancy
choriocarcinoma

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48
Q

31 yo f, LMP 6 weeks ago - bHCG 100,000 - US has a snowstorm pattern

A

gestational trophoblastic dz

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49
Q

gestational trophoblastic dz includes both benign and malignant

A

proliferation of placental cells

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50
Q

3 signs of gestational trophoblastic dz

A

bHCG higher than expected
size/date discrepancy
hyperemesis

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51
Q

2 rf for molar pregnancy

A

maternal age extremes (<20, >35)
previous molar pregnancy

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52
Q

benign gestational trophoblastic dz

A

molar

aka hydatidiform moles

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53
Q

two types of molar pregnancy

A

complete
incomplete

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54
Q

6 signs of complete molar pregnancy

A

huge amounts of hCG
missed periods
positive pregnancy test
vaginal bleeding
hyperthyroidism sx
uterus larger than expected for GA

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55
Q

3 US findings of molar pregnancy

A

grape-like mass
snow storm
swiss cheese pattern

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56
Q

2 signs of incomplete molar pregnancy

A

-elevated hCG but not as much as complete
-uterus NOT larger than expected

57
Q

most incomplete molar pregnancies result in

A

spontaneous abortion

58
Q

t/f:both complete and incomplete molar pregnancies are premalignant conditions that can develop into invasive moles

A

t!

59
Q

malignant trophoblastic pregnancy can develop from (2)

A

benign moles (complete and incomplete)
choriocarcinoma

60
Q

malignant trophoblastic gestation is same-same

A

invasive moles

61
Q

placental ca that mc occurs in absence of molar pregnancy

A

choriocarcinoma

62
Q

invasive moles ALWAYS develop after _

choriocarcinoma may develop after _

A

invasive moles: molar pregnancy
choriocarcinoma: molar pregnancy OR regular pregnancy

63
Q

hCG > _ are diagnostic of molar pregnancy

A

100,000

64
Q

with complete molar pregnancies, _ may be seen on one or both ovaries

A

lutein cysts

65
Q

with incomplete moles, fetal parts may be visible and there is often

A

oligohydraminos

66
Q

dx of invasive moles and choriocarcinoma is made when (3)

A

-hCG levels plateau (remain w.in 10% of previous result x 3 weeks)
OR
-hCG levels increase > 10% across 3 values x 2 weeks
OR
-there is detectable serum hCG up to 6 months after evacuation of molar pregnancy

67
Q

2 US findings of invasive mole

A

anechoic areas
high vascular flow

68
Q

US findings of choriocarcinoma

A

-heterogeneous single mass distending from uterus
-areas of necrosis and hemorrhage

69
Q

work up for persistent mole and choriocarcinoma

A

-CXR
-head/abd/pelvis CT

70
Q

stages I-IV invasive moles/choriocarcinoma

A

I: tumors confined to uterus
II: tumors extend to fallopian tubes, ovaries, or vagina
III: tumors have lung metastases, regardless of genital structure metastases
IV: tumors have metastases in any organ other than lungs or genital structures

71
Q

tx for complete and incomplete mole

A
  1. uterine evacuation via suction curretage
  2. histological analysis of contents
  3. hCG weekly until no longer detectable for 3 weeks; then monthly x 5 months
  4. if bHCG rises: consider persistent invasive mole vs choriocarcinoma
72
Q

tx for choriocarcinoma

A

0-6: low risk -> MTX
> 6: high risk -> combo chemo

73
Q

remission of choriocarcinoma is defined as

A

3 consecutive undetectable hCB levels during weekly monitoring

74
Q

32 yo F, G7P0A3 in 13th week of pregnancy - hx of 3 consecutive fetuses before 20 weeks gestation and 3 spontaneous first trimester abortions

A

incompetent cervix

75
Q

premature, dilation, or shortening of the cervix during the second or early third trimester of pregnancy

A

incompetent cervix

76
Q

incompetent cervix mc presents with _ trimester miscarriages

A

second trimester

77
Q

5 rf for incompetent cervix

A

prev hx
hx of injury/surgery
colonization
DES exposure in utero
anatomic abnormalities

78
Q

PE findings of incompetent cervix

A

cervical dilation > 2 cm
minimal contractions until 4 cm
bleeding/d.c mc in 2nd trimester

79
Q

dx for incompetent cervix

A

transvaginal US

80
Q

US finding of incompetent cervix

A

funneling of the cervix

81
Q

btw 18-22 weeks, the US focuses on

A

detecting fetal abnormalities

82
Q

normal length cervix:
incompetent cervix length:

A

normal: 30 mm
incompetent: < 25 mm before 24 weeks

83
Q

tx for incompetent cervix

A

-cervical cerclage placed at 12-16 weeks
-removed at 36-38 weeks for delivery

84
Q

2 things that need to be done before placement of a cervical cerclage

A

-culture G/C and GBS
-comfirm viable intrauterine pregnancy

85
Q

29 yo F, 36 weeks gestation w. sudden onset of back pain w. uterine contractions that are very close together - c/o painful bright red vaginal bleeding - pelvis is ttp - cervix is closed, no e/o rupture of membranes

A

placental abruption

86
Q

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

A

placental abruption

87
Q

mc cause of third trimester bleeding

A

placental abruption

88
Q

5 rf for placental abruption

A

prev hx
trauma
smoking
HTN
preeclampsia
cocaine

89
Q

heavy painful vaginal bleeding in the 3rd trimester is _ until proven otherwise

A

placental abruption

90
Q

dx for placental abruption

A

clinical…always

91
Q

US finding of placental abruption even tho you don’t need it for dx

A

retroplacental blood collection

92
Q

what might you find in the vagina w. placental abruption

A

blood stained amniotic fluid

93
Q

2 fetal signs of placental abruption

A

decelerations -> fetal hypoxia
bradycardia

94
Q

tx for placental abruption (5)

