pregnancy complications Flashcards
what is the medical management for gestational Diabetes?
*glyburide or metformin
What is a positive result from the 3 hr 100g oral glucose tolerane test?
*fasting >95mg/dL
*1hr >180mg/dL
*2hr >155mg/dL
*3hr >140mg/dL
What is a positive result from the 1 hr 50g oral glucose tolerane test?
glucose >130-140mg/dL 🡪 go on to 3hr test
What is the most common type of Gestational trophopblastic disease?
Benign Hydatidiform mole
-complete molar 90% & partial molar 10% pregnancies
what is Gestational Trophoblastic Disease
abnormal proliferation of placental trophoblasts arise from gestational tissue.
What is the difference between complete molar pregnancy & Partial moalr pregancy?
Complete: diploid (46, XX): a sperm fertilize an egg absent of maternal chromosomes & the sperm then duplicates.
Partial mole: triploid (69, XXX, XXY or XYY): 1 egg is fertilized by 2 haploid sperms
How is a molar pregnancy diagnosed?
VERY HIGH HCG (>100,000)
Complete moles: diagnosed by ultrasound examination: absence of an embryo or fetus and the presence of an intrauterine mass with many anechoic spaces (black) described as a “snowstorm” or “”cluster of grapes”.
Partial: gestational sac, fetal heart tone may be present + abnormal tissue.
How are molar pregnancies managed?
Dilation and curettage (D&C) + weekly β-hCG levels should be checked until they are undetectable for 3 consecutive weeks then every month for 1 yr.
What are the presentation of gestational trophoblastic disease
Painless vaginal bleeding (cherry-like clusters), **preeclampsia (HTN) BEFORE 20wks
**, hyperemesis gravidarum
uterine size & date discrepancies (larger or smaller than expected)
How dose excess beta HCG affect the ovaries? What disease is this associated with?
Ovarian theca lutein cysts: excess beta-hCG mimic LH & FSH causes hyperplasia of theca interna cells (rare)
*seen in hydatidiform mole
What is the treatment of low risk choricocarcinoma?
methotrexate monotherapy or combination with actinomycin D
What is the treatment of high risk choricocarcinoma? (hint: EMA-CO
EMA-CO
-Etoposide
-Methotrexate
-actinomycin-D
-Cyclophosphamide
-Vincristine
What is choriocarcinoma?
aggressive malignant neoplasm of trophoblastic cells (placental tissue) that can develop during or after pregnancy (most often a complete molar)
Where is the most common location for mets for choriocarcinoma?
lungs via spread through bloodstream
How is choriocarcinoma diagnosed?
Serum quantitative hCG – To assess response to therapy and disease status
Pelvic ultrasonography – May show persistent molar tissue in the uterus
Chest radiograph – Recommended because the lung is the most frequent site of metastasis
What is the presentation of choriocarcinoma?
abnormal bleeding 6 wks after pregnancy
What is incompetent cervix?
inability of the cervix to hold pregnancy in the 2nd trimester = premature os opening with fetal expulsion w/o contraction/labor
What is a common risk factor for incompetent cervix?
previous cervical trauma or procedure (LEEP, conization)
Presentation of cervical incompetence?
Mild pelvic pressure, backache
painless cervical changes, shortening, funneling at internal os
Incompetent Cervix Diagnostics
Transvaginal U/S: funneling of the cervical canal. (length <25 mm b/4 24 wks)
Incompetent Cervix treatment
Cerclage (suturing of cervical os)
Progesterone: help maintain pregnancy
when is RH D administer?
between 26 and 28 weeks gestation and is administered again after delivery if the baby is Rh-positive.
What is couvelaire uterus? What is it associated with?
Couvelaire uterus is the penetration of blood into the uterus resulting the uterus appearing bluish/purple on lap examination.
This is associated with placenta abruption-> on physical exam the uterus feels wood like and tender as a result of the blood generation.
What is the most common complication of placenta abruption?
Disseminated intravascular coagulopathy-> Maternal bleeding leads to increased consumption of fibrinogen. No fibrin left for clot formation = bleed out.
What are the main risk factors of placenta abruption?
1) history of placenta abruption
2) smoking, alcohol, cocaine use, maternal HTN = vasoconstriction.
What is a low-lying placenta?
when the edge of the placenta is less than 2 cm from the internal cervical os but does not cover it
what are the common risk factors for placenta previa?
Multifetal gestation
* Increasing parity and maternal age
* Previous cesarean delivery
* Previous placenta previa
* Previous intrauterine surgical procedure (e.g., curettage)
* Cigarette smoking
Patient with placenta previa should avoid?
sexual intercourse and cervical examination for risk of causing further bleeding
what is the difference between vasa previa and placenta previa?
vasa previa: fetal vessels are unprotected in the membranes near the internal os of cervix (painless vaginal bleeding and fetal distress (bradycardia))- blood from baby)
Placenta previa: the abnormal implantation of the placenta over the cervical os (partial or completely) = painless vaginal bleeding and no fetal distress (blood from mom)
what are the causes of vasa previa?
1) bi-lobed placenta with the unprotected fetal vessels running between the two placenta over the internal cervical os.
2) One placenta is present however a portion of the fetal vessels are unprotected by wharton’s jelly and runs over the internal cervical os.
what is the difference between the different placenta accreta spectrums?
Placenta accreta is invasion of the placenta into the uterine wall (myometrium)
1)placenta accreta: invasion into the uterine myometrium
2)placenta increta: invasion into deep into the myometrium
3) Placenta precreta: invasion through the myometrium to the uterine serosa and surrounding organs can be invaded.
How are the placenta accreta spectrum treated?
Hysterectomy
high risk of postpartum hemorrhage
What are the major risk factors of placenta accreta spectrum?
Intrauterine scarring
-prior c-section/multiple c-section births.
-myomectomy
-dilation & curettage
-uterine surgery
Due to uterine scaring, the placenta has to embed deeper into the uterus
What is the presentation of uterine rupture?
Fetal distress
loss of fetal station
abdominal pain
cessation of uterine contractions
palpable fetal parts on abdominal exam
Hemodynamic instability, referred shoulder pain with abdominal irritation
What is pre-eclampsia?
Systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg on two occasions at least 4 hours apart after 20 weeks’ gestation with previously normal blood pressures
+
Proteinuria >300mg/day on 24 hour urine collection or protein/creatinine ratio >0.3
OR END ORGAN damage(liver, kidney, eye, brain)
What is the hypothesized cause of pre-eclampsia?
-abnormal remodeling of the spiral arteries causing placental hypo-perfusion.
-placenta releases inflammatory proteins = endothelial cell damaged
—> increased permeability
—>narrowing of vascular
–> Formation of thrombi (to fix permeability)
–>retention of Na+ in kidneys which cause damage = proteinuria.
Eclampsia seizures may be treated with (med) _______________
magnesium sulfate
is defined as the development of seizures in a woman with preeclampsia
Eclampsia
Common complications associated with preeclampsia include placental abruption, coagulopathy, _______failure, and eclampsia.
Common complications associated with preeclampsia include placental abruption, coagulopathy, renal failure, and eclampsia.
Eclampsia is definitively treated by .
Eclampsia is definitively treated by immediate delivery of the child
Early signs of preeclampsia, before 20 weeks, can be an effect of the increased human chorionic gonadotropin associated with
Early signs of preeclampsia, before 20 weeks, can be an effect of the increased human chorionic gonadotropin associated with hydatidiform mole .
_________is a variant of preeclampsia associated with thrombotic microangiopathy involving the liver.
Hemolysis, elevated liver enzymes, low platelets syndrome (HELLP syndrome) is a variant of preeclampsia associated with thrombotic microangiopathy involving the liver.
____________ is a medication used in severe hypertensive emergency in pregnancy, where first-line medications have failed to lower the blood pressure.
Sodium nitroprusside
Incomplete invasion of decidual arterioles by cytotrophoblasts during placentation is a common cause of
preeclampsia
Patients with preeclampsia without severe symptoms are generally induced into labor after __________________weeks of gestation.
37
What is the treatment of magnesium toxicity?
Calcium gluconate
Pre-eclampsia w severe feature?
1 of the following
BP >160/110
platelets <100,000
Serum creatinine >1.1 or x2 normal limits
ALT/AST 2x normal limits or RUQ pain/epigastric pain
pulmonary edema
cerebral/visual changes (headache, blurry vision)
In preeclampsia with severe features, delivery should occur at what gestational age?
34 weeks if well managed with anti-hypertensive
if not will managed & less than 34 weeks -> deliver.
What are the two medications used for BP stabilization associated with eclampsia?
Labetalol & hydralazine
What is the diagnostic criteria for HELLP syndrome?
Hemolysis (>2 of the following)
–> Schistocytes on peripheral blood smear
–>elevated serum bilirubin (>1.2mg/dL)
–> low serum haptoglobin
–> drop in Hgb unrelated to blood loss.
Elvavted Liver Enzymes
—> AST or ALT >2x upper limits of normal
—> Lactate Dehydrogenase > 2x upper limit of normal
Low Platelets
—> <100,000