A

delivery of fetus and placenta
corticosteroids
type and screen
coag studies
large bore IV

95
Q

why give corticosteroids for placental abruption

A

enhance fetal lung maturity

96
Q

management of small placental abruptions

A

expectant management

97
Q

32 yo f, G2P1 at 35 weeks gestation - c/o painless vaginal bleeding x 2 hr w. substantial amt of blood clot d/c - no cramping, fetal HR nl - last pregnancy was via emergency c section at 37 weeks due to breech

A

placenta previa

98
Q

condition in which placenta lies very low in the uterus and covers all parts of the cervix

A

placenta previa

99
Q

5 types of placenta previa

A

complete
partial
marginal
low-lying
vasa previa

100
Q

placenta completely covers internal os

A

complete placenta previa

101
Q

placenta covers a portion of the intenal os

A

partial previa

102
Q

edge of the placenta reaches the margin of the os

A

marginal previa

103
Q

placenta implanted in lower uterine segment in close proximity but not extending to the internal os

A

low-lying previa

104
Q

fetal vessel may overlie the cervix

A

low lying previa

105
Q

painless vaginal bleeding after 28 weeks is always

A

placenta previa

106
Q

bleeding from placenta in placenta previa results from (2)

A

-small disruptions in placenta
-thinning of lower uterin segment during third trimester

107
Q

5 fetal complications of placenta previa

A

preterm delivery
preterm PROM
intrauterine growth restriction
vasa previa
congenital abnormalities

108
Q

4 rf for placenta previa

A

prior c section
multiple gestations
multiple induced abortions
advanced maternal age

109
Q

dx for placenta previa

A

transvaginal US

110
Q

what exam is contraindicated w. placenta previa

A

digital vaginal exam

111
Q

tx for placenta previa

A

strict rest
no intercourse
no vigorous exercise
+/- transfusion
c-section
Rhogam if Rh-
delivery 34-37 weeks

112
Q

what differentiates eclampsia from preeclampsia

A

eclampsia: development of sz in a woman w. preeclampsia

113
Q

time period in which pre-eclampsia may occur

A

20 weeks gestation to 6 weeks postpartum

114
Q

preeclampsia triad

A

HTN
proteinuria
+/- edema

after 20 weeks gestation

115
Q

mild preeclampsia parameters

A

-140/90 - 160/10
-proteinuria: > 300 mg/24 hr OR > +1 on dipstick
-edema of face, hands, feet

116
Q

only cure for preeclampsia

A

delivery ->
at 34-36 weeks

117
Q

t/f: preeclampsia requires c section

A

f!

only if complications

118
Q

management of moderate preeclampsia

A

-steroids to mature lungs at 26-30 weeks
-daily weights and BP
-weekly dipstick
-bed rest

119
Q

severe preeclampsia parameters

A

-BP > 160/110
-proteinuria: > 5 g x 24 hr OR no urine OR 3+ on dipstick
-pulmonary edema

120
Q

complication of severe preeclampsia

A

HELLP syndrome:
hemolysis
elevated LFTs
low platelets

121
Q

management of severe pre eclampsia

A

-hospitalization
-Mg sulfate
+/- BP meds

122
Q

indication for BP meds w. severe eclampsia

BP med of choice

A

BP > 180/110

hydralazine

123
Q

HTN + proteinuria should make you think

A

pre eclampsia

124
Q

pt’s w. preeclampsia w.o severe sx are generally induecd into labor after _ weeks

pt’s w. severe preeclampsia are generally induced at _ weeks

A

preeclampsia: 37 weeks
severe preeclampsia: 34-36 weeks

125
Q

what drug should a pt with preeclampsia receive if less than 34 weeks gestation

A

antenatal steroids

126
Q

medication for sz prophylaxis for preeclampsia pt

A

Mg sulfate

127
Q

gestational HTN (pregnancy induced HTN) is BP > _ after 20 _ weeks into the pregnancy that resolves _ weeks postpartum

A

> 150/90
20 weeks
12 weeks

128
Q

what differentiates pregnancy indcued HTN from preeclampsia

A

proteinuria w. preeclampsia

129
Q

HTN w.o proteinuria in pregnant pt should make you think

A

gestational HTN

130
Q

management of pregnancy induced HTN

A

+/- meds
if meds: hyralazine, labetalol

131
Q

when is gestational HTN considered chronic HTN

A

BP > 140/90 prior to 20 weeks gestation
that persists > 6 weeks postpartum

132
Q

management of chronic HTN in pregnant pt

A

-BP q 2-4 weeks, then weekly at 34-36 weeks
-delivery 39-40 weeks

133
Q

when should meds be initiated in pt w. chronic HTN

what meds are safe?

A

> 150/100

labetalol
nifedipine
hydralazine

134
Q

if the mother is Rh_
and the baby is Rh
then the mother may develop abs against the infant’s blood

A

mother: Rh-
baby: Rh+

135
Q

t/f: first pregnancy can never be affected by Rh incompatability

A

t!

136
Q

dx for Rh incompatability (4)

A

-ABO blood group
-RhD type
-indirect erythrocyte abs screen
-indirect coombs
-fetal monitoring 2nd trimester

137
Q

tx for Rh incompatability

A

rhogam given at:
-28 weeks
-72 hr of delivery
-during any uterine bleeding throughout pregnancy

138
Q

Rhogam should be given if the mother is Rh_,
the father is Rh_,
or if unknown

A

mother: Rh-
father: Rh+

139
Q

consequence of Rh incompatability

A

hydrops fetalis

EOR - Women's Health (15 decks)

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